Ordering Imaging

[BobA]

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Two questions
1) Do you order imaging for new onset psychosis?

2) What kind of imaging do you order? (that is, if it's an MRI do you need contrast?)?

 

[billypilgrim37]

We order MRIs. I don't order contrast because there's much more risk than there is benefit to adding it.

 

[nitemagi]

I'm a strong proponent of MRI's for first episode psychosis, w/w/out contrast. The risks with MRI contrast is pretty low relative to iodine, unless they have end stage renal disease(Nephrogenic Systemic Fibrosis), which is uncommon in first stage psychosis patients. ED's and internists often order a non-con CT, but that's fairly useless except for acute bleeds or blatant structural abnormalities. If you're seriously investigating, then in my opinion an MRI is the only way to go. Otherwise you've never really ruled anything out.

If you look at the few papers that're out there, such as by Freudenreich, there's no real consensus on what constitutes an adequate workup for first episode psychosis.

 

[billypilgrim37]

There's a good bit of controversy surrounding the NSF, and I'm not sure five years from now we all won't be really nervous about how much gadolinium we were injecting into people. Or maybe I just didn't take my Risperdal today. 😉

 

[YogiDO]

Link to an article from 2005
http://www.clinicalpsychiatrynews.c...ans-for-first-break-psychosis/56956bead2.html

 

[dianamd]

Two questions
1) Do you order imaging for new onset psychosis?

2) What kind of imaging do you order? (that is, if it's an MRI do you need contrast?)?

1) Absolutely, I would order imaging. But not necessarily in the ER, more likely after admission.

2) Usually MRI. However, if it was an older person out of range for first-break of schizophrenia, I might think towards getting a CT in the ER just to r/o something obvious. A younger person, in my opinion, gets the full workup with MRI after admission. (And a dose of risperdal/ativan on the spot!) I don't order either with contrast.