Neuroimaging Psychiatry

1. NEUROIMAGING IN
PSYCHIATRY
CHAIRPERSON : DR.K.NARASIMHA
REDDI
( PROF & HOD)
PRESENTER : DR.B.NITYA
AISWARYA
(1ST YEAR PG)

2. SCHEME OF PRESENTATION
• INTRODUCTION
• BRAIN NEUROIMAGINGMODALITIES
• CLINICALNEUROIMAGING INPSYCHIATRY
• PSYCHOTROPICDRUGS& fMRI
• CONCLUSION
• REFERENCES

3. INTRODUCTI
ON
• Neuroimaging methodologies allow
measurement of the structure, function, and
chemistry ofthe human brain.
• Over the past decade, studies using these
methods have provided new information about
the pathophysiology of psychiatric disorders
that may prove to be useful for diagnosing
illness and for developing new treatments.
• In addition to structural neuroimaging with CT
and MRI, arevolution in functional
neuroimaging has enabled clinical scientists to
obtain unprecedented insights into the diseased
human brain.

4. • Primary observation of structural and
functional brain imaging inneuropsychiatric
disorders such asdementia, movement
disorders, demyelinating disorders, and
epilepsy has contributed to a greater
understanding of the pathophysiology of
neurological and psychiatric illnesses and
helps practicing clinicians in difficult
diagnostic situations

5. NEUROIMAGING TECHNIQUES
• Plain Skull
Radiography
• Pneumo-
encephalography
• CT–Scan
• Structural MRI
STRUCTURAL FUNCTIONAL
• MRS
• Functional MRI (fMRI)
• PET
• Single photon
emission computed
tomography (SPECT)
• Brain electrical activity
mapping (BEAM).
• Evoked potential

6. CT SCAN

7. • Revolutionized diagnostic neuroradiologyby
permitting imaging of the brain tissue in live
patients.
• The first CTScanner was developedin 1972
by Godfrey Housenfield of UK.
• The amount of radiation that passes
through, or is not absorbed from, each angle
is digitized and entered intoacomputer.

8. • The computer uses matrix algebra
calculations to assign aspecific density to
each point within the head and displaysthese
data asa set of two-dimensional images.
When viewed in sequence, the images allow
mental reconstruction of the shape of the
brain.
• Allan Cormark developedthe matrix alzebra
which is used toreconstruct the CTimage.
• The invention of CTScanner earned
Housenfield & Allan Cormark the Noble Prize
forMedicine in 1979.

9. Allan Cormark GodfreyHousenfield

11. • CTimages determined only by degree to
which tissues absorbX-ray
• Bone, clotted blood, calcified tissue,
contrast material appear white & CSFblack.
• The only component of brain better seen on
CTscan is Calcification, which may be
invisible onMRI.
• Plain:- Diagnostic accuracy82%
• Contrast:- IV iodinated contrastmedium,
Diagnostic accuracy92%

12. CRITERIA FOR CONTRAST
Patients with H/O seizure
Patients with H/O cerebro-vascular accident
Suspicion of intracranial space occupyinglesions
including granulomas, CNStumours, metastatic
lesions

13. INDICATIONS FORCT-SCAN
• Delirium.
• Dementias of unknowncause.
• First episode of psychosis.
• First episode of major affective disorder
after 50 years ofage.
• Personality changes after 50 years of age.
• Psychiatric symptoms followinghead injury.
• Prolonged catatonia

14. • Torule out complications due to possible
head trauma
• Coexistence ofseizure in psychiatric
symptoms
• Movement disorders of unknown etiology
• Focal neurological signsaccompanying
psychiatric symptoms

15. ADVANTAGES
• Simpler, cheaper, moreaccessible.
• Tolerated by claustrophobics.
• No absolutecontraindications.
• Fewer pitfalls ininterpretation.
• Better than MRfor bone detail.

16. DISADVANTAGES
• The bony structures absorb high amounts of
irradiation and tend to obscure details of
neighboùring structures, an especially
troublesome problem in the brainstem, which
is surrounded by a thick skull base.
• There is relatively little difference in the
attenuation between gray matter and white
matter in X-rayimages.

17. • Details of the gyral pattern may be difficult
to appreciate in CTscans.
• Certain tumors may be invisible on CT
because they absorb asmuch irradiation as
the surrounding normalbrain.
• Appreciation of tumors and areas of
inflammation, which can cause changes in
behavior, can be increased by intravenous
infusion ofiodine-containing contrast agents

18. • Iodinated compounds, which absorb much
more irradiation than the brain, appear
white
• Blood-brain barrier normally prevents the
passage of the highly charged contrast
agents. The blood-brain barrier, however,
breaks down in the presence of
inflammation or fails to form within tumors
and thus allows accumulation of contrast
agents, these sites then appear white than
the surroundingbrain

19. CT SHOWING B/L CHOROIDAL
PLEXUS
CALCIFICATION

20. MRI

21. PRINCIPLE OF MRI
• MRI scanning entered clinical practice in 1982 ,
it is based on the principle of nuclear magnetic
resonance (NMR).
• In 1946, Edward Purcell (1912–1997)and Felix
Bloch (1905–1983) independently
demonstrated NMR at Harvard and Stanford
Universities, and for this discovery they shared
the 1952NobelPrize in Physics.
• This states that the nuclei of all atoms are
thought to spin about an axis, which is
randomly oriented inspace.

22. • When atoms are placed in amagnetic field,
the axes of all odd-numbered nuclei align
with the magneticfield.
• The axis of anucleus deviates away from the
magnetic field when exposed to a pulse of
radiofrequency electromagnetic radiation
oriented at 90 or 180degrees to the
magnetic field.
• When the pulse terminates, the axis of the
spinning nucleus realigns itself with the
magnetic field, and during this realignment,
it emits its own radiofrequency signal.

23. • MRI scanners collect the emissions of
individual, realigning nuclei and use
computer analysis to generate a series of
two-dimensional images that represent the
brain
• By far the most abundant odd-numbered
nucleus in the brain belongs to hydrogen.
The rate of realignment of the hydrogen axis
is determined by its immediate environment.
• Hydrogen nuclei within fat realign rapidly,
and hydrogen nuclei within water realign
slowly. Hydrogen nuclei in proteins and
carbohydrates realign at intermediate rates.

24. • The two parameters that are varied are the
duration of the radiofrequency excitation
pulse and the length of the time that data
are collected from the realigning nuclei.
• T1pulses are brief and data collection is
brief, hydrogen nuclei in hydrophobic
environments are emphasized.Thus,fat is
bright on T1,and CSFisdark.
• The T1image most closely resembles thatof
CTscans and Is most useful for assessing
overall brainstructure.

25. • T1is also the only sequence that allows
contrast enhancement with the contrast
agent gadolinium diethylene triamine penta
acetic acid (gadolinium- DTPA).
• Gadolinium remains excluded from the brain
by the blood-brain barrier, except in areas
where this barrier breaks down, such as
inflammation or tumor.
• On T1images, gadolinium-enhanced
structures appearwhite.

26. • T2pulses last fourtimes aslong asT1pulses,
and the collection times are also extended,
to emphasize the signal from hydrogen
nuclei surrounded by water. Thus, brain
tissue is dark, and CSFis white onT2images.
• Areas within the brain tissue that have
abnormally high water content, such as
tumors, inflammation, or strokes, appear
brighter on T2images.
• T2images reveal brain pathologymost
clearly.

27. • The third routine pulse sequence is the
proton density, or balanced sequence. In
this sequence,a short radio pulse is followed
by aprolonged period of data collection,
which equalizes the density of the CSFand
the brain.
• This allows for the distinction of tissue
changes immediately next to the ventricles.
• An additional technique, sometimes usedin
clinical practice for specific indications, is
fluid-attenuated inversion recovery(FLAIR).

28. • In this method, the T1image is inverted and added
to the T2image to double the contrast between
gray matter and white matter.
• Inversion recovery imagingis useful for detecting
sclerosis of the hippocampus in temporal lobe
epilepsy and for localizing areas of abnormal
metabolism in degenerative neurological
disorders.
• MRI scans cannot be used for patients with
pacemakersor implants of ferromagnetic metals.
• Asignificant number of patients cannot tolerate
the claustrophobic conditions of routine MRI
scanners and may need an open MRI scanner,
which hasless power and thus produces imagesof
lower resolution.

29. NORMAL HUMAN BRAIN ON
MRI

30. TI WEIGHTED T2 WEIGHTED
CSF, cortical bone, air &
rapidly flowing blood have
negligible signals
appear dark
CSF has bright signal
intensity &relative to a dark
signal from grey &white
matter
Fat &bone marrow have
high signal intensity
appear white
Useful in evaluation of
cerebropontine angle,
cistern &pituitary fossa
Useful in demyelination,
edema &tumor infiltration,
to reveal brain pathology
more clearly.

31. T1
WEIGHTED
T2
WEIGHTED

32. INDICATIONS
• Torule out organic causeof psychiatric
illness
• Abruptchange in mental state
• New onset memoryloss
• New onsetdementia

33. • ADVANTAGES
• Does not expose
the patient to
ionizing radiations
• Generates imagesin
three planes
• Demyelinating
disease can be
assessedreliably
• Tostudy posterior
fossa structures
• DISADVANTAGES
• Avoided inpatients
wearing metallic
devices
• Claustrophobia
• Does not pick up
bony abnormalities
• Difficult in
uncooperative
patients

34. MAGNETIC RESONANCE
SPECTROSCOPY (MRS)
• Basic principle is similar to MRI , exceptMRS
can detect several odd-numbered nuclei ,
permits study of many metabolic processes.
• Nuclei align themselvesin the strong magnetic
field
• Aradiofrequency pulse causesthe nuclei of
interest to absorb & then emit energy
• The readout of an MRS device is usually in the
form of a spectrum, can also be converted into
a pictorial image ofthe brain.

35. NUCLEI USES
H1 Decreased aspartate (NAA) in dementia &
other neural loss
Li7 Pharmacokinetics ofLithium
C¹³ Study of metabolic pathway
F 19 • Pharmacokinetics of certaindrugs
like SSRIs (Fluoxetine, Fluoxamine)
• Analysis of glucose metabolism
P³¹ Tissue metabolism (compound
containing high energy phosphates like
ATP, ADP etc.)

36. FUNCTIONAL MRI(fMRI)
• ASubtype ofMRI scanner
• Usesthe new T2or the blood –oxygen level
dependent ( BOLD) sequence Detects
levels of oxygenated Hb in the blood
Maps brainfunction.
• Neuronal activity within the brain causesa
local increase in blood flow , which in turn
increases the local hemoglobin
concentration.

37. • Although neuronal metabolism extracts more
oxygen in active areas of the brain, the net
effect of neuronal activity is to increase the
local amount of oxygenated hemoglobin.
• This change can be detected essentially in real
time with the T2sequence, which thus detects
the functionally active brainregions.
• What f MRI detects is not brain activity per se,
but blood flow. The volume of brain in which
blood flow increases exceeds the volume of
activated neurons by about 1to 2cm and limits
the resolution of the technique.

38. • Thus, two tasks that activate clusters of
neurons 5 mm apart,such asrecognizing two
different faces, yield overlapping signals on
fMRI
• Functional MRI is useful to localize neuronal
activity to a particular lobe or subcortical
nucleus and has even been able to localize
activity to a singlegyrus.
• The method detects tissue perfusion, not
neuronal metabolism. In contrast, PET
scanning may give informationspecifically
about neuronalmetabolism.

39. • No radioactive isotopes are administered in
fMRI, advantage overPETand SPECT
.
• Different nuclei are available for in vivo for
MRSand have varying potential clinical
uses.

40. • ADVANTAGE
• Non invasive andno
radiation
• High spatial
resolution
• Detects changesin
cerebral regional
blood flow
• Widely available
hardware
• DISADVANTAGE
• Poor temporal
resolution
• Analysis is complex
and time consuming
• Very sensitiveto
artifacts
• Many
contraindications

41. POSITRON EMISSION
TOMOGRAPHY (PET)

42. • Aradioactive isotope is injected & decays,
emitting aβ +particle.
• Within a short distance, the β +particle bumps
into an electron & the two annihilate,
producing apair of g -rays.
• By detecting & reconstructing where the g –
rays. we can measure the location & conc of
radio-isotope.
• Most Commonly UsedIsotopes
• F18
• N13
• O15

43. APPLICATIONS
• Toestimate regional cerebral bloodflow
• Toestimate regional cerebral glucose
metabolism (regional cerebralmetabolic
rate forglucose -rCMRglu)
• For receptor imaging.
• Tostudy normal braindevelopment.

44. CEREBRAL BLOOD FLOW
• This parallels the regional blood glucose
consumption in the brain & changes with
activation ofthe cortical neurons
• rCBFis about 70 ml/100g/min in grey matter
& 20 ml/100g/min in white matter
• O15 & N13are usedto measure cerebral
blood flow.

45. REGIONAL CEREBRAL
METABOLIC RATE
• The normal resting value is from 20–60
micromol/100 g/min in grey matter & from 10-
20 micromol/100 g/min in whitematter
• Fluorodeoxyglucose(F18DG)is used to
measure cerebral glucosemetabolism
• Used for refractory epilepsy to localize precise
area of resection
• Depression (decreased glucosemetabolism)

46. RECEPTOR IMAGING
• Study DA, serotonin, BZDreceptors
• D2receptors can be studied byusing C1
1,F18.
These receptors are known targets for
antipsychotic drugs.
• D1receptors can be imaged using C1
1&Br76
• Decreased D1receptor binding in the
prefrontal cortex ascompared to control
correlates with negative symptoms in
schizophrenia.

47. SPECT

48. INTRODUCTION
• Study DA, serotonin, BZDreceptors
• D2receptors can be studied by using C1
1,
F18.Thesereceptors are known targets for
antipsychotic drugs.
• D1receptors can be imaged using C1
1&Br76
• Decreased D1receptor binding in the
prefrontal cortex ascompared to control
correlates with negative symptoms in
schizophrenia.

49. Gammarays emitted detected by scanner
Translated into 2-Dimage
Theseimages addedtogether to get a3-D
image

51. USES
• Regional cerebral bloodflow
• T
c99 is most commonly used for deeper
structures of brain
• Xe133for superficial structures of brain
(rCBFTechnique)
• Muscarinic cholinergic system
• I 123

52. • Dopaminergic system
• Radiolabelled receptor binding agents I 123,
IBZM (Iodobenzamide) forD2receptors.
• Adrenergic system
• Early diagnosis ofAlzheimer's disease

53. SPECT PET
Singlephoton Positron
99mTcor I 123 1
1
Cor18F
Short halflife Longer halflife
Lesssensitive Highly sensitive (100times
more thanSPECT)
Canbuy isotopes Localcyclotron
Goodfor study of drugaction Goodfor study ofdrug
delivery
Low spatialresolution Superior sampling ratesand
special resolution
Cheaper and easilyavailable
than PET
Costlynot easilyavailabe

54. Diffusion tensor imaging(DTI)
• DTI provides a method for estimating the
paths followed by water asit diffuses within
the white matter
• This allows the identification of white matter
tracts in the brain with respect to location
and orientation.
• Afurther advance of DTI is its ability to
noninvasively construct 3Dtrajectoriesof
neural tracts in-vivo.

55. • It is possible to reconstruct the brain’s
underlying neuronal microstructure thatis
normally invisible using conventionalMRI.
• At this point in time the ability of DTI to
characterise the white matterarchitecture
of the brain is unparalleled by any other
imaging modality

56. • Tractographic
Reconstruction of
neural connections
via DTI

57. • ADVANTAGES
• High spatial resolution
• Non-invasive
• Able to identify white matter fibers
• DISADVANTAGE
• Difficult to perform group comparisons
(tractography)

58. VOLEX BASED MORPHOMETRY
(VBM)
• VBM is aMRI-based computational andtime
intensive technique
• It can provide detailed information relating
to changes in grey-white matter
composition within thebrain.
• The technique is based on a series of
computational steps that correct the MR
images for large-scale differences in gross
anatomy prior tostatistical evaluation.

59. • Steps-
–Spatial normalisation
–Segmentation of tissueclasses
–Smoothening of images
• Limitations
• Needslarge sample size,difficult to apply to
individuals.
• Assumes brain is composed solely of white
matter, grey matter and CSFhence analysis
difficult in group with pathologies like tumor
and stroke.

60. Implications of neuroimagingin
psychiatry

61. NEUROIMAGING IN OCD
• MRI INOCD
• Larger anterior cingulate volumes (ACV)
a/w increased OCDsymptoms severitybut
not duration of illness
• ACVinversely correlated withstriatal
volumes in OCDpatients
• Pituitary Volume Abnormality is noted.
• Decreased total cerebral white matter
volume & significantly greater cerebral
cortical volume isreported.

62. • Left orbito frontal cortical volume is smaller.
• Corpuscallosum abnormality in length is
noted .
• MRSIN OCD
• Greater caudate Glutamatergic conc.,is
noted when measured by ¹H-MRSin
comparison to controls.
• MRSwas used to measure NAA
concentrations in the anterior cingulate,the
left basal ganglia & the left prefrontal lobe
of thesubjects.
• Significantly lower NAAconcentrationsin
responders to SSRI+AAPin anterior
cingulate gyrus.

63. • SPECTIN OCD:
• Reducedserotonergic input into the fronto-
subcortical circuits
• Reduced midbrain-ponsserotonin
transporter binding
• Right basal ganglionhypoperfusion
• PETIN OCD:
• 5HTavailability was significantly reducedin
the thalamus &midbrain

64. META-ANALYSIS OF PET&
SPECT IN OCD
• Differences in radio-tracer uptake
consistently in the orbital gyrus & the head
of thecaudate nucleus
• Head of thecaudate
• PET: Greater activity
• SPECT: Decreasedactivity

65. IMAGING IN MOOD DISORDERS
• MRI
• reduced hippocampal volume in individuals
suffering from MDD.
• pediatric patients with familial depression also have
reduced hippocampal volumes, suggesting risk
factor for developing MDD.
• reductions of 39 and 48 %in the mean gray matter
volume in the prefrontal cortex ventral to the genu
of the corpus callosum in both familial bipolar
depressives and familial unipolar depressives.

66. • fMRI
• DLPFC--->reduction in CBFandmetabolism
associated with depression.
• Unipolar depressed and bipolar depressed
subjects both manifest abnormal increases
of metabolism and CBFin the left
mediodorsal nucleus of thalamus .
• Decreased striatal response to happy stimuli
during episodes of depression and increased
striatal activity in a manicstate.

67. • MRS
• NAAlevels may be reduced in the frontal
lobe of bipolar patients
• NAAmay be reduced in the hippocampus of
depressed and anxiouspatients.
• elevated choline levels in the basalganglia
of mood disorder subjects compared to
those ofhealthy comparisons.
• markedly abnormal concentrations ofGABA
and glutamate in several brain regions.

68. • SPECT:
• Baseline cerebral blood flow (CBF) was
lower in depressed patients – in frontal
cortex &subcortical nuclei bilaterally.
• In response to Medication there is
normalization of CBFdeficit.
• SERT(Serotonin Transporter) availability in
the midbrain area is reduced in depression.

69. PET
• Reduced5-HTTin depressedpatient in the
vicinity of the pontine raphe nuclei.
• Depression severity correlated negatively
with 5-HTTin the thalamus in MDD subjects.
• Depressedphases of MDD& BPADboth
asso.with elevated 5-HTTbinding in the
insula, thalamus & striatum, but showed
distinct abnormalities in thebrainstem.

71. • MRI inAD
• increased number of subcortical
hyperintensities, generalizedatrophy(medial
temporal lobe) and ventricular enlargement
• Significant volume lossof up to 5 %brain
volume peryear
• MRS inAD
• Decreased concentration of NAAin the
temporal lobes & increased concentration of
inositol in the occipitallobes

72. SPECT IN AD

73. PET IN AD
PETof glucose
Metabolism in
normal vs.
Alzheimer’s
disease.
In AD shows
hypometabolis
m

75. FUNCTIONAL MRI IN DEMENTIA
• fMRI studies have consistently
demonstrated that patients with Alzheimer's
disease have decreased fMRI activation in
the hippocampus and related structures
within the medial temporal lobe during the
encoding of new memories compared to
cognitively intact oldersubjects.

76. IMAGING IN ANXIETY
DISORDERS
• MRI:
• Smaller hippocampal volume was attributed to
the neuro-toxic effects of elevated levels of
cortisol & excitatory amino acids
• Smaller left hippocampal volume reported in
adult women with childhood sexual abuse & in
women with PTSDsecondary to childhood
sexual abuse
• PanicDisorders
• Smaller temporal lobe
• Hippocampus : normal

77. • MRS:
• In panic d i s o r d e r s  used to record
the l
e
v
e
l
sof lactate, whose IV infusion can
precipitate panic episodes in 3/4th of the
pts with either Panic disorder or Major
Depression.
• Brain lactate concentrate, were found to
be elevated during panic attacks, even
without provocative infusion

78. IMAGING IN SCHIZOPHRENIA

79. • CT IN SCHIZ
• Enlarged ventricle
• progressive cortical gray and whitematter
volume loss in anumber of cortical regions
• MRS IN SCHIZ
• reductions in NAAlevels in many cortical and
limbic brain regions in schizophrenic
individuals .
• normal or low levels of glutamate and
increased levels of glutamine in medication-
free patients withschizophrenia.

80. • fMRI of Schizophrenia
• fMRI has emerged asthe primary approach
for probing disturbances in the activity of
particular brain regions and specified circuits
associated with the risk for developing
schizophrenia, the symptoms and cognitive
impairments associated with schizophrenia,
and the impact of antipsychotic treatments.
• Patients exhibited reduced prefrontal
cortex activation when performing tasks
that put demands on working memory.

81. IMAGING IN ADHD
• f MRI
• Hypoactivation in frontal
regions and
frontostriatal networks
• DTI
• White matter
abnormalitiesespecially
in frontostriatal &
frontocerebellar
circuitary.

82. IMAGING IN ALCOHOL
DEPENDENCE
• MRI studies have been the principal tool to
describe in vivo the many sources of
neurotoxicity associated with alcoholism
including
• (1) the direct neurotoxic and gliotoxic effects of
ethanol.
• (2) the neurotoxic effects of poor nutrition that
often accompany the abuse of alcohol.
• (3) the excitotoxicity associated with the ethanol
withdrawal state.
• (4) the possible disruption in adult-neurogenesis-
associated ethanol intoxication and withdrawal.

83. • Toxicity is reflected as loss of both gray and
white matter, and these losses appear to be
related to cognitive impairments.
• DTIstudies provide evidence of disturbance
in the integrity of white matter tracks
associated with alcoholism.
• The volumetric changes are particularly
severe in patients withWernicke–Korsakoff
syndrome, arising from nutritional
deficiency.

84. • Functional MRI
• Studies suggest that recovering alcohol-
dependent patients show abnormal activation
patterns in frontal cortex, thalamus, striatum,
cerebellum, and hippocampus related to
impairments in attention, learning and memory,
motor coordination, and inhibitory control of
behavior.
• Individuals show increased limbic and
orbitofrontal cortex activation when exposed
to alcohol-related cues that elicit alcohol
craving.

85. • Studies are now attempting to utilize these
craving-related changes in fMRI for testing
putative pharmacotherapies foralcoholism.
• 1H MRS
• studies of GABAhaveprovided insights into
alterations in cortical inhibitory
neurotransmissions associated with the
recovery from alcoholdependence.

86. sMRI-AUTISM
• Focal hypoplasia of the superior vermian
lobules has beenreported.
• In cerebrum, volume loss of the parietal lobe
cortex, white matter, as well as the posterior
corpus callosum has beenreported.
• The brain stem and cerebellar vermiswere
significantly smaller in autistics than in
controls.
• PET-increasein diffuse corticalmetabolism

87. Other substanceabuses
• Cocainedependence:
• Pet scansof brains of patients being treated for
cocaine addiction show high activation of the
mesolimbic da system when addict Profoundly
crave adrug
• Patients describefeelingsof intense craving for
the drug while petscan showed activation in
area from the amygdala and anteriorcingulate
to the tip of both temporal lobes.

88. • Opioid dependence:
• Few studies using pet have suggested that one
effect of all opioids is decreased blood flow in
selected regions of brain in persons with opioid
dependence.

89. Psychotropic drugs&fMRI
• CBFand metabolism canbe reduced by acute
& chronic administration of BZDand
antipsychotic drugs.
• fMRI studies conversely be designed to
investigate neuropsychological effectsof
psychotropic treatments.
• By imaging before & during treatment, the
effects of psychotropic drugs on basal
perfusion or hemodynamic response to
sensory & cognitive events be characterized

90. CONCLUSION
• Neuroimaging can be structural / functional
• Functional imaging more useful than structural in
psychiatry.
• Neuroimaging in psychiatry is presently used
mainly to rule out neurological causes, and in
evaluation of dementia.
• Sensitivity & specificity of imagingin psychiatry is
not much.
• Still various studies and their findings and newer
developments holds apromising future for
neuroimaging in psychiatric diagnosis &
managements

91. REFERENCES
• Kaplan & Sadock’sComprehensive Textbook
0f Psychiatry 10th edition
• Kaplan & Sadock’sSynopsis 0f Psychiatry
13th edition

92. THANK YOU……