TABLE 1.
Suggested laboratory workup in patients with suspected depression and anxiety
| Test | Rationale |
|---|---|
| Complete blood count with differential | To rule out symptomatic anemia, infection and less likely hematological malignancy. Elevated mean corpuscular volume is common in decompensated cirrhosis but also may be important to rule out hypothyroidism, and other causes of megaloblastic anemia (eg, alcohol use disorder associated with severe nutritional deficiencies) |
| Comprehensive metabolic panel with INR | To assess Child-Pugh-Turcotte, MELD 3.0, and rule out electrolyte abnormalities (sodium, calcium), or worsening kidney function, hypo/hyperglycemia. Particularly important rapid serum sodium shifts to avoid the development of central pontine myelinolysis |
| 25-hydroxy vitamin D, B12 | To rule out nutritional deficiency in the setting of severe alcohol use disorder |
| Anti-nuclear antibody, ESR, CRP, auto-antibodies | While not specific of chronic liver disease, some of these test could point toward autoimmune hepatitis and will be important to consider when treating depression associated with autoimmune hepatitis |
| AUDIT-C (Alcohol Use Disorders Identification Test), urine drug screen, plasma phosphatidylethanol (PEth) | The patient encounter will provide clues to ascertain potential substance use disorder |
| Urinalysis | To exclude urinary tract infection and/or renal pathology, in particular, in the setting of acute decompensation |
| Neuroimaging (non contrast CT, first) | HE is a diagnosis of exclusion and is critical to have a baseline imaging to exclude other causes of encephalopathy (eg, hemorrhage and masses) |
| STOP BANG | To identify people who might have obstructive sleep apnea and includes snoring, tiredness, observed apnea, presence of high blood pressure, body mass index >35 kg/m2, age 50+, neck circumference >16 inches and sex (male), being 3+ indication to refer for more studies |
| Medication review history | In particular, medications associated with depressions (eg, beta-blockade) or anxiety (eg, corticosteroids) |
Bold shows first-line testing.
Abbreviations: AUDIT-C, Alcohol Use Disorders Identification Test; CRP, c-reactive protein; ESR, erythrocyte sedimentation rate; INR: International Normalized Ratio; MELD, Model for End-Stage Liver Disease; PEth, phosphatidylethanol.