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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
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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.


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.

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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.

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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.

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

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

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TABLE 3.SPECT Improvement by GAF Improvement


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