0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

REGULAR ARTICLES   |    
Improved Outcomes Using Brain SPECT-Guided Treatment Versus Treatment-as-Usual in Community Psychiatric Outpatients: A Retrospective Case-Control Study
John F. Thornton, M.B., FRCPC; Howard Schneider, M.D., CCFP; Mary K. McLean, M.B., FRCPC; Muriel J. van Lierop, M.B.B.S., MGPP; Robert Tarzwell, M.D., FRCPC
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:51-56. doi:10.1176/appi.neuropsych.12100238
View Author and Article Information

From Rossiter-Thornton Associates, Toronto, Ontario, Canada; Sheppard Associates, Toronto, Ontario, Canada (HS); Dept. of Nuclear Medicine and Division of Adult Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

Send correspondence to Dr. Schneider, Sheppard Associates; e-mail: howard.schneider@gmail.com

Copyright © 2014 by the American Psychiatric Association

Received October 04, 2012; Revised January 20, 2013; Accepted January 25, 2013.

Abstract

Brain single-photon emission computed tomography (SPECT) scans indirectly show functional activity via measurement of regional cerebral blood flow. Thirty patients at a community-based psychiatric clinic underwent brain SPECT scans. Changes in scoring of before-treatment and after-treatment scans correlated well with changes in patient Global Assessment of Functioning (GAF) scores before treatment and after treatment. Patients were retrospectively matched with controls with similar diagnoses and pretreatment GAF scores, and those who underwent SPECT-guided treatment improved significantly more than the control patients.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

FIGURE 1. Example of a Brain 3D SPECT ECD Image, Outside Cortical 3D Inferior Surface View

Perfusion defects representing hypoperfusion bilaterally in the prefrontal cortex are seen, as well as bilateral defects in the antero-medial aspects of the temporal lobes.

ECD: ethyl cysteinate dimer.

FIGURE 2. Interior View of Brain Shown in Figure 1 (3D SPECT ECD Image)

Top 8%, 15%, and 45% pixels are represented respectively by white, red, and blue colors. The activity seen in this view in the occipital region and elsewhere is largely within normal limits.

Anchor for Jump
TABLE 1.Relationship Between 3D SPECT Findings and Their Clinical Significance
Table Footer Note

ADHD: attention-deficit hyperactivity disorder; CBT: cognitive-behavior therapy; SSRIs: selective serotonin-reuptake inhibitors.

Anchor for Jump
TABLE 2.Characteristics of SPECT-Scanned Patients and Control Patients
Table Footer Note

SPECT: single-photon emission computed tomography; GAF: Global Assessment of Functioning.

Anchor for Jump
TABLE 3.SPECT Improvement by GAF Improvement
+

References

Amen  DG;  Carmichael  BD:  High-resolution brain SPECT imaging in ADHD.  Ann Clin Psychiatry 1997; 9:81–86
[CrossRef] | [PubMed]
 
Sheehan  W;  Thurber  S:  Review of two years of experiences with SPECT among psychiatric patients in a rural hospital setting.  J Psychiatr Pract 2008; 14:318–323
[CrossRef] | [PubMed]
 
Amen  DG;  Hanks  C;  Prunella  J:  Preliminary evidence differentiating ADHD using brain SPECT imaging in older patients.  J Psychoactive Drugs 2008; 40:139–146
[CrossRef] | [PubMed]
 
Brockmann  H;  Zobel  A;  Joe  A  et al:  The value of HMPAO SPECT in predicting treatment response to citalopram in patients with major depression.  Psychiatry Res 2009; 173:107–112
[CrossRef] | [PubMed]
 
Kanahara  N;  Shimizu  E;  Sekine  Y  et al:  Does hypofrontality expand to global brain area in progression of schizophrenia? a cross-sectional study between first-episode and chronic schizophrenia.  Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:410–415
[CrossRef] | [PubMed]
 
Amen  DG:  Images of Human Behavior: A Brain SPECT Atlas .  Newport Beach, CA,  Mindworks Press, 2004
 
Mena  FJ;  Mena  I;  Alamos  BA  et al:  SPECT Tc99m-HMPAO brain uptake in normal children: a comparison to normal elderly subjects. Alasbimn Journal 1998; 1:AJ01-3; http://www.alasbimnjournal.cl/revistas/1/children.htm
 
Darcourt  J;  Mena  I;  Cauvin  J-C  et al:  Absolute calibration of HMPAO SPECT, using 133-Xe rCBF values. Alasbimn Journal 1999; 2:http://www.alasbimnjournal.cl/revistas/5/darcourt.htm
 
Payne  JK;  Trivedi  MH;  Devous  MD  Sr:  Comparison of technetium-99m-HMPAO and xenon-133 measurements of regional cerebral blood flow by SPECT.  J Nucl Med 1996; 37:1735–1740
[PubMed]
 
Ichise  M;  Chung  DG;  Wang  P  et al:  Technetium-99m-HMPAO SPECT, CT and MRI in the evaluation of patients with chronic traumatic brain injury: a correlation with neuropsychological performance.  J Nucl Med 1994; 35:217–226
[PubMed]
 
American Psychiatric Association:  Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR) .  Washington, DC,  American Psychiatric Publishing, Inc., 2000
 
Juni  JE;  Waxman  AD;  Devous  MD  et al:  Procedure Guideline for Brain Perfusion SPECT Using 99mTc Radiopharmaceuticals, 3.0. July 2009, Society of Nuclear Medicine; http:// www.snm.org/guidelines
 
Leveille  J;  Demonceau  G;  Walovitch  RC:  Intrasubject comparison between technetium-99m-ECD and technetium-99m-HMPAO in healthy human subjects. J Nucl Med 1992;33:480–484
 
Tanaka  F;  Vines  D;  Tsuchida  T  et al  Normal patterns on 99m-Tc-ECD brain SPECT scans in adults. J Nuclear Med 2000; 41:1456–1464
 
Gowda  NK;  Agrawal  D;  Bal  C  et al:  Technetium Tc-99m ethyl cysteinate dimer brain single-photon emission CT in mild traumatic brain injury: a prospective study.  Am J Neuroradiol 2006; 27:447–451
[PubMed]
 
Cherkasova  MV;  Hechtman  L:  Neuroimaging in attention-deficit hyperactivity disorder: beyond the frontostriatal circuitry.  Can J Psychiatry 2009; 54:651–664
[PubMed]
 
Thornton J, Schneider H: A quantitatively-based visual scoring system for 3D SPECT brain images, 2009; available at howard.schneider@gmail.com
 
Hanley  JA;  McNeil  BJ:  A method of comparing the areas under receiver operating characteristic curves derived from the same cases.  Radiology 1983; 148:839–843
[PubMed]
 
Usui  C;  Hatta  K;  Doi  N  et al:  Brain perfusion in fibromyalgia patients and its differences between responders and poor responders to gabapentin .  Arthritis Res Ther2010; vol. 12
 
Amen  DG;  Highum  D;  Licata  R  et al:  Specific ways brain SPECT imaging enhances clinical psychiatric practice.  J Psychoactive Drugs 2012; 44:96–106
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 10.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 10.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 10.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 10.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 6.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles