The document provides an overview of functional neuroimaging techniques used in psychiatry, including their principles, applications, and future trends. It discusses various imaging modalities such as MRI, fMRI, MRS, PET, SPECT, and diffusion tensor imaging. It describes how these techniques are used to study structural and functional correlates of psychiatric disorders and examine areas of the brain involved in conditions like schizophrenia, depression, addiction, and dementia. The document also outlines how neuroimaging is enhancing our understanding of psychopathology and treatment responses in these illnesses.
Cognitive changes have been a defining feature of Sz since onset. A lot of research has been done in understanding these changes and its implication in developing novel methods of treatments. This ppt summarises the cognitive changes occurring in the brain.
Neuropsychological rehabilitation focused on improving cognitive functions which further results in improving symptoms, functional ability which enhance overall quality of life.
The Neurobiology of Depression (Dr Imran Waheed)Imran Waheed
A lecture delivered in the West Midlands by Dr Imran Waheed, Consultant Psychiatrist, on The Neurobiology of Depression. For further information visit www.bhampsych.com
This is a presentation done on 4/6/11 for the Grand Rounds at Wayne State university by Pallav Pareek M.D.
This presentation talks about the concept of prdrome as it is(if?) applicable to schizophrenia, and if schizophrenia is becoming more of a preventable illness as science progresses. If so what are the various ways and means in which we can accomplish this prevention.
Amidst so much controversy on the issue , whether there is a prodrome for this illness or not, here I have tried to present the recent advances in this field and the recent scientific literature in this regard.
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
Hans Jürgen-Current situation and future perspetives of antipsychotics in sch...Fundación Ramón Areces
'Psiquiatría: situación actual y perspectivas de futuro'. Este es el título del simposio internacional que organizamos el 16 de junio de 2016 en la Fundación Ramón Areces con las fundaciones Juan José López-Ibor y Lilly en homenaje al doctor Juan José López-Ibor, fallecido en enero de 2015. Durante esta jornada, expertos internacionales abordaráon la profunda crisis que atraviesa la psiquiatría como disciplina científica y especialidad médica. Además, a las 19.00 horas, se presentará el libro con el mismo título del simposio, también en recuerdo del doctor López-Ibor.
Psychotherapy the biological dimensionismail sadek
is it real word can affect your brain?
many people say not and don't believe that the psychotherapy change not only our behavior but also it can change the brain structure
Cognitive changes have been a defining feature of Sz since onset. A lot of research has been done in understanding these changes and its implication in developing novel methods of treatments. This ppt summarises the cognitive changes occurring in the brain.
Neuropsychological rehabilitation focused on improving cognitive functions which further results in improving symptoms, functional ability which enhance overall quality of life.
The Neurobiology of Depression (Dr Imran Waheed)Imran Waheed
A lecture delivered in the West Midlands by Dr Imran Waheed, Consultant Psychiatrist, on The Neurobiology of Depression. For further information visit www.bhampsych.com
This is a presentation done on 4/6/11 for the Grand Rounds at Wayne State university by Pallav Pareek M.D.
This presentation talks about the concept of prdrome as it is(if?) applicable to schizophrenia, and if schizophrenia is becoming more of a preventable illness as science progresses. If so what are the various ways and means in which we can accomplish this prevention.
Amidst so much controversy on the issue , whether there is a prodrome for this illness or not, here I have tried to present the recent advances in this field and the recent scientific literature in this regard.
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
Hans Jürgen-Current situation and future perspetives of antipsychotics in sch...Fundación Ramón Areces
'Psiquiatría: situación actual y perspectivas de futuro'. Este es el título del simposio internacional que organizamos el 16 de junio de 2016 en la Fundación Ramón Areces con las fundaciones Juan José López-Ibor y Lilly en homenaje al doctor Juan José López-Ibor, fallecido en enero de 2015. Durante esta jornada, expertos internacionales abordaráon la profunda crisis que atraviesa la psiquiatría como disciplina científica y especialidad médica. Además, a las 19.00 horas, se presentará el libro con el mismo título del simposio, también en recuerdo del doctor López-Ibor.
Psychotherapy the biological dimensionismail sadek
is it real word can affect your brain?
many people say not and don't believe that the psychotherapy change not only our behavior but also it can change the brain structure
Brief description of various neuroimaging modalities used in psychiatry which help in early detection, diagnosis and treatment of various neuropsychiatric disorders.
In Feb 2022, Dr. Cassano presented this NYU-MGH study at LifeStance Health. The presentation covers in-vitro and pre-clinical data in support of the use of transcranial PBM for Alzheimer’s disease (AD). The most recent clinical data on PBM for AD were also reviewed. The NYU-MGH study was described: a large randomized, double-blind clinical trial (n=125) sponsored by NIH/NIA and by the Alzheimer’s Association.
A guideline for discontinuing antiepileptic drugs in seizure-free patients – ...Dr. Rafael Higashi
Aula apresentada por Dr. Rafael Higashi, médico neurologista sobre quando retirar droga antiepilética. A guideline for discontinuing antiepileptic drugs in seizure-free patients – Summary Statement
No association between prepulse inhibition of the startle reflex and neuropsyc...Benjamin Cortes
Abstract: Sensorimotor gating deficits are relevant in schizophrenia and can be measured using prepulse inhibition (PPI) of the startle reflex. It is conceivable that such deficits may hinder the cognitive functions in schizophrenia patients. In this study, using PPI and a neuropsychological battery, we studied this possibility in a group of 23 acute, neuroleptic-free schizophrenia patients and 16 controls. A non-significant decrease in PPI was found in the patients as compared to the controls, as well as significant differences in the performance of Trail A and B in Wisconsin
Card Sorting and Digit/Symbol Tests. No statistically significant correlations between PPI and neuropsychological performance were found after the correction for multiple comparisons in any group. Our results suggest that PPI deficits in schizophrenia patients may not contribute to the cognitive deficits typical of that illness, at least in patients with a non-significant PPI decrease.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Overview
• Aim
• Introduction
• History
• Functional Imaging Techniques
• Physics and principles
• Applications in Psychiatry
• Future trends
• Take home message
• References
2
3. Aim
• Familiarisation to functional Neuro-imaging modalities
• fMRI / MRS / DTI/ SPECT / PET
•Physics & Techniques
•Interpretation
• Relevance to psychiatry
• Current
• Future
3
4. Introduction
• Prospective method
• Structural & Functional correlates of
– Psychiatric disorders
– Psychopathology (Perception/ thought/
Behavior)
– Diagnosis / Prognosis / Taxonomy
– Where do I hit ??
– Do I cure? Can I?
– Organicity in Functional disorders
4
5. Classification of Neuro-imaging Techniques
X Ray Skull
radiography,
CT Scan
NMR MRI, fMRI,
MRS, DWI,
MRA
Emission PET ,
SPECT
5
Structural Plain skull
XRay,
PEG,
CT Scan,
MRI
Functional fMRI
MRS
SPECT
PET
DWI/DTI
6. Structural Neuro-Imaging- Background
Alzheimer’s
Dementia
MTL atrophy -marker - MCI
Whole-brain and hippocampal atrophy rates -
markers of progression of neurodegeneration
Schizophrenia •Total Brain Vol, GM loss > WM
•Increased ventricular size/ CSF Vol,
•30% lower reductions in antipsychotic-naïve
compared with the medicated patients
•Progressive volume decreases for frontal,
temporal, and parietal white matter
Depression Decrease in right hippocampal volume-
poorer treatment response
6
P. Fusar-Poli, A meta-analysis of longitudinal MRI studies, Neuroscience and Biobehavioral
Reviews (2013)
7. Structural Neuro-Imaging- Background
ADHD Reduced right globus pallidus and putamen volumes
as well as decreased bilateral caudate volumes
Adults - ADHD symptoms - (ACC) volume reduction
OCD Reduced GM volume - inferior and medial frontal
gyrus, cingulate gyrus, superior temporal gyrus, and
insula and caudate nucleus
PTSD Reduced Hippocampal (B/L), ACC and Left Amygdala
BPAD •Reduced volume- OFC, DLPFC, left precentral gyrus
Hippocampal GM & amygdala
•Increase –B/L amygdala, left hippocampus and
bilateral thalamus in lithium-treated
7
Carlos López-Jaramillo, Increased hippocampal, thalamus and amygdala volume in long-term
lithium-treated bipolar I disorder patients compared with unmedicated patients and healthy
subjects, Bipolar Disorders 2017
8. History of Neuro-imaging
8
MRI Handbook: MR Physics, Patient Positioning, and Protocols, M. Elmaoğlu, First Edn,
2012 Springer Science+Business Media
Wilhelm K Roentgen,
Discovery of X Ray, 1895
Nobel Prize, Physics, 1901
Godfrey Hounsfield,
CT Scanner, 1972
Nobel Prize, Medicine, 1979
9. History of Neuro-imaging
9
MRI Handbook: MR Physics, Patient Positioning, and Protocols, M. Elmaoğlu and A.
Çelik, Springer Science+Business Media, LLC 2012
Discovery of NMR,1946
Nobel Prize, Physics,
1952
Richard Ernst
Fourier
transformation,
1964
Nobel Prize,
Chemistry, 1991
Human MR images, 1970s
Nobel Prize, Medicine 2003
15. Basic Concepts/ Physics of MR
• NMR:
– MRI & MRS
• Spin of certain (odd) nuclei
can be detected after
magnetisation
– Species of nucleus
– Strength of Magnetic Field
• Detection of net
magnetisation
10
MRI Handbook: MR Physics, Patient Positioning, and Protocols, M. Elmaoğlu and A.
Çelik, Springer Science+Business Media, LLC 2012
16. 16
RF pulse
External Magnetic Fd
MRI Handbook: MR Physics, Patient Positioning, and Protocols, M. Elmaoğlu and A.
Çelik, Springer Science+Business Media, LLC 2012
20. MR Spectroscopy (MRS)
• Non invasive in-vivo
chemical assay
• Information in form of
a spectrum
• Biochemical
information
contained within a
selected voxel of
tissue
• Nuclei used in
psychiatric
research-
– 1H, 31 P
21
Ai-qin Lin, Metabolic changes in acute cerebral infarction: Findings from proton Magnetic
Resonance Spectroscopic imaging, Experimental And Therapeutic Medicine, 2013
21. 22
Baló's concentric sclerosis presenting as a stroke-like syndrome, Ellen M Mowry,
John H Woo and Beau M Ances, Nature Clinical Practice Neurology (2007) 3, 349-
354doi:10.1038/ncpneuro0522
22. Nuclei Uses in MRS
H¹ Amino acid neurotransmitters and neuronal
and glial compounds; imaging of water and
lipids
C¹³ Study of metabolic pathways
P³¹ High energy phosphate levels, intracellular
pH, phospholipid head groups
Li 7 Pharmacokinetics of lithium
O 15 Cerebral O2 consumption
F 19 Cerebral pharmacokinetics of fluorinated
drugs like fluoxetine and fluvoxamine
23
Maddock R, MR Spectroscopic Studies of the Brain in Psychiatric Disorders, Curr Topics
Behav Neurosci, Springer-Verlag Berlin Heidelberg 2012
23. H¹ 2 ppm – NAA Neuronal Health, viability and
mitochondrial function
3.2 ppm - Cho
peak
Reflect membrane turnover
In pathological process like
gliosis Cho peak -elevated
1.3 ppm –
Lactate
Cerebral Lactate is elevated in
ischemia, hypoxia or in tumors
3.5 ppm –
Inositol
metabolites
Intracellular msg transduction
Serves as glial cell marker and
indicator of neurotoxicity
24
Lin A, Metabolic changes in acute cerebral infarction: Findings from proton magnetic
resonance spectroscopic imaging, Experimental And Therapeutic Medicine, 2013
Maddock R, MR Spectroscopic Studies of the Brain in Psychiatric Disorders, Curr Topics
Behav Neurosci, Springer-Verlag Berlin Heidelberg 2012
24. Dementia NAA & MI Neuronal loss & Gliosis
MRS & Psychiatry
Mood
disorders
Li-7 & F-19 Pk & Brain conc of drugs
H-1 NAA Hippocampus (depressed/anxious)
Frontal (Bipolar)
H-1 choline Basal Ganglia
H-1 GLX Reversible GABA & glutamate/
glutamine level abnormalities
P-31 PME BPAD; dys-regulated signal
transduction and membrane
metabolism.
25
Maddock R, MR Spectroscopic Studies of the Brain in Psychiatric Disorders, Curr Topics
Behav Neurosci, Springer-Verlag Berlin Heidelberg 2012
25. NAA Cortical and limbic areas
MRS & Psychiatry- Schizophrenia
26
MRS finding Meaning PM correlate Other Evidence
NAA –
medication
naïve.
Impaired
neuronal
integrity
(structural)
neuronal
size and
dendritic
arborization
DTI – disturbed
integrity of
long fiber
pathways
metabolic
disturbances
Mitochondrial
dysfunction
PET
Glutamate
I Glutamine
Over activity of Glu transmission
Maddock R, MR Spectroscopic Studies of the Brain in Psychiatric Disorders, Curr Topics
Behav Neurosci, Springer-Verlag Berlin Heidelberg 2012
26. MRS & Psychiatry
ADS H-1 NAA Alcohol related neuro-toxicity
H-1 choline
H-1 GABA N- acute withdrawal
- Recovery/ Abstinence
27
Maddock R, MR Spectroscopic Studies of the Brain in Psychiatric Disorders, Curr Topics
Behav Neurosci, Springer-Verlag Berlin Heidelberg 2012
27. Current Trends MRS
• Correlation of metabolites (Glx) with symptoms and
role of intervention
– Elevated Glx in certain brain areas in Schizophrenia
– H1 MRS
– Anti-psychotic treatment lowers Glx
– Corresponds with symptoms reduction in some of
the studies
• BPRS
• PANSS SANS
28
Egerton A, Effects of Antipsychotic Administration on Brain Glutamate in Schizophrenia
A Systematic Review of Longitudinal 1H-MRS Studies. Front. Psychiatry, (May 2017)
29. Functional MRI (fMRI)
• Principle: differential magnetic
susceptibilities of O2-Hb and
deoxygenated Hb
• Differential r CBF & r CMR
• DeOxy-Hb is para-magnetic
• Oxy Hb is diamagnetic
• Lower the de-oxy Hb better
the signal from the adjacent
tissue. i.e images are BOLD
• Detect tissue perfusion not the
neuronal metabolism
30
Clinical Applications of Functional MRI, Neuroimaging Clinics of North America, Nov 2014
30. Mechanism of BOLD fMRI
Brain activity
Oxygen consumption Cerebral blood flow
Oxyhemoglobin
Deoxyhemoglobin
Magnetic susceptibility
T2*
MR signal intensity
31
Clinical Applications of Functional MRI, Neuroimaging Clinics of North America, Nov 2014
31. Functional MRI (fMRI)
32
Silvia Francesca Storti, Automatic selection of resting-state networks with functional
magnetic resonance imaging , Front. Neurosci., 20 May 2013
33. fMRI
• Indications
• Role in seizure localisation
• Study of neurodevelopmental disorders
• Post-stroke recovery
• Limitations
– Vascular pathology reducing regional blood
flow will impede signal acquisition by BOLD
imaging
– Psychotropic drugs
• BZD agonist , antipsychotics – reduce CBF
34
Clinical Applications of Functional MRI, Neuroimaging Clinics of North America, Nov 2014
34. fMRI & Psychiatry
35
Gur et al , FMRI in schizophrenia , Dialogues in Clinical Neuroscience - Vol 12 . 2010
35. fMRI & Psychiatry
36
Iwabuchia SJ, Localized connectivity in depression: A meta-analysis of resting state
functional imaging studies , Neuroscience and Biobehavioral Reviews 51 (2015)
36. fMRI & Psychiatry
37
Dementia Schizophrenia Mood Disorders
Serial fMRI-
differential rate of
volume changes
Alterations in
fn connectivity
LTC
LCSPTC
Reduced activation
of MTL
Activation of
PFC
rCBF & rCMR
in OFC & VLPFC
No diagnostic
criteria
rCBF & rCMR
in DLPFC
ReHo in MPFC
Iwabuchia SJ, Localized connectivity in depression: A meta-analysis of resting state
functional imaging studies, Neuroscience and Biobehavioral Reviews 51 (2015) 77–86
37. fMRI in Substance Abuse
• GM volume reduction in ADS - frontal and temporal
lobes
• Heavy drinking is associated with greater volume
loss
• Abstinent demonstrated greater tissue gain than LD
or relapse.
• Recovery in GM > WM.
38
Valerie A. Cardenas, Deformation-based morphometry of brain changes in alcohol
dependence and abstinence, NeuroImage 34 (2007) 879–887
38. fMRI in Substance Abuse- Stimulant
– Compromised white matter integrity
– leading to functional impairments in decision
making.
39
Karen D Ersche, Meta-analysis of structural brain abnormalities associated with stimulant
drug dependence and neuroimaging of addiction vulnerability and resilience, Current
Opinion in Neurobiology 2013,
39. fMRI Impact
40
Cognitive
neuroscience
Affect/ emotion
Reward pathways- neuro-economics
Memory
Default mode network
Plasticity and brain development
Legal Minimum age for capital punishment
Lie detector
Neuro-imaging before capital punishment
Social: Parity
Insurance
Social cognition & meta-cognition (MFC)
Therapeutic Reversibility of rCBF changes in depression
Compliance
Efficacy of treatments like DBS
41. Diffusion MRI
• Principle: diffusion of
water molecules provides
contrast
• Information about the
integrity and orientation
of white matter tracts in
the brain.
• Assessing the tract
disruption in disease
states
42
Mori S, Principles of Diffusion Tensor Imaging and Its Applications to Basic Neuroscience
Research, Neuron, Volume 51, Issue 5, 7 September 2006
42. Diffusion MRI
• Clinical utility:
• Early identification
of ischemic stroke
• Differentiation of
acute from chronic
stroke
• Assessment of the
extent of diffuse
axonal injury
• Assessment of
active demyelination
43
Mori S, Principles of Diffusion Tensor Imaging and Its Applications to Basic Neuroscience
Research, Neuron, Volume 51, Issue 5, 7 September 2006
43. • Diffusion Tensor
Imaging (DTI)
–Type of DWI
–several sets of
diffusion weighted
images are acquired
with the diffusion
gradients applied in
different directions.
–Enables the
detection of diffusion
anisotropy in various
mediums such as brain
white matter.
44
Mori S, Principles of Diffusion Tensor Imaging and Its Applications to Basic Neuroscience
Research, Neuron, Volume 51, Issue 5, 7 September 2006
Han-Cheng Wang , Diffusion Tensor Imaging of Vascular Parkinsonism, Arch neurol/vol 69
44. 45
Shizukuishu T, Diffusion Tensor Imaging Analysis for Psychiatric Disorders; Systematic Review,
Magn Reson Med Sci, Vol 12, 2013
47. Radio tracer Imaging
• Radio – unstable atom that decay
• Tracer – administered in trace amounts
• Typical tracer methods
– PET
– SPECT
• PET – positron emitter – collides with electron - two
photons released
• SPECT – decays – single high energy photon
48
48. Radio tracer Imaging (Contd.)
• Process of interest –
– incorporate radionuclide
in to a molecule of
known
physiological significance.
• RADIOTRACER
– Inhalation
– Ingestion
– Intravenous
• Tracer uptake measured
over time PET
49
53. Mood Disorders
• PET
– Hypofrontality on frontal lobe in MDD but reversal
occurs in Mania.
– Less 5HT Tpt (SERT) availability in MDD
– More 5HT 1A predict poor response.
– High DAT availability in Rt caudate in MDD
– Increased ACC and OFC activity - positive response
to treatment
– Activation in the right amygdala, striatum and
insula -poor response
54
Cynthia H.Y. Fu, Predictive neural biomarkers of clinical response in depression:
A meta-analysis of functional and structural neuroimaging studies of pharmacological and
psychological therapies, Neurobiology of Disease 52 (2013) 75–83
54. PET in Depression
56
Cynthia H.Y. Fu, Predictive neural biomarkers of clinical response in depression: A
meta-analysis of functional and structural neuroimaging studies of pharmacological
and psychological therapies, Neurobiology of Disease 52 (2013) 75–83
55. Substance Abuse
• PET & SPECT-
– Deficit DA in mesolimbic system
– Low 5HT in Type B & reverse in Type A
– GABA receptor levels are low in frontal, temporal
and parietal cortices in dependent cases.
– HMPAO SPECT – poor rCBF in WKS
– In Cocaine dependent -hypodopaminergic state &
high DAT levels.
57
Kaplan and Saddock’s Comprehensive Textbook of psychiatry, 9th edn, 2009 LWW
56. Future Directions
• Simultaneous PET/MRI
– Biomarkers for
psychiatric disorders
• DTI
– Tracts for identification
of various pathologies.
• Genetic-Imaging studies-
predicting vulnerabilities
• The future of fMRI lies in
understanding the
pathophysiology, diagnosis
and prognosis of Psychiatric
disorders (Thomas Insel) 58
58. Take Home Message
60
• Neuro-imaging provides a valuable and reliable tool in
delineating organicity
• Functional neuro-imaging can demonstrate subtle
physiological changes before the actual structural
changes become evident
• Concept of organic and functional disorders
• Physiological correlates of Psychiatric disorders have
been shown
• ? Causal / Vulnerability
• Cost and availability- restrict their use as universal
diagnostic biomarkers
59. References
• Kaplan and Saddock’s Comprehensive Textbook of
psychiatry, 9th edn, 2009 LWW.
• New Oxford Textbook of Psychiatry, 2nd edn, 2012, OUP
• Kaplan and Sadock's Synopsis of Psychiatry 11th
Edition, 2014, LWW
• Neuroradiology- The Prerequisites – 3rd edn, Grossman,
2010
• Clinical Applications of Functional MRI, Neuroimaging
Clinics of North America, Nov 2014
61