SPECT Imaging Notes: Just looking is the first step

SPECT Brain Imaging Works

SPECT Gamma Camera

Brain imaging is starting to find its way, interestingly enough, even in the medical-medical literature.

In a previous post here at CorePsychBlog I discussed briefly an article from the Annals of Internal Medicine on schizophrenia, SPECT findings, and celiac. I reported in that post the dramatic confluence of metabolic, psychiatric and SPECT findings… and the resolution of the schizophrenia as a result of treating the metabolic problems discovered on SPECT and confirmed by laboratory.

So how come SPECT [gamma camera picture] isn't popping up as a useful tool in medical-psychiatric literature? The reasons are several:

1. Psychiatric/Academic competition: Some academicians [UCLA disagrees] say SPECT is still in the “research phase.”
2. The pharma companies are not paying for the research to translate SPECT clinical findings into clinical interventions [not their responsibility]
3. Very few psychiatrists have actually used SPECT findings to guide psychiatric treatment  [I have a plan – stay tuned here for CoreBrain Training].
4. Outcome studies, with both clinical and SPECT resolution of specific symptoms and brain dysfunction are few and costly [money is a big issue with SPECT aftercare].
5. The SPECT tradition comes more from a “findings” rather than a follow up tradition.[We  do need more longitudinal studies]

For the record: SPECT imaging evidence is remarkably useful and could be used in any psychiatric or mental health office with basic training. If you understand SPECT, you can use it to further understand specific nuances of brain function and the context of each clinical presentation. No, SPECT imaging is not mandatory, but often proves necessary.

And yes, I agree with Thomas Insel MD, PhD, [quoted by Amen] Director of the National Institute of Mental Health: We really should make the effort to understand this new information for application in our office practices. [See Insel's very interesting article on Psychiatry and Neuroscience – JAMA ref below] These quotes below from Insel:

• Brain imaging in clinical practice is the next major advance in psychiatry.
• Trial and error diagnosis will move to an era where we understand the underlying biology of mental disorders.
• We are going to have to use neuroimaging to begin to identify the systems pathology that is distributed in each of these disorders and think of imaging as a biomarker for mental illnesses.
• The DSM-IV has 100% reliability and 0% validity. [Strongly agree on this one – remember: DSM IV is phenotypic, not endophenotypic!] We need to develop biomarkers, including brain imaging, to develop the validity of these disorders.
• We need to develop treatments that go after the core pathology, understood by imaging.
• The end game is to get to an era of individualized care.
  

Stay tuned as we discuss both the ongoing evolution and developmental arrest of SPECT imaging.
– And bring a seat cushion, as there will be some bumps along the way.

Insel, T.R., Quirion, R. (2005). Psychiatry as a Clinical Neuroscience Discipline. Journal of the American Medical Association, 294(17), 2221-2224.