CENTER ON BEHAVIORAL MEDICINE

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DIAGNOSTIC TESTING

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Testing

Trina S. Willson
2006


Test
Psychological Difficulties
Necessary Materials
Normal Range
Values Above Indicate
Values Below Indicate
Cautions
Arterial Blood Gases 1.  Decreased  PCO2 - Anxiety

2.  Increased pH - Anxiety neuroses
 

Blood 1.  35-45 mm Hg

2.  7.35-7.45 
 

1.  Respiratory deoression.  Respiratory acidosis. Breathing cannot keep up with demand.

2. Respiratory alkalosis or metabolic alkalosis.
 

1. Respiratory alkalosis.  Hyperventilation, emotion pain and respiratory overventelation
Respiratory alkalosis.

2.  Respiratory or metabolic acidosis.
 

Respiration can be inhibited by the use of sedative-hypnotics or narcotics.  Also, some over the counter drugs can cause hyperventilation. 
Chronic obstructive pulminary disease changes the way that breathing is triggered and thus can alter measurement.
 
 
Hematocrit Anxiety
Depression
Panic Disorders
 
Blood Male 42-52%

Female 37-47%

Elderly decreased values

Children 32-44%
 

Erythrocytosis
Congenital heart disease, Polycythemia vera
Severe dehydration
Severe chronic obstructive pulmonary disease
Anemia, hemoglobinopathy, cirrhosis, hemolytic anemia, hemorrhage, dietary deficiency Abnormalities in red blood cell size may alter values, elevated white blood cell decrease values, pregnancy alters values, high altitudes cause increased values, values may not be reliable after hemorrhage, drugs can cause decreased levels
Blood Glucose Acute Stress Response, anxiety, depression, psychosis Blood Male <50->400 mg/dl

Female <40- <400mg/dl

Child 70-105mg/dl
 

Hyperglycemia - diabetes mellitus, insulin overdose Hypoglycemia - insulinoma, hypothyroidism, hypopituitarism, Addison’s disease, extensive liver diseas insulin overdose, starvation Caffeine may cause increased levels, time of day plays a factors, stress can increase glucose levels, drugs can effect glucose level, pregnancy can effect glucose levels
Immunoglobulin Electrophoresis Allergies that may be causing behavioral symptoms Blood Minimal Increased indicate the production of antibodies
Drugs can cause an interaction
Elimination Diets and challenging tests. Chronic Fatigue Syndrome
Nervousness, Agitation
 
Suspect food, food diary
When a substance is reintroduced, Increased symptoms indicate a food allergy/intolerance Decreased symptoms when food is removed indicates allergy/intolerance to that food. Some symptoms can be life threatening, reintroduce in small pieces
White Blood Count Anxiety, depression, 
psychosis
 
Blood 5000-10,000/mm3 Infection, leukemic neoplasia, malignancy, trauma, stress or hemorrhage, tissue necrosis, inflammation, dehydration, thyroid storm, steroid use Drug toxicity, bone marrow failure, overwhelming infections, dietary deficiency, congenital marrow aplasia, bone marrow infiltration, autoimmune disease hyperplenism Eating, physical activity and stress may increase WBC, pregnancy increases, lower in the morning and higher in late afternoon, age related, drugs can alter WBC level
Serum aspartate aminotrnsferase Anxiety, depression,
psychosis
 
Blood Young child 15-50

Older child 10 -50

Teenager 10-40

Adult 0-35 U/L
 

hHart disease, liver disease, skeletal muscle disease, acute hemolytic anemia, acuye pancreatitis Acute renal disease, beriberi, diabetic ketoacidosis, pregnancy, chronic renal dialysis Pregnancy decrease, exercise may increase, drugs alter values
Serum alanine aminotransferase Anxiety, depression, psychosis Blood 4-36 IU/L Significant - hepatitis, hepatic necrosis, hepatic ischemia
Moderate - cirrhosis, cholestasis, hepatic tumor, hepatotoxic drugs obstructive jaundice, severe burns, trauma to striated muscle
Mild - myositis, pancreatitis, myocardial infarction, infections monnucleosis, shock
 

IM injections increase level, drus increase
Serum calcium Depression, anxiety
psychosis
 
Blood Child 8.8-10.8 mg/dl

Adult 9.0-10.5 mg/dl
 

Hyperparathyroidism, nonparathyroid PTH producting tumor, metastatic tumor to bone, Paget’s disease of bone, prolonged immobilization, Mild-alkali syndrome, vitamin D intoxication, lymphoma, granulomatous infections, Addison’s disease, Acromegaly, hyperthyroidism Hypoparathyroidism renal failure hyperphosphatemia, rickets, vitamin D deficiency, osteomalacia, malabsorption, pancreatitis, fat embolism, alakalosis Vitamin D intoxication alters levels, excessive ingestion of mild may cause increased levels, serum pH can affect calcium values, drugs can alter
Serum sodium Depression, anxiety
psychosis
 
Blood Adult 136-145 mEq/L

Child 134-145
 

Uncreased dietary intake Cushing’s syndrome, hyperaldosteronism Addison’s disease, diarrhea, intraluminal bowel loss, diuretic administration chronic renal insufficiency Recent trauma, surgery or shock may increase levels, drugs may alter
Serum potassium Depression, anxiety
psychosis
 
Blood Adult <2.5 or >6.5 mEq/L Excessive dietary intake, excessive IV intake, acute or chronic renal failure, Addison’s disease, hypoaldosteronism, aldosterone-inhibiting diuretic, crush injury to tissue, hemolysis, transfusion of hemolyzed blood, infection, acidosis Deficient dietary intake, deficient IV intake, burns, GI disorders, diuretics, hyperaldosteronism, Cushing’s syndrome, renal tubular acidosis, licorice ingestion, alkalosis, insulin administration, glucose administration ascites, renal artery stenosis, cystic fibrosis, truma/sugery/burns Opening and closing hand during drawing can alter values, hemolysis of blood causes increase, drugs alter
Serum cholesterol Anxiety, depression, psychosis Blood Adult <200 mg/dl

Child 120-200 mg/dl
 

Familial hypercholesterolemia, familial hyperlipidemia, hypothyroidism, diabetes mellitus, nephrotic syndrome, pregnancy, high cholesterol diet, xanthomatosis, hypertension, myocardial infarction, atherosclerosis, biliary cirrhosis, extrahepatic billiary, stress, nephrotic syndrome Malabsorption, malnutrition, advanced cancer, hyperthyroidism, cholesterol lowering medication, pernicious anemia, hemolytic anemia, sepsis/stress, liver disease, acute myocardial infarction Pregnancy elevated, recumbent position is associated with decreased levels, drugs alter levels
T4 Anxiety, depression, psychosis Blood Adult male 4-13 ug/dl

Female 5-12 ug/dl
 

Primary hyperthyroid states, acute thyroiditis, familial dysalbuminemic, factitious hyperthyroidism, struma ovarii
TBG increase
 
Hypothyroid states, pituitary insufficiency, hypothalamic failure, protein malnutrition, iodine insufficiency, nonthyroid illnesses Increased after iodinated contrast x-ray studies, pregnancy increases, drugs alter
B12 Anxiety, depression, autism symptoms, psychosis Blood 160-950 pg/ml Leukemia, polycythemia vera, severe liver dysfunction, myeloproliferative disease Pernicious anemia, malabsorption syndromes, intestinal worm infestation, atrophic gastritis, Zollinger-Ellison syndrome, large proximal gastrectomy, resection of terminal ileum, achlorhydria, pregnancy, vitamine C deviciency, folic acid deficiency Chloral hydrate increase, drug decrease
Protein electrophoresis Anxiety, depression, psychosis Blood 6.4 - 8.3 g/dl 

Albumin 3.5-5 g/dl 

Albumin- dehydration Albumin - malnutrition, pregnancy, liver disease, protein-losing enteropathies, protein-losing nephropathies, third-space loses, overhydration, increased capillary permeability, inflammatory disease, familial idiopathic dysproteinemia Drugs can alter levels
Iron level Anxiety, depression, psychosis, neurological impairment, inability to concentrate Blood Male 80-180ug/dl

Fmale 60-160 ug/dl
 

Hemosiderosis or hemochromatosis, iron poisoning, hemolytic anemia, massive blood transfusion, hepatitis or hepatic necrosis, lead toxicity Insufficient dietary iron, chronic blood loss, inadequate intestinal absorption of iron, pregnancy, iron-deficiency anemia, neplasia Blood transfusions may increase, meal ingestion, hemolytic disease may be associated with high levels, drugs may alter value
Urea Nitrogen Anxiety, depression Blood Adult 10-20 mg/dl Hypovolemia, shock, burns, dehydration congestive heart failure, myocardial infarction, GI bleeding, excessive protein catabolism, starvation, sepsis, renal disease, renal failure, nephrotoxic drugs, ureteral obstruction, bladder outlet obstruction Liver failure, overhydration, negative nitrogen balance, pregnancy, nephrotic syndrome Protein intake may affect, muscle mass determines BUN levels, pregnancy may increase levels, hydration with affect levels, drugs may alter
Creatine Phosphokinase Anxiety, depression, psychosis Blood Male 55-170

Female 30-135 U/L
 

Disease that affect CNS, electroconvulsive therapy, adenocarcinoma, pulmonary infarction, acute myocardial infarction, cardiac aneurysm surgery, cardiac defibrillation, myocarditis, ventricular arrhythmias, cardiac ischemia, rhabdomyolysis, muscular dystrophy, myositis, electromyography, IM injections, crush injuries, delirium tremens, malignant hyperthermia, recent convulsions, shock, hypokalemia, hypothyroidism
IM injections can increase levels, exercise or recent surgery can increase levels, early pregnancy may decrease levels, muscle mass is realted to level, drugs can alter
Urinalysis Anxiety, depression, psychosis, delirium, mental dysfunction, memory loss, concentration, ability to stay on task, Urine 1. appearance: clear

2. color: amber yellow

3. odor: aromatic
4. pH: 4.6-8.0

5. Protein 0-8 mg/dl

6. specific gravity: 1.005-1.030

7. leukocyte esterase: negative

8. Nitrites: none

9. Ketones: none

10. Bilirubin: none

11. Urobilinogen: 0.01-1.0

12. Crystals: none

13.  Casts: none

14. Glucose 50-300 mg/24hr
 
 

1/2.  Infection, gross hematuria, drug therapy, overhydration, diabetes insipidus, diuretic therapy, glycosuria, fever, excessive sweating, dehydration, jaundice, hemoglobinuria, myoglobinuria, porphyria

3.  Ketonuria, urinary tract infection, enterovesicle fistula, maple sugar urine, phenylketonuria

4.  Alkalemia, urinary tract infections, gastric suction, vomiting, renal tubular acidosis, acidemia, diabetes mellitus, starvation, respiratory acidosis, chronic obstructive pulmonary disease

5.  Nephrotic syndrome, glomerulonephritis, malignant hypertension, diabetic glomerulosclerosis, polycystic disease, lupus erythematosus, Goodpasture’s syndrome, heavy metal poisoning, bacterial pyelonephritis, nephrotoxic drug therapy, trauma, macroglobulinemia, multiple myelomas, preclampsia, congestive heart failure, orthostatic proteinuria, severe muscle exertion, renal vein thrombosis, bladder tumor, urethritis or prostatis, amyloidosis

6.  Dehydration, pituitary tumor, decreased renal blood flow, glycosuria, water restriction, fever, excessive sweating, vomiting, diarrhea

7.  Urinary tract infection

8.  Urinary tract infection

9.  Poorly controlled diabetes mellitus, starvation, alcoholism, weight-reduction diets, prolonged vomiting, anorexia, fasting, high-protein diets, glycogen storage disease, febrile illnesses in infants and children, hyperthyroidism, sever stress or illness, excessive aspirin ingestion, anestheisia

10.  Gallstones, extrahepatic duct obstruction, extensive liver metastasis Dubin-Johnson syndrome, Rotor’s syndrome

11.  Hemolytic anemia, pernicious anemia, hemolysis due to drugs, hematoma, excessive ecchymosis

12.  Renal stone formation, urinary tract infection

13.  Acute tubular necrosis, urinary tract infection, glomerulonephritis, pyelonephritis, nephrosclerosis, chronic lead poisoning, exercise, stress, renal transplant rejection, nephrotic syndrome, diabetic nephropathy, glomerulonephritis, chronic renal disease, mercury poisoning, fat embolism, glomerulonephritis, eclampsia, heavy metal poisoning, acute renal allograft rejection, acut tubular necrosis, acute glomerulonephritis due to streptococcal infection, orthostatic proteinuria, fever, strenuous exercise stress, pyelonephritis, congestive heart failure
 

11.  Biliary obstruction, cholstasis 1/2.  Sperm may cause cloudiness, cloudy if refrigerated for more than one hour, foods can change color, darkens as it stands

3.  Food may change, as it stands it decomposes

4.  Becomes alkaline when standing, dietary factors influence pH, drugs alter

5.  Transient proteinuria associated with severe emotional stress, radiopaque contrast may cause false positive, diets alter, drugs alter, hemoglobin may cause a positive

6.  Radiographic dyes increase, cold causes falsely high specific gravity, drug alter

7.  Vaginal secretions can contaminate, false negative with high levels of protein

8.  Diets may alter, drugs may alter

10/11.  Not stable in urine, pH can affect, drugs alter

12. Radiographic contrast may alter
 


Test
Psychological Difficulties
Necessary Materials
Normal Range
Values Above Indicate
Values Below Indicate
Cautions

 
References

Bland, J. (1984).  Hair Tissue Mineral Analysis: An Emergent Diagnostic Technique.  New York, NY: Thorsons Publishing Inc.
Braly, J. (n.d.). Allergy testing.  Retrieved April 12, 2006 from www.centeronbehavioralmedicine.com
Koran, L. M. (1991).  Medical Evaluation Field Manual.  Retrieved April 12, 2006 from www.centeronbehavioralmedicine.com