Brain Imaging and Psychiatry

[astral]

I am reading a book called "Magnificent Mind At Any Age" by Daniel Amen, MD who is a clinical neuroscientist and psychiatrist. The book includes heavy discussion of SPECT imaging to determine a patient's cerebral blood flow, brain activity patterns, and proclivity to addictive behavior, depression, anxiety, or impulsive behavior.

The author's clinics, "Amen Clinics" try to evaluate and treat brain-behavior problems with heavy use of SPECT, and supposedly the clinic has over 50,000 brain activity images.

Do mainstream pscyhiatrists utilize brain imaging heavily to treat patients? I did not know that it could provide such interesting information.

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[astral]

3. Left TL deficit (suicidal child)

4. Head Trauma and Drug Abuse

5. Healthy Brain

 

[astral]

an answer? anyone?

 

[Gavanshir]

I believe there is a lot of controversy surrounding Amen Clinics because the use of SPECT and specifically Dr. Amen's use of SPECT to compare healthy and diseased brains has not been scientifically proven to be accurate or effective. I wish it would be because the idea is an exciting one.

 

[MacDonaldTriad]

If this were possible, do you think we would be fighting it, or just perhaps we would be embracing it?

 

[Gavanshir]

View attachment 208878 If this were possible, do you think we would be fighting it, or just perhaps we would be embracing it?

I would embrace the heck out of it, I think we are in dire need of more objective measures of data and the field could stand to branch out further into areas like imaging. Even if the science isn't quite there yet.

 

[WisNeuro]

There is an Amen clinic here, I've seen plenty of reports from patients who have been there. They are some of the absolute worst clinical products I have ever laid eyes upon. Not too mention the proprietary, and very expensive, "treatments" that are recommended. SPECT and such may have a place, but it's still way too early for prime time and generally when it's used as such, it's by people with some snake oil to sell you.

 

[tr]

Yes this. Amen is a quack. But he is raking it in by showing people pretty, clinically meaningless pictures of their brains and prescribing OTC supplements.

 

[romanticscience]

http://www.amenclinics.com/conditions/marital-conflict/

An added benefit of the clinic is allowing patients to further reinforce over-valued biological beliefs of their illness. In turn, disavowing them of any responsibility for their troubled behavior.

Good deal, I'd say.


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[birchswing]

I wish I could remember what a phenomenon was called from a class I took, but I can't even remember which class it was. There is some sort of logical fallacy where when people see images of brain scans and associated research they take the research more seriously than they should because it seems so cutting edge—it's something about it being images of the brain itself that led to people's perception of the images being too trusting. It was unique to the content (brain—maybe other subjects, but I don't recall). I tried googling it but that just came up with brain study research rather than the concept about brain study research. I don't even really remember the entire concept, but I remember it being interesting. Is anyone familiar with this?

 

[Amygdarya]

I wish I could remember what a phenomenon was called from a class I took, but I can't even remember which class it was. There is some sort of logical fallacy where when people see images of brain scans and associated research they take the research more seriously than they should because it seems so cutting edge—it's something about it being images of the brain itself that led to people's perception of the images being too trusting. It was unique to the content (brain—maybe other subjects, but I don't recall). I tried googling it but that just came up with brain study research rather than the concept about brain study research. I don't even really remember the entire concept, but I remember it being interesting. Is anyone familiar with this?

Yes, I've read about this phenomenon, too, though I'm not sure if it has a specific name. Basically, brain pictures with some highlighted areas make things look more "science-y" and therefore more authoritative.

 

[birchswing]

Yes, I've read about this phenomenon, too, though I'm not sure if it has a specific name. Basically, brain pictures with some highlighted areas make things look more "science-y" and therefore more authoritative.

Yeah--that was it. Maybe it wasn't from a class but an article I read. I thought maybe it was in my research methods class but I just searched the textbook (it's PDF) and didn't find it.

 

[smalltownpsych]

It is really simple to test the theory by using a blinded procedure. In other words, can a clinician diagnose a mental disorder solely by examining the SPECT scan. There was some promising research with differentiating MCI from DAT a few years back where the SPECT scan had a high degree of sensitivity and specificity that was comparable to a standard neuropsychological assessment, but I have not heard anything close to those numbers with any other type of disorder. The other question is if it is diagnostically reliable, does it add benefit in either improving diagnostic reliability or guide treatment. Dr. Amen says it does, and I have had patients who went to his clinic and were told that the SPECT scan identified the type of brain dysfunction that led to their specific brand of ADHD and that he had specific treatments for that.

I worked at a private pay adolescent program so our patient base overlapped a bit with the Amen clientele. Desperate parents would fly their kids in to get the scans in hopes of a miracle cure. I recall a particular patient who was on a raft of supplements and we held firm that we would not enroll the kid in our program and administer that crap without a doctors order which was not going to happen with the psychiatrist that we sent kids too cause he was legit. Initially the parents were a bit resistant, but since their child had not improved at all with the Amen treatment recommendations, they went with it. Can't remember if we were successful with that individual case or not but about 80% of our kids showed remarkable improvement. The sad thing is that I know what does work for the run of the mill ADHD, ODD, MDD, GAD, PTSD, RAD, or budding Axis II types of kids, and brain scans and supplements are clearly not it. Even standard medications can often be more of the problem than a solution especially when that is the sole treatment. Unfortunately, it is nearly impossible to deliver the type of effective treatment needed in the community setting so we just keep chasing after false hopes.

 

[birchswing]

Someone lent me his book once, and I skimmed through it. Only thing I remember was he recommended watching positive media, like the Disney movie Pollyanna. I actually think there's something to that. Having a TV on in the background can be nice. I don't buy from QVC, but sometimes when I just want a break from things I put it on. They're always very positive (yes, I know, it's because they want me to buy things—but I'll take it). Nice break from the news.

 

[Dharma]

Way too early in the game for clinical applications in regards to imagining.

 

[MacDonaldTriad]

Way too early in the game for clinical applications in regards to imagining.

And given your Avatar, I agree with you completely.

 

[Fan_of_Meehl]

I wish I could remember what a phenomenon was called from a class I took, but I can't even remember which class it was. There is some sort of logical fallacy where when people see images of brain scans and associated research they take the research more seriously than they should because it seems so cutting edge—it's something about it being images of the brain itself that led to people's perception of the images being too trusting. It was unique to the content (brain—maybe other subjects, but I don't recall). I tried googling it but that just came up with brain study research rather than the concept about brain study research. I don't even really remember the entire concept, but I remember it being interesting. Is anyone familiar with this?

There is a difference between 'science' and 'scientism'

This appears to be an ugly confluence between 'scientism' and extreme 'biological determinism'

It also may be an instance of what Jacob Cohen termed 'methodolatry' (or, the worship of method).

Trying to 'solve' mental illness by simply focusing on 'brain scans', no matter how detailed/elaborate strikes me as just as futile as trying to fix a computer that has been infested with malware by taking an image of distribution of data across its physical hard drive or looking at the physical locations where the hard drive 'lights up' when power is provided to the malfunctioning machine.

 

[Fan_of_Meehl]

It is really simple to test the theory by using a blinded procedure. In other words, can a clinician diagnose a mental disorder solely by examining the SPECT scan. There was some promising research with differentiating MCI from DAT a few years back where the SPECT scan had a high degree of sensitivity and specificity that was comparable to a standard neuropsychological assessment, but I have not heard anything close to those numbers with any other type of disorder. The other question is if it is diagnostically reliable, does it add benefit in either improving diagnostic reliability or guide treatment. Dr. Amen says it does, and I have had patients who went to his clinic and were told that the SPECT scan identified the type of brain dysfunction that led to their specific brand of ADHD and that he had specific treatments for that.

I worked at a private pay adolescent program so our patient base overlapped a bit with the Amen clientele. Desperate parents would fly their kids in to get the scans in hopes of a miracle cure. I recall a particular patient who was on a raft of supplements and we held firm that we would not enroll the kid in our program and administer that crap without a doctors order which was not going to happen with the psychiatrist that we sent kids too cause he was legit. Initially the parents were a bit resistant, but since their child had not improved at all with the Amen treatment recommendations, they went with it. Can't remember if we were successful with that individual case or not but about 80% of our kids showed remarkable improvement. The sad thing is that I know what does work for the run of the mill ADHD, ODD, MDD, GAD, PTSD, RAD, or budding Axis II types of kids, and brain scans and supplements are clearly not it. Even standard medications can often be more of the problem than a solution especially when that is the sole treatment. Unfortunately, it is nearly impossible to deliver the type of effective treatment needed in the community setting so we just keep chasing after false hopes.

Interestingly, this exact methodology ('blind' (to diagnostic condition or treatment arm) readings by radiologist of PET scans) was utilized in one of the first studies (I think I read it in 1995) examining changes in PET scans of OCD patients who had been treated with a medication, behavior (exposure with response prevention) therapy, and--I think--wait list control. The radiologists, who read the pre-post PET scans of all study participants, were able to detect pre-post changes in the PET scans in specific brain areas that were observed from both medication therapy and behavior therapy (but they were unable to differentiate patients on the basis of which active treatment they received) while these changes were not seen in the patients who were in the wait-list arm of the study.

So much for pure biological determinism.

 

[Amygdarya]

Someone lent me his book once, and I skimmed through it. Only thing I remember was he recommended watching positive media, like the Disney movie Pollyanna. I actually think there's something to that. Having a TV on in the background can be nice. I don't buy from QVC, but sometimes when I just want a break from things I put it on. They're always very positive (yes, I know, it's because they want me to buy things—but I'll take it). Nice break from the news.

I have nothing to say about positive media but your post reminded me that the most dangerous kind quackery is the one that combines a pinch of valid treatment with a whole lot of snake oil. That pinch of validity can make the quackery seem legit even in the eyes of otherwise reasonable people.

 

[Fan_of_Meehl]

I have nothing to say about positive media but your post reminded me that the most dangerous kind quackery is the one that combines a pinch of valid treatment with a whole lot of snake oil. That pinch of validity can make the quackery seem legit even in the eyes of otherwise reasonable people.

On the topic of biological determinism, this reminded me of a really interesting manuscript by my favorite philosopher of science--Philip Kitcher--entitled, "1953 and all that. A tale of two sciences" in which he examines/contrasts classical genetics with molecular genetics and uses this contrasting analysis to illustrate the futility of material reductionism when taken to extreme...in the area of genetics (wow). Not sure how well it holds up to the modern state of genetic research (and modern molecular genetics), but I remember it made quite an impression on me when I read it about 20 years ago and really cemented in my mind the importance of appreciating the limits of biological reductionism in psychology/psychiatry.

http://web.mit.edu/bskow/www/810-S12/kitcher.pdf

 

[Amygdarya]

On the topic of biological determinism, this reminded me of a really interesting manuscript by my favorite philosopher of science--Philip Kitcher--entitled, "1953 and all that. A tale of two sciences" in which he examines/contrasts classical genetics with molecular genetics and uses this contrasting analysis to illustrate the futility of material reductionism when taken to extreme...in the area of genetics (wow). Not sure how well it holds up to the modern state of genetic research (and modern molecular genetics), but I remember it made quite an impression on me when I read it about 20 years ago and really cemented in my mind the importance of appreciating the limits of biological reductionism in psychology/psychiatry.

http://web.mit.edu/bskow/www/810-S12/kitcher.pdf

Can't agree with you more! As someone with a strong background in "hard" sciences and years of basic science research, I know all too well about the limits of reductionism even in "harder" science. I've been taking to people who changed their minds from psychiatry to internal medicine or neurology, and they often say they were uncomfortable with the lack of objective measures and the ambiguity inherent to psychiatry. While I agree that it's useful to have some "objective" measures for many reasons, I also think that by being able to measure serum potassium or seeing that intraparenchymal bleed on CT people are only fooling themselves into thinking they *really* know what's going on. But hey, I'm an agnostic

 

[Fan_of_Meehl]

Can't agree with you more! As someone with a strong background in "hard" sciences and years of basic science research, I know all too well about the limits of reductionism even in "harder" science. I've been taking to people who changed their minds from psychiatry to internal medicine or neurology, and they often say they were uncomfortable with the lack of objective measures and the ambiguity inherent to psychiatry. While I agree that it's useful to have some "objective" measures for many reasons, I also think that by being able to measure serum potassium or seeing that intraparenchymal bleed on CT people are only fooling themselves into thinking they *really* know what's going on. But hey, I'm an agnostic

I think we may have some intellectual kinship . I was 'in love' with the natural sciences (physics, biology, chemistry, etc.) before I ever decided to go into psychology (and, ultimately, the field of clinical psychology). But I really like them all...for me it is very much a 'both-and' sort of situation rather than an 'either-or.'

By the way, I heartily recommend Kitcher's 'Believing Where We Cannot Prove' essay as well (link below) and I've used it in seminars for psychology interns where we explored the scientific bases for professional psychology and the importance of learning a bit about the philosophy of science proper (e.g., notions of scientific explanation vs. description, causality, falsificationism, nature of scientific laws and theories, operationism, etc.) in order to really understand a lot of what we deal with in professional psychology and psychiatry.

The first line in Kitcher's essay is, "Simple distinctions come all too easily..."

http://joelvelasco.net/teaching/hum9/kitcher82-chap2believing.pdf

It starts off kind of slow, but the second half of the manuscript is a good summary of key principles involved in the scientific approach to any field of study.

 

[Dharma]

And given your Avatar, I agree with you completely.

hahaha! missed that there. you may say i'm a dreamer...

 

[Fan_of_Meehl]

hahaha! missed that there. you may say i'm a dreamer...

....but you're not the only one

 

[birchswing]

I have nothing to say about positive media but your post reminded me that the most dangerous kind quackery is the one that combines a pinch of valid treatment with a whole lot of snake oil. That pinch of validity can make the quackery seem legit even in the eyes of otherwise reasonable people.

I'm a pretty strong skeptic. While I looked into Amen many years ago and I don't remember everything I read, I remember my general takeaway was that even if the scans were effective, it seemed the treatments he ended up using weren't different (I see mention of supplements, but at the time I believe he was using conventional psychiatric drugs). I thought that even if it were diagnostic, at the most you might get to a certain treatment faster than trial and error. But I didn't assume they were accurate. You have a good point generally, though. Perhaps it's a bit egotistical to think I'm the exception to the rule, and certainly the nature of certain biases is that you can't see them.

I would point out that even in mainstream medicine there is misinformation, quackery, and cultural biases that influence care and recommendations. There are countries where that is less and more true. In some countries doctor have to conform quite rigidly to methods based on research that governing boards agree is the best (if you're practicing within the NHS, for example). There is more leeway in the US to defer to a physician's hunch or curiosity, I think both to our detriment and benefit. But I think that because doctors are charged with conventional, life-saving treatments, what you say holds true for the mainstream, as well. The authority in medicine conveys an authority in cultural issues and treatments that are outside evidence-based practice. It's not always a bad thing, not always a good thing.

 

[Ceke2002]

My Psychiatrist's sub-specialty is NeuroPsych. I would think it there was anything substantiated regarding brain scans and miracle treatments for mental health conditions that he would have run me through a SPECT machine himself by now, seeing as I'm quite sure I haven't been in long term therapy for 6 or so years just because he really likes having me around.