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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
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Elizabeth Wolf
DSL 100
SPECT Scans
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.
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).
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
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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.
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.
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.
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
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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.
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:
“Your brain is involved with everything you do
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When the brain works right, you work right. When the brain is troubled, you generally
experience trouble in your relationships, work, or within yourself.
The brain is the most complicated organ in the universe
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.
Certain parts of the brain tend to do certain things.
Problems in certain brain areas are often associated with specific learning, behavioral or
emotional problems.
Most psychiatric illnesses are not single or simple disorders
Imaging the brain helps mental health professionals be more effective, decreases stigma
and increases compliance for patients
The brain can change!” (www.amenclinics.com).
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.
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
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clinical history they will have enhanced understanding about the illness and this will result in
acceptance.
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
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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.
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
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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.
Work Cited
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www.amenclinics.com
findarticles.com/p/articles/mi_hb4345/is_9_34/ai_n29293260/
www.sciencebasedmedicine.org/?p=76