NY Times article on brain imaging & psychiatry

[Miklos]

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Entitled: "Can Brain Scans see depression?"

(For those of you who don't want to register in order to view the article, I recommend BugMeNot, which generates a login and password to bypass the compulsory web registration.)

Thoughts on the article?

 

[OldPsychDoc]

Entitled: "Can Brain Scans see depression?"

(For those of you who don't want to register in order to view the article, I recommend BugMeNot, which generates a login and password to bypass the compulsory web registration.)

Thoughts on the article?

I once heard an attending refer to functional imaging as "Pseudo-color Phrenology", and I tend to agree. I think this article is a long overdue antidote to the usual "Gee-whiz, look-what-researchers-have-discovered now" articles in the mainstream media.

Functional imaging is useful for research, but it really doesn't change our clinical practice much. Always remember that the best diagnostic tool in psychiatry is the clinical interview. About once a month I get a patient (or worse, a patient's family member) who has bought into what I call the "Tricorder Fallacy"--that we will "run some tests" and find out what's REALLY wrong with them. 🙄

 

[Miklos]

I once heard an attending refer to functional imaging as "Pseudo-color Phrenology", and I tend to agree. I think this article is a long overdue antidote to the usual "Gee-whiz, look-what-researchers-have-discovered now" articles in the mainstream media.

Functional imaging is useful for research, but it really doesn't change our clinical practice much. Always remember that the best diagnostic tool in psychiatry is the clinical interview. About once a month I get a patient (or worse, a patient's family member) who has bought into what I call the "Tricorder Fallacy"--that we will "run some tests" and find out what's REALLY wrong with them. 🙄

Thanks.

I'm much of the same opinion.

Recently, I was approached by a friend of a friend (an anesthesiologist) who had taken herself, her kids and her husband (IMO, none of whom has MI) to a psychiatrist who uses functional imaging. The images, though very cool looking, were used by him to make a diagnosis of ADHD in one of the kids and the husband. She swore that her child's performance in school improved inmeasurably after being put on gabapentin. As she was completely enamored by the psychiatrist's methods, all I could manage was something like: "Well, that's cutting edge stuff."

Your (or anyone else's) thoughts?

 

[OldPsychDoc]

Thanks.

I'm much of the same opinion.

Recently, I was approached by a friend of a friend (an anesthesiologist) who had taken herself, her kids and her husband (IMO, none of whom has MI) to a psychiatrist who uses functional imaging. The images, though very cool looking, were used by him to make a diagnosis of ADHD in one of the kids and the husband. She swore that her child's performance in school improved inmeasurably after being put on gabapentin. As she was completely enamored by the psychiatrist's methods, all I could manage was something like: "Well, that's cutting edge stuff."

Your (or anyone else's) thoughts?

Umm--so "cutting-edge" that it has not a shred of evidence on which to be based?

 

[PublicHealth]

Umm--so "cutting-edge" that it has not a shred of evidence on which to be based?

This man appears to be putting together the "shreds of evidence:" http://www.loni.ucla.edu/~thompson/MEDIA/ATLAS/bbc_atlas.html

 

[OldPsychDoc]

This man appears to be putting together the "shreds of evidence:" http://www.loni.ucla.edu/~thompson/MEDIA/ATLAS/bbc_atlas.html

Undoubtedly...but it doesn't seem to be related to the example of prescribing the ever-popular Neurontin for a scan-based dx of ADHD!!

 

[PublicHealth]

Undoubtedly...but it doesn't seem to be related to the example of prescribing the ever-popular Neurontin for a scan-based dx of ADHD!!

But who's to say that this may not be possible someday, albeit not presently?

 

[El Chupacabra]

I agree the use of neuroimaging has been blown out of proportion in terms of its use in the clinical setting; however, to imply the use of neuroimages as the sole criteria for Dx is false; it merely facilitates Dx. I couldn't agree more that there needs to be more (or some for that matter) research dedicated to neuroimaging, but there are some cases where I believe these images warrant a place in clincial medicine. I formerly worked for a neuropsychiatrist, and we regularly saw Px with substance dependency issues (inpatient more often than not). On SOME of the scans, there was clearly evidence of "toxic exposure' (scalloping). I really believe it helps the clinician to say, "Hey, look what you are doing to your brian." Often, these Px attributed the fact they had 'physically' seen what they have done to their brain resulted in abstaining from the substance at 6-month or 1-year follow-up.
There are also legitamate cases of tumors and cyst were picked up by the scans, which would be difficult to pick up in a clinical history (some don't present Sx). I also believe there is convincing evidence (not sure on research) about the use of functional neuroimaging and pfc hypoactivity (ADHD). Although, many of the other disorders which some clincians claim to 'see' on scans are questionable at best.

 

[OldPsychDoc]

I agree the use of neuroimaging has been blown out of proportion in terms of its use in the clinical setting; however, to imply the use of neuroimages as the sole criteria for Dx is false; it merely facilitates Dx. I couldn't agree more that there needs to be more (or some for that matter) research dedicated to neuroimaging, but there are some cases where I believe these images warrant a place in clincial medicine. I formerly worked for a neuropsychiatrist, and we regularly saw Px with substance dependency issues (inpatient more often than not). On SOME of the scans, there was clearly evidence of "toxic exposure' (scalloping). I really believe it helps the clinician to say, "Hey, look what you are doing to your brian." Often, these Px attributed the fact they had 'physically' seen what they have done to their brain resulted in abstaining from the substance at 6-month or 1-year follow-up.
There are also legitamate cases of tumors and cyst were picked up by the scans, which would be difficult to pick up in a clinical history (some don't present Sx). I also believe there is convincing evidence (not sure on research) about the use of functional neuroimaging and pfc hypoactivity (ADHD). Although, many of the other disorders which some clincians claim to 'see' on scans are questionable at best.

All fine, but in a world where scans cost thousands of dollars, and millions of our patients can't afford generic antidepressants, someone needs to ask the question of whether the expenditure is justified.

 

[50960]

Dr. Amen here in Ca does alot of this, and claims to have a science basis for his recommendations. He uses SPECT imaging.

 

[El Chupacabra]

All fine, but in a world where scans cost thousands of dollars, and millions of our patients can't afford generic antidepressants, someone needs to ask the question of whether the expenditure is justified.

According to most reinbursement protocol...it's not. But I believe there was a similar argument when CT was becoming mainstream.

 

[2010]

Thought id put in my 2 cents,
I agree with the majority, brain imaging is an exciting and evolving research tool, and may be useful for diagnostics in the far future.
Psychiatric diagnosis today is based on symptomology not pathophysiology, although I see this changing in our lifetimes.
Currently, the use of imaging in diagnosis is not based on solid science. It will take a lot of research and time before this becomes mainstream. Those that utilize these techniques are, in my opinions, not doing the field any favors, and obviously not practicing evidence based medicine.
Example, there are specific changes in ADHA that can be picked up on fMRI. As there are specific alterations in schizophrenia ie altered D1 binding in the PFC for example, but we dont use PET to diagnose schizophrenia, we use clinical symptoms.
Anyone "selling" imaging studies to diagnose psych disorders is just selling nice color pictures of peoples brains (those who can afford it off course).