365 Advanced Topics in Psychopharmacology: Quiz 38

Answer: False

Explanation: If imaging of the brain is needed in a patient with first-episode psychosis, an MRI should be preferred over a CT scan. This is because an MRI has much greater sensitivity for picking up brain pathology AND because an MRI avoids exposure to ionizing radiation (Forbes and Stuckey, 2020).

Review: Order an MRI of brain in first-episode psychosis?

Answer: False

Explanation: The dose of lorazepam for catatonia varies from 2 to 16 (or even more!) mg per day (Pelzer et al., 2018; Sienaert et al., 2014).

Often, relatively low doses work really well (Rasmussen et al., 2018). But, some patients with catatonia don’t respond until higher doses of lorazepam are given (Rasmussen et al., 2018).

You may be wondering—“Won’t moderate or high doses of lorazepam cause excessive sedation, especially in a patient who is already lying still and not doing very little?”

Lorazepam treatment of catatonia is generally not associated with any significant side effects (Pelzer et al., 2018). Surprisingly, high doses of lorazepam are often tolerated by these patients without any sedation (Sienaert et al., 2014; England et al., 2011).

Of course, patients must still be carefully monitored due to the possibility of excessive sedation or even respiratory depression (Sienaert et al., 2014).

Review: Lorazepam for catatonia: How much? How long?

Answer: True

Explanation: Medications that lower the seizure threshold and increase the risk of an unwanted seizure include bupropion, tricyclic antidepressants, clozapine, and possibly others.

Examples of medications that raise the resting motor threshold are antiepileptics like carbamazepine and lamotrigine (Ziemann et al., 1996).

– If a patient is on a medication that raises the motor threshold, TMS treatment can still proceed but a higher dose intensity will be required. The opposite will be the case if the patient is on a medication that lowers the motor threshold.

– Generally speaking, medications should not be changed during a course of TMS so that the outcome of TMS treatment can be more clearly assessed.

– But, if a new medication that may affect the motor threshold is started while a course of TMS treatment is going on, the motor threshold should be remeasured to see if it has changed after the new medication was started.

Review: Important! Motor threshold in TMS may be affected by medications