what SPECT scans are, how they are a tool in diagnosing a patient in psychiatry, 7 types of ADD, how it helps understanding and acceptance of having a mental illness

1. Elizabeth Wolf<br />DSL 100<br />SPECT Scans <br />SPECT scans for brain imaging is a part of Nuclear Medicine. Many people who hear about SPECT scans for brain imaging have many questions such as; what does SPECT stand for, what does it do, how does it work? In this paper I am hoping to answer those very questions. For starters SPECT stands for Single Photon Emission Computed Tomography. <br />SPECT scans for brain imaging is a technique in Nuclear Medicine that physicians examine the cerebral blood flow of patients. By evaluating the cerebral blood flow it can tell the physician’s parts of the brain that function well, parts that are overactive, and areas that are underactive. The way a physician tells if a part is overacting, under acting, or functioning well is first by injecting the patient with Radioactive Isotope. Then the patient lies on a table for 20 minutes while the SPECT “gamma” camera goes around the patients head. Following this a supercomputer makes 3-D pictures of the brain activity levels. “With these maps, physicians have been able to identify certain patterns of brain activity that correlate with psychiatric and neurological illnesses” (www.amenclinic.com). <br />There are many people against SPECT scan imaging for brains and the effectiveness of the whole process. These are the arguments, “No one knows if the scans really improve accuracy of diagnosis ,whether the defects we see represent causes or results of the illness, what the progressive changes from scan to scan really mean, whether seeing a picture of their brain actually improves patients’ understanding of their disease, whether it improves their compliance with treatment, and whether Amen’s whole process actually improves patient-oriented outcome compared to optimal treatment without scans” (http://findarticles.com/p/articles/mi_hb4345/is_9_34/ai_n29293260/). But many people feel that the whole process of SPECT scans saves lives, gives understanding, and peace of mind. <br />What people against SPECT scans miss is that they should only be used in certain contexts which are appropriate. “Like any medical test, SPECT should only be used in the context of a patient’s clinical history and examination. SPECT is not a “doctor in a box” and findings need clinical correlation. Which means that the client should go through a history, and have tests done along with having a scan, a scan alone cannot diagnosis and will not replace a clinician” (www.amenclinics.com). The evaluation process should go something like this; a trained professional usually a historian will take a history, followed by questionnaires consisting of: prior/ present medications, prior attempts to correct problems/ psychiatric history, and then a family history, following the questionnaires there should be tests of mood and attention which include: general symptom check list, brain system check list, learning disability screening questionnaire, medical review of the systems, and a neuropsychiatric system check list, once all these things have been completed then it is time for a SPECT scan. <br />There are things that a SPECT scan cannot do and the people doing the SPECT scans are aware of that. First of all a SPECT scan cannot provide a diagnosis without clinical information. Second, SPECT’s cannot give a date to a head injury, toxic exposure, or an infection. The third thing is it cannot examine or assess IQ, and the fourth and last thing is it cannot evaluate the guilt/innocence/ motivation/ or sanity of a criminal defendant. <br />Then when are SPECT brain imaging scans best used? It is best to use them in complex and treatment – resistant cases. An example of a complex case would be someone who would be diagnosed with multiple disorders, which would make their medications complicated. In a treatment- resistant case the patient would have tried a bunch of different medications and none of them seemed to work, and they are still mentally ill. When a patient who comes in who is either a complex case or treatment- resistant the physician knows two things; each area of the brain has a function and problems can occur within each area of the brain. With a SPECT scan the physician can see where in the brain the problem is occurring and see what there is to do about it. Some of the options are medication, natural supplements, and psychotherapy. An example of this would be the prefrontal cortex which is located in the front of the brain; and its functions are attention span, perseverance, judgment, impulse control, organization, self monitoring, problem solving, critical thinking, forward thinking, learning from experience, ability to feel and express emotions, it influences the limbic system, and it enables to be empathic. The problems that can occur in the prefrontal cortex are; short attention span, distractibility, lack of perseverance, impulse control problems, hyperactivity, chronic lateness/ poor time management, disorganization, procrastination, unavailability of emotions, misperceptions, poor judgment, trouble learning from experience, short term memory problems, and social and test anxiety.<br /> There are not many physicians that perform SPECT scans. This is due to the controversy around them, but as time progresses more and more physicians are seeing them as a useful tool. The leading physician that performs and does research for SPECT scans and has multiple clinics is Dr. Daniel G Amen. Along with doing research he is an author of several books and he manufactures his own vitamins. Dr. Amen came up with 9 principles for brain health which are: <br />“Your brain is involved with everything you do<br />When the brain works right, you work right. When the brain is troubled, you generally experience trouble in your relationships, work, or within yourself. <br />The brain is the most complicated organ in the universe<br />Your brain is very soft, yet it is housed in a very hard skull that has many ridges. Mild traumatic brain injuries can change people’s whole lives and virtually no one knows it, because mental health professionals never look at brain function. <br />Certain parts of the brain tend to do certain things. <br />Problems in certain brain areas are often associated with specific learning, behavioral or emotional problems. <br />Most psychiatric illnesses are not single or simple disorders<br />Imaging the brain helps mental health professionals be more effective, decreases stigma and increases compliance for patients<br />The brain can change!” (www.amenclinics.com). <br /> His clinics are located in Newport Beach, CA, Fairfield, CA, Tacoma, WA, and one on the east coast in Reston, VA. A few other physicians that perform SPECT scans are the Life Bridges Diagnostics- Vieira, FL, Dr. Uszler- Santa Monica, and Dr. Klindt in San Jose, CA.<br />When working with someone you suspect has ADD/ADHD a SPECT can do many things. Along with a clinical history it can help determine whether or not you have ADHD. Another thing it can do is assist in deciding what type of ADHD you have if you have ADHD and to steer a patient’s treatment in the right direction. It can observe if the treatment is effective and is at optimal point. SPECT scans along with a clinical history can assist in determining if there are any co-occurring conditions that need to be looked at and resolved. With the understanding the patient gets from all the steps the physician takes, it will help lessen the emotional hurt brought about by the stigma of the disorder he or she might have. With this understanding of their disorder with create greater compliance with the physicians they work with. Finally, once the families see the biological component of ADHD through a SPECT and a clinical history they will have enhanced understanding about the illness and this will result in acceptance. <br />This is an example of how SPECT scans helped prove that for every different type of ADD different parts of the brain are affected and because of that there are different treatments that need to be used. “ADHD is characterized by persistent short attention span, distractibility, disorganization, procrastination and problems with forethought, judgment and impulse control” (www.amenclinics.com). There are six types of ADD, each of which are unique and have different characteristics. Type one-Classic ADD: the symptoms include key ADD symptoms then add on hyperactivity, restlessness, and impulsivity. On a SPECT scan it would look like this, on a concentration scan (remember we do a concentration scan and a scan at rest) it would have low activity in the prefrontal cortex. Because of the area and the symptoms of this type of ADD it is recommended that the patient take stimulant medications. Type two- Inattentive Type: The symptoms here are the key ADD symptoms then add on low energy, motivation, they are spacey, and internally in a world of your own. Type two is usually diagnosed later in life and is more common in girls. The concentration SPECT scan would show low activity in the prefrontal cortex and the cerebellar activity. In type two stimulant medications are recommended again. Type Three- Over focused ADD: They have the key symptoms of ADD and cognitive inflexibility, difficulty shifting attention, get stuck on negative thoughts and behaviors, they worry and hold grudges, they are argumentative, oppositional, and need sameness in their everyday life. On a concentration SPECT scan an over focused patient would have low activity in the prefrontal cortex but high activity in anterior cingulated. This is what works for these patients in either the antidepressant Effexor or a mixture of SSRI’s and a stimulant. Type four- Temporal Lobe ADD: have symptoms such as the key ADD symptoms and they have a short fuse, they misinterpret what people say, have periods of anxiety, history of head injury, that leads to headaches, they have dark thoughts, memory problems, and they struggle with reading. On a concentration SPECT scan for them it would have low activity in the temporal lobe and low activity in the prefrontal cortex. These patients would be asked to take antiseizure medicine and a stimulant. Type Five- Limbic ADD: they also have the key ADD symptoms and constant mild sadness, negativity, they socially isolate themselves, and they have poor appetite and do not sleep regularly. The concentration scan would show us that they have high activity in the deep limbic system and low activity in the prefrontal cortex. These patients would need a stimulating antidepressant such as Wellbutrin. Type Six- Ring of Fire ADD: these symptoms include the key factors of ADD and severe moodiness, anger outbursts, they are oppositional, they are not flexible, they have racing thoughts, they talk excessively, and are very sensitive to lights and sounds. In their concentration scan they had very high activity in the limbic system, the basal ganglia, and the cingulate; their scans turn out to be a huge red ring. As you can see from above only two had the same medications the rest were all different that’s because different areas of the brain are being affected. <br />The information from the scans, along with a detailed clinical history can helps us understand the underlying brain patterns associated with our patients’ problems and helps to pinpoint the right treatment to balance brain function. “With SPECT scans physicians have been able to identify certain patterns of brain activity that correlate with psychiatric and neurological illnesses” (www.amenclinics.com). If more and more psychiatrists would use this tool it wouldn’t put them out of a job it would enhance their probability of being correct about getting someone’s diagnosis right. But they have to remember that there is a whole evaluation process that goes on before the scan is ever done so you can compare what you found in the scan to the tests, questionnaires, and clinical history. <br />Work Cited<br />www.amenclinics.com<br />findarticles.com/p/articles/mi_hb4345/is_9_34/ai_n29293260/<br />www.sciencebasedmedicine.org/?p=76<br />