In this Hub Bites video, Dr Sanil Rege covers the main aspects for psychiatrists to consider in a medical evaluation for patients presenting with depression. These aspects may also apply to patients with mood disorders in general.

Areas to cover:

1. Vital signs – pulse and BP
2. Examination of hands and arms for signs of an eating disorder, self-harm or substance use
3. Respiratory system – Obstructive sleep apnoea, sleep disorders, lung malignancy
4. Organ insufficiency – oedema, hepatic encephalopathy, renal dysfunction
5. Endocrine disorders – thyroid dysfunction, Cushing’s disease, Addison’s disease, OC pills
6. Neurological evaluation – parkinsonism, movement disorders, the neurological exam for TIA and CV disease, Multiple sclerosis
7. Metabolic Profile (BMI, Waist circumference) – Antidepressants and AntiPsychotic medications leading to metabolic dysfunction
8. Cardiac evaluation – ECG and effect of medications on Qtc interval
9. Blood evaluation – neutropenia, pharmacokinetic dose adjustments in poor renal and liver function, Vit B12, Folate, and Vit D deficiency, Hyponatraemia (SIADH with antidepressants ), GI bleeding risk in elderly
10. Urine – Urine drug screen and Midstream urine for infection