A detailed laboratory analysis is usually not feasible in the emergency situations that we describe (1), in which an unknown patient with severe mental or somatic illness is presented to a rescue service, an emergency department, or a psychiatric clinic, posing an acute danger. Nonetheless, such situations often require therapy to be immediately initiated, while results from therapeutic drug monitoring can sometimes take several days. Furthermore, as patients are often uncooperative and do not agree to blood sampling, physicians have to limit themselves to a short physical examination, medical history (often reported by others), and, if possible, a blood glucose test (2). In the further course of treatment, laboratory tests including therapeutic drug monitoring are certainly indicated, in particular if relapsing aggressive behavior occurs despite the therapy and if high-dose monotherapy or antipsychotic polypharmacy appear necessary (3, 4).
Dr. med. Sophie Hirsch, B. Sc.
Prof. Dr. med. Tilman Steinert
Klinik für Psychiatrie und Psychotherapie I der Universität Ulm
Conflict of interest statement
The authors declare that no conflict of interest exists.
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