Are these statements TRUE or FALSE?
Though the links to the relevant articles are provided, you DON’T have to re-read that article. Correct answers are given in just few sentences.
1. A CT scan of the brain is usually preferred over a brain MRI in a patient with first-episode psychosis. This is because even though a brain MRI is more sensitive in detecting brain pathology, it is associated with significantly greater exposure to ionizing radiation.
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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).
2. The dose of lorazepam used for catatonia varies from 1 to 6 mg per day. Doses greater than that should be avoided in patients with catatonia due to the risk of oversedation.
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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).
3. If the TMS treatment is given to the patient on bupropion, the TMS treatment can still proceed but lower dose intensity may be needed.
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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
Related Pages
365 Advanced Topics in Psychopharmacology: Quiz 37
365 Advanced Topics in Psychopharmacology: Quiz 36
365 Advanced Topics in Psychopharmacology: Quiz 35
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