CorePsychBlog

SPECT Functional Brain Imaging Is Not 'Mind Reading'

Image via WikipediaLet's Take the Woo Woo out of New Brain Science Discoveries
If you are interested in the science of brain imaging on any level you will be interested in just taking a moment over at CBS 60 Minutes from this past Sunday night.

In an interesting report on functional brain imaging Lesley Stahl graphically demonstrates [excellent video footage] some of the exciting progress with the actual brain 'pictures of thinking' - thinking about specific items: hammer, screwdriver etc. Dr Just at Carnegie Mellon is one of the interviewees - in this short report they put a 60 Minutes producer in the fMRI machine, took pictures of her brain activity, then demonstrated exactly what she was thinking whilst in the machine. Good Stuff!

With fMRI and SPECT the essential key word here is "functional" brain imaging - this MRI photo >> is simply an example of a static MRI picture, not functioning, not actually thinking in process, just anatomic structure. The 'brain action' is in the 'function.'

We have been talking about SPECT imaging here since we started, and posted on this controversy with SPECT imaging with Carlat and Amen in May '08. SPECT can be used very effectively in the context of good psychiatric practice.

In the comments that follow on the CBS site one can easily see how the 'Mind Reading' spin clearly terrified some folks, as the researchers indicated that we would soon have beams bouncing off our heads that would know our private thoughts. Not to worry, the benefit outweighs the risk - and the hype does a disservice to the message.

And if you are interested in SPECT applications in mental health office practice: Do sign up for notification of SPECT Training here at CorePsychBlog.

Take a look at 60 Minutes to see what's going on, and don't fret the hype.

Gluten/Celiac, Migraine, & ADD/ADHD Connections 1

Migraine and ADD Clearly Connect with Brain Vascularity - Blood Flow
Image via Wikipedia
Blood Vessels Diminished in Function Contribute to Migraines and to ADD.
- One cause for all these problems, often over-looked, is gluten sensitivity. I have posted many notes here on this topic, but with the last post at CorePsychBlog added the migraine interest. Celiac Disease, 'CD' in some of these abstracts, is end stage gluten sensitivity.

When we do SPECT imaging at CorePsych we measure rCBF - regional cerebral blood flow, and there you can see the brain vascular problems often associated with migraines on the SPECT image.

These are some additional reference links you will appreciate on migraine, blood flow and gluten sensitivity:

1. Hadjivassiliou M, Gibson A, Davies-Jones GA, et al. Does cryptic gluten sensitivity play a part in neurological illness?. Lancet 1996;347:369–71.  "Our data suggest that gluten sensitivity is common in patients with neurological disease of unknown cause and may have aetiological [causal] significance."
2. Hadjivassiliou et al. Headache and CNS white matter abnormalities associated with gluten sensitivity Neurology 2001; 56: 385-388  "The authors describe 10 patients with gluten sensitivity and abnormal MRI. All experienced episodic headache, six had unsteadiness, and four had gait ataxia. MRI abnormalities varied from confluent areas of high signal throughout the white matter to foci of high signal scattered in both hemispheres. Symptomatic response to gluten-free diet was seen in nine patients."
3. This excellent link at Celiac.com has several references on migraines including one regarding migraines in children.
4. This link will take you to several articles at Celiac.com that address the ADD/Gluten connection.
5. Mirza M, et al Interictal SPECT with Tc-99m HMPAO studies in migraine patients, Acta Neurol Belg. 1998 Jun;98(2):190-4. "The SPECT images revealed clear interhemispheric asymmetry in the upper frontal and occipital parts of the brain in migraineurs. It is suggested that an impaired regional cerebral vascular autoregulation may exist even during headache-free intervals in patients suffering from migraine." [SPECT Imaging shows impaired vascular activity even when not having a migraine.]

I'll have some more soon - interesting how migraine and ADD can similarly impaired problems with cerebral blood flow

PsychoTherapy Networker & IITAP: From Isolation to Connections

Two Meetings, both with similar themes and with many innovative new directions:

International Institute for Trauma and Addiction Professionals in Scottsdale - hosted by recovery luminary and international  addiction expert Pat Carnes PhD,and  his remarkable team, and -

Psychotherapy Networker >3000 attendees at the Shoreham in DC - hosted by Rich Simon PhD, editor and hundreds of dedicated volunteers.... 

Both echoed a common theme: the evolution from isolation to connections and real relationships within the treatment community.

Also interesting from my personal perspective, having presented extensively at both of these [dare-I-say] awesome meetings: applied neuroscience has found firm footing with many refreshingly informed professionals.

Attendees know the brain lingo, know the neurophysiology, and easily connect with the compelling treatment implications this new evidence brings to the office/table. The audiences were there, and there in good humor, not overwhelmed. For me it was great fun.

In fact, watching quietly from my neuroscience perch, it seemed that the interest in that real scientific evidence provided a considerable aspect of that fertile, interesting, common-meeting-ground to consider ways to work together. - Kind of a trapper's rendezvous...

To bring yet another new and interesting person to your awareness, I suggest you closely follow the evolution of Sarah Ullman PhD, in Philadelphia, an addiction/recovery maven, with a comedian's heart and a scientist's perseverance. Sarah presented with Dr Carnes her findings on the specificity of sexual addiction patterns and brain response based upon specific sites of brain dysregulation with specific neurotransmitter implications.

Now if you think that last sentence is foggy, it is... because the specifics for her forthcoming publication on these remarkable matters is not complete - just important now to stay tuned to Sarah - and she has agreed to a CorePsychPodcast on the Neuroscience of Sexual Addiction just as soon as I get that recording material ready.

Check out CorePsych Books

CorePsych Books is now open at the websites, so if you receive this missive by FeedBlitz email, or get it with an RSS channel, please go over to the CorePsychBlog or CorePsychPodcast website and take a look at the freshly built Amazon CorePsych Books link there, or just click on the Books hyperlink at the first link in this post. I will be interested in what you think about it.

I put some notes on most of the books there, and invite you to make suggestions regarding books you have found helpful in your work with patients, or with your own recovery process. As I indicated over there, it's a work in progress, so please feel free to make your suggestions on or offline.

The great thing about Amazon is the ability to review the books online, - and remember they have used books for sale as well.

Thanks! Good reading-

Blood Supply and Brain Function: Insights from Cardiology

Brain science and brain function cannot be considered without thinking of vascularity, blood flow, and the nutrients and oxygen carried by that good blood flow. Impaired blood flow often results in a broad array of psych symptoms that can effect affect [feelings] and cognition [thinking].

The canary in the coal mine: The heart and the brain are two of the most sensitive organs regarding proper nutrition and oxygen transfer, and both should be considered simultaneously if we are looking at a comprehensive treatment plan. [We can see the signs of sleep apnea on brain scans.]

This photo from a new book by Alexander Tsiaras author of the InVision Guide to a Healthy Heart [video link].

Cognitive decline, memory, focus, verbalization, moods are all dependent on adequate blood supply. When we measure rCBF [regional cerebral blood flow] with SPECT, we are measuring blood flow - key point. Low blood flow can cause diminished function, and we see that functional difficulty while looking, for example, at brain injury with SPECT scans.

Anyone interested in "brain function" will very much appreciate the Heart Scan Blog and the Track Your Plaque website by William Davis, MD, visionary cardiologist. His book, Track Your Plaque [excellent refs], should be read by anyone remotely interested in brain function. When you read it, you simply can't put it down. This book pulls together the traditional and the nutritional, and, as you read it you will find very similar themes to our message here at CorePsychBlog. And...if you have any kind of a vascular/heart problem you simply must read this book.

Out of the box thinking doesn't mean forgetting the fundamentals. Our challenge is a coalescence of basic scientific *principles* with the interesting challenge of the *policies* in place that may limit our thinking -  with either brain or heart health.

So how does he track plaque? Calcification, read on...

SPECT Imaging Notes: Just looking is the first step

Brain imaging is starting to find its way, interestingly enough, even in the medical-medical literature.

In a previous post here at CorePsychBlog I discussed briefly an article from the Annals of Internal Medicine on schizophrenia, SPECT findings, and celiac. I reported in that post the dramatic confluence of metabolic, psychiatric and SPECT findings... and the resolution of the schizophrenia as a result of treating the metabolic problems discovered on SPECT and confirmed by laboratory.

So how come SPECT [gamma camera picture] isn't popping up as a useful tool in medical-psychiatric literature? The reasons are several:

1. Psychiatric/Academic competition: Some academicians [UCLA disagrees] say SPECT is still in the "research phase"
2. The pharma companies are not paying for the research to translate SPECT clinical findings into clinical interventions [not their responsibility]
3. Very few psychiatrists have actually used SPECT findings to guide psychiatric treatment  [I have a plan].
4. Outcome studies, with both clinical and SPECT resolution of specific symptoms and brain dysfunction are few and costly [money is a big issue with SPECT aftercare].
5. The SPECT tradition comes more from a "findings" rather than a follow up tradition.[We  do need more longitudinal studies]
   
6. Daniel Amen is the single person with the largest body of evidence [and a Brain Atlas which describes these findings - and, quite reasonably, he sees no good reason to give it all away].

Sagience: Blending Age, Wisdom, and Science

An announcement and Invitation:         

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This 12-session program, The Next Chapter for Baby Boomers: Thriving in the 21st Century, is based on seminal research about the body, brain, mind, and spirit. It’s specifically geared to dynamic professionals who can apply the same intellect and talents they use in their work to maximizing their vitality and development as they move into new life stages.

Founded and directed by my good friend and DC colleague, Dr Catherine Fitzgerald [check out her bio here], - this is a series-not-to-miss. Catherine, co-author of Executive Coaching, is simply the most widely informed professional and the most experienced person on the planet regarding the challenges of adult development. Need I say more?

The Next Chapter for Baby Boomers is a teleseminar for executives, therapists, coaches, brain, body and mind experts who use cutting edge information in their leadership and consultation practices. The key word here is coalescence. Catherine is connecting her best resources with the larger community of those interested in understanding the newest and most important issues in human development.

If you're one of our CorePsych readers in Australia, no problem, you can attend!

The Black Swan Flies: Call the Black Swan, Be Ready

When you finish the Black Swan, be ready to read it again.

I knew I would like it as I reported the buzz on it back in June. I liked it more than I thought I would. It's an easy leap to suggest that if you are reading this blog you will very much enjoy the Black Swan. Why? -Simple:

Taleb connects interesting observations from statistical analysis in economics to epidemiology and medical evolution... on the subject of acceptance - acceptance of real evidence, beyond statistical analysis. He documents the limitations of tunnel vision - thinking that the world is only occupied by White Swans [agreed upon conclusions].

Check out this interesting interview by Stephen Dubner with Taleb in the NYTimes.

Over time, over the years of practice, the Black Swans events in our offices can either teach new perspectives - or we can simply ignore their impact and hang tight with the popular belief system of the day - founded on stats: The Standard of Care. The Standard is not a bad thing, but may be a limiting perspective for any single patient that calls the Black Swan for us.

So many of our medical ideas must fall within a Gaussian curve of predictable probability, while what we see in the office often presents as quite unpredictable and out of the ordinary. Take a look at this view of the Gaussian curve:

Brain Blood Flow Gives Clues to Treating Depression

A brief note on SPECT imaging for assessing depression from Israel: Keeping up with brain science.

This interesting press release from the Society of Nuclear Medicine makes it clear that the naysayers who don't get the significance of SPECT imaging in everyday psych practice need to rethink their tunneling position. We can see types of depression if we look. Here is a brief review:

The usefulness of established molecular imaging/nuclear medicine approaches in identifying the "hows" and €"whys" of brain dysfunction and its potential in providing immediately useful information in treating depression are emphasized in a study in the August Journal of Nuclear Medicine.

"€œIndividuals in a depressed emotional state have impaired cerebral (brain) blood flow," explained Omer Bonne, head of inpatient psychiatry and associate professor in the Department of Psychiatry at Hadassah-Hebrew University Medical Center in Jerusalem, Israel.

"Currently, clinical psychiatry is based almost solely on subjective observer-based judgment. Our findings suggest that objective imaging evaluations could support subjective clinical decisions."€ he said.

Sounds like what we have been saying, what Amen has been saying, for many years. Doesn't mean we have to run out and scan everybody, just that others do see the validity of the evidence.

The link above is only the press release, but links to the article are available there [above].

Report from the Science Front: The Society for Nuclear Medicine

The Society for Nuclear Medicine continues to set the scientific foundation for brain imaging and our clinical work

Brain views are alive and well at the SNM [Society for Nuclear Medicine] meeting starting Saturday and going thru the week at the voluminous Washington DC Convention Center.  I went up to DC this last  weekend for a great adventure and a day of interesting brain imaging updates with molecular and cellular science thrown in.

I'll touch briefly on some remarkable highlights to keep you posted. [Plan: to get back to non medical treatments for ADD with several posts this forthcoming weekend.] SNM is the main world meeting site for the research crowd on the frontier of functional SPECT and PET imaging, mainly for hearts and brains, but clearly involved in all of nuclear med including veterinary medicine and imaging the entire body.

For a guy like myself with an abiding interest in applied brain science this meeting was for me like a kid in a candy store. I confess I have always been a closet geek, and the cameras, the isotope configurations and the software platforms were mind boggling. Picture the GE PET exhibit for cardiology covering about 15% of the main floor with the newest cameras and the Cedar Sinai software spinning hearts pumping on enormous plasma screens. The busy exhibit hall not only included of the latests technological gear, but reps from the nuclear med societies from Japan, Europe, S. Africa, Australia and New Zealand all showed with their own meeting plans for the year.

All day Saturday the Brain Forum presented a series of papers on the research aspects of using isotopes for Advances in Brain Molecular Imaging. Without waxing pedantic, it was great fun, and much of what we talk about in these posts here at CorePsychBlog is on the table with these many researchers. Some of the topics from the week include: