Routine CT screening of psychiatry inpatients

During a 3-year period, all inpatients in the psychiatry unit underwent routine screening computed tomography (CT) in an effort to detect clinically unsuspected intracranial abnormalities. Of 261 patients examined who had no focal neurologic deficits, 103 had schizophrenia, 71 had depression, 48 had bipolar disorders, and 39 had paranoid delusions. Findings on 230 (88.1%) of the CT scans were within normal limits, and 27 (10.4%) showed only cortical atrophy. The remaining four cases (1.5%) demonstrated basal ganglia calcification (n = 2), old lacunar infarction (n = 1), or osteoma arising from the inner table of the skull (n = 1), all of which were considered to be clinically unrelated to the patients' psychiatric conditions. In the absence of focal neurologic deficits or other findings suggesting an intracranial abnormality (eg, papilledema, seizures, persistent or increasing headaches), there is no justification for routine CT scanning in patients admitted to the hospital for psychiatric disorders.