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Daniel G. Amen, M.D., is really a clinical neuroscientist, a psychiatrist, as well as the director of clinics in California, Washington state, and Virginia. Furthermore to operating a personal practice, he could be an assistant clinical professor of psychiatry and human behavior on the University of California, Irvine, College of Medicine. He may be the author of Healing ADD, Healing Anxiety and Depression, and Make Positive Changes To Brain, Make Positive Changes To Life.
Lisa C. Routh, M.D., is often a neuropsychiatrist with special learning neurology, general psychiatry, child psychiatry, and functional brain imaging.  She lives in Houston, Texas. 
CHAPTER 1

Seeing Anxiety and Depression:

Brain SPECT Imaging

Sean was one in the cutest, brightest ten-year-old boys with blond hair and big blue eyes we'd ever seen. He arrived to our clinic clutching Dr. Amen's book Change Your Brain, Improve Your Life, which his mother had directed at him and that he had actually read from cover to cover. Based about what he had read within the book he predicted that they might have problems in the deep limbic system and left temporal lobe. When we asked him how he knew this, he was quoted saying which he had periods of really bad depression, a really bad temper, knowning that he had attemptedto kill himself the year before when he was feeling really sad. He also said that sometimes he saw shadows and bugs crawling on walls when there have been none. As section of Sean's evaluation we did a brain SPECT series. When we reviewed the scans with Sean it became clear that they had perfectly predicted their own SPECT results. He previously excessive activity within the brain's emotional center (the deep limbic system) and decreased activity inside the left temporal lobe. As he and the parents looked with the images for the computer screen, tears rolled down Sean's and the mother's cheeks. "I never planned to feel below par or be so mad," he said. "I always desired to be good. I guess I understand why I needed those problems." On the right treatment, guided by the scans, his history, and our clinical observations, Sean's mood and temper stabilized anf the husband thrived in college and also at home.

A picture may be invaluable. Once we started our imaging work we're able to clearly notice that these diseases were in fact brain problems. From the first month performing scans, over twelve years ago, imaging has changed the way we have a look at patients. Before we had been capable of perform brain scans, our way of diagnosis and treatment was depending on patient interviews and symptom checklists, including those found within the DSM (Diagnostic and Statistical Manual) published through the American Psychiatric Association. The DSM, now in its fifth version, is recognized as by many people to get the bible for diagnosing psychiatric illness. Unfortunately, psychiatric diagnoses within the DSM remain based on symptom clusters and also have little reely to complete with underlying brain dysfunction.

Shortly after starting the imaging work, we learned to make use of the scan images like radar to aid us target treatment toward the particular brain regions that have been abnormal. The greatest aspect individuals work was observing that effective treatment causes a patient's brain to actually start healing. We could change brain patterns, find it on the follow-up scan, optimize brain function, and subsequently help people heal through the inside out.

Using brain imaging to aid diagnose psychiatric illness wasn't section of our training, even though we trained at some from the most respected institutions inside the country. Dr. Amen trained on the Walter Reed Army Medical Center in Washington, D.C., and Dr. Routh on the Mayo Clinic in Rochester, Minnesota, and Timberlawn Hospital in Dallas, Texas. Brain imaging is normally not really a significant part with the curriculum for most psychiatric training programs. Although most psychiatric illnesses are strongly brain-based, psychiatrists don't examine thinking processes because:

* imaging is usually not only a part of psychiatric training programs;

* imaging is not just a part of psychiatric tradition;

* most psychiatrists don't know how you can read brain scans or what are the results mean;

* most psychiatrists are uncertain how to use information from brain scans to help with diagnosis and guide treatment;

* many psychiatrists trust it is hard to acquire brain imaging studies approved by insurance providers inside ages of managed care;

* most psychiatrists still perceive brain imaging tools as experimental;

* many psychiatrists are uncomfortable with technology.

We have argued for greater than twelve years it is vital for psychiatrists to appear at the brain on a day-to-day clinical basis. The field is changing, although much more slowly than we would like. We're actively associated with teaching the imaging techniques in this book to psychiatric residents and other physicians across the country.

Physicians use a amount of other ways to check at the brain. MRI and CT scans are examples of anatomical studies. They reveal what the brain looks like, although not what it really has been doing and therefore are rarely helpful as diagnostic aids for neuropsychiatric and behavioral problems. Using a vehicle engine analogy, the situation is usually with how the engine works, not the way it looks. A car engine may look beautiful in a very photograph, yet it may not start. Are you able to imagine how much time a service center would remain in business if the mechanic's standard reply to some car owner's complaint was, "Well, it looks just fine"? Yet that is exactly what are the vast most those who have brain dysfunction hear from your medical community after their EEG, MRI, or CT results come in. We haven't any doubt that generally these brains "look just fine" because the situation is not with "looks" but instead with the way the brains work.

Currently, there are five ways to gauge brain function:

Electroencephalogram (EEG), a technology that's seventy years old, uses electrodes to record electrical activity from your scalp and infer information about brain function. It has poor resolution and is also rarely ideal for psychiatric purposes.

Quantitative EEG studies (QEEG) is really a newer version of EEG that uses computers to boost electrical signals, but nevertheless relies on inferring data in relation to its the brain through the scalp, skull, and coverings of the brain. Dr. Amen used QEEG before he switched to SPECT in 1991.

Positron emission tomography (PET) is a nuclear medicine study utilizing minute doses of radioisotopes to look at living brain blood flow and metabolism. PET studies provide elegant views of brain function, but the equipment tends being obtainable in research centers and can't be accessed by large variety of patients.

Single photon emission computed tomography (SPECT) can also be a nuclear medicine study that evaluates cerebral blood flow. SPECT is the study we perform in the Amen Clinics. We think it is essentially the most practical and value effective, and yes it provides amazing pictures of brain function.

Functional MRI, or fMRI, a newer study, is overtaking much of the research in psychiatry. fMRI's advantages include no radiation, as against PET and SPECT, nonetheless it is in the first stages of use with little clinical application to psychiatry with this point.

SPECT: A Window into Anxiety and Depression

Before we go further, it is important to remember of SPECT technology. SPECT stands for single photon emission computer tomography. It is really a sophisticated nuclear medicine study that permits us to visualize brain blood flow and metabolism. In this study, a radioactive isotope is attached with a substance (Ceretec) that is easily taken on from the cells inside the brain. A tiny amount on this compound is injected right into a patient's vein, travels from the bloodstream, and locks into brain cells. Since the isotope breaks down it releases energy inside the form of gamma rays. The gamma rays are just like beacons of light that signal the location where the compound is inside the brain. People do not have access to allergic reactions to SPECT studies. Special crystals within the SPECT "gamma" camera detect these beacons of sunshine since the camera rotates across the patient's head for around fifteen minutes. About 10 million gamma rays strike the crystals during a typical scan, along with a supercomputer then translates these records into sophisticated blood flow/metabolism maps and three-dimensional images with the brain. Physicians and researchers use these maps to identify patterns of brain activity that correlate to healthy thinking processes and those which can be associated with psychiatric and neurological illnesses.

SPECT imaging belongs to a branch of medicine called nuclear medicine. Nuclear medicine studies measure the physiological functioning with the body. They are accustomed to diagnose a variety of medical conditions: heart disease, certain types of infection, multiplication of cancer, and bone and thyroid diseases. Brain SPECT studies help inside diagnosis of brain trauma, dementia, atypical or unresponsive mood disorders, strokes, seizures, the impact of drug abuse on brain function, complex forms of Attention Deficit Disorder, and atypical or aggressive behaviors.

Brain SPECT studies were initially used within the late 1960s and early to mid-1970s. CT and the more sophisticated MRI anatomical studies replaced SPECT studies inside the late 1970s and 1980s. At the time, the resolution (image clarity) of the studies was superior to SPECT for seeing tumors, cysts, and blood clots. Yet, despite their clarity, CT scans and MRIs could offer images of only a static brain and its anatomy; they gave no information regarding the activity of your working brain. In the final decade it is now increasingly recognized that many neurological and psychiatric disorders aren't disorders in the brain's anatomy, but are problems of brain function.

Two technological advancements have again encouraged using SPECT studies. The early SPECT cameras were called single-headed cameras since they used only one imaging tool and took as long as you hour to rotate around an individual's brain. People had trouble holding still for your long, the images were fuzzy and difficult to read (earning nuclear medicine the nickname "unclear medicine"), and so they would not give much information regarding the activity levels from the deep brain structures. Then multi-headed cameras were developed with special filters that imaged the brain faster with enhanced resolution. Advancements in computer technology allowed for improved data acquisition. Your brain SPECT studies of today, making usage of their markedly improved resolution, can see deeper in the inner workings of the brain with much better clarity.

We typically do two scans when we evaluate a patient's brain. We execute a baseline scan during that this patient is asked to allow his mind wande... --This text refers to a out of print or unavailable edition of the title.












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