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SPECT Questioned: Brain Function, Medications and ADD/ADHD Interventions

Posted Sep 16 2008 4:50am

SPECT Brain Imaging: SPECT scans can be helpful with many psych diagnoses, even as basic and commonplace as ADD/ADHD - so why write SPECT studies off as *unproven*?     Istock_000002527083xsmall

ADD/ADHD Over Diagnosed
If so many are thinking that ADD/ADHD is "over diagnosed" or "incorrectly diagnosed" because meds aren't working correctly - why not dig a little deeper for more brain and body evidence? 

ADD/ADHD Incorrectly Diagnosed
By the way, I completely agree that ADD is often incorrectly diagnosed, especially regarding the multiplicity of comorbid states, giving rise to the oft noted: "These meds aren't working, must not be ADD." Most of the time the problem is deeper than phenotypic ADD, but, rather, an aggregation of types of endophenotypic ADD with combinations of the subsystems below.

SPECT Scan Evidence
And in the context of all this national debate, with many interesting applied psychopharmacological studies reported regularly at meetings of The Society for Nuclear Medicine on SPECT and dopamine in the Prefrontal Cortex - do we need to wait for more evidence?

Why not take this position: "SPECT scans are working, they do provide additional information, now let's teach SPECT applications and process, write more about SPECT results and evolve the parameters of SPECT application"?

Brief Report From My Office Chair
After 20 years of SPECT scan findings with clear brain evidence associated with clinical ADD/ADHD symptoms, we often see many of these findings alone or in combination, - even beyond the PFC [and readers, this list is dashed off quickly, -having seen all of these brain presentations with "ADD/ADHD" previously diagnosed from the surface view]:

  1. Genetically inherited inferior orbital Prefrontal Cortex [PFC] hypoperfusion
  2. Posterior lateral PFC hypoperfusion - injury, genetics, important for drug interactions
  3. Prefrontal Pole hypoperfusion - injury, specific PFC brain areas associated with addictive patterns
  4. Superior anterior PFC hypoperfusion - injury or metabolic change
  5. Anterior Cingulate hyperperfusion - stress, cognitive worry
  6. Temporal lobe - both hypo and hyperperfusion associated with several comorbid clinical issues
  7. Parietal lobe - hypoperfusion, injury, dementia, metabolic changes - even gluten sensitivity
  8. Occipital lobe - hypoperfusion, visual processing speed diminished, injury
  9. Cerebellum - hypoperfusion, processing speed, anticipation, diaschisis, metabolic, injury
  10. Limbic hyperperfusion - depression comorbid
  11. Basal Ganglia hyperperfusion - anxiety directed internally and/or externally, cognitive and/or affective comorbid
  12. Diffuse Cortical hyperperfusion - often associated with bipolar mood disorder, but often metabolic issues
  13. Diffuse Corticalhypoperfusion - often associated with metabolic challenges, celiac, immune disorders
  14. Asymmetrical Cortical hypoperfusion - often worse on concentration scans, can be secondary to many issues and effect multiple areas of cognition, focus and attention - neurotoxins, mold, injury, Lyme, inhalants, drugs and alcohol, and BTW, toxic reactions to psych meds!

Debate Notes
These brief remarks come to mind subsequent to the heated debate following Dr Carlat's cold and invective diatribe, [softened a bit after some self-reflection, see the links to Carlat and Amen comments below] - launched upon Amen at first, but secondarily directed to all of us using SPECT diagnostically. The reason for all of this dialog is simple: SPECT results do matter a great deal, and are extremely useful, if you know how to use them.

Noted previously: SPECT investigations include more than the Amen perspective.

Just knowing brain physiology, just knowing the implications of SPECT scan general patterns does not make anyone a good clinician. The interesting phenomenon with SPECT results: they do force psychiatrists away from the dreams and platitudes of *only psychopharmacology*...

SPECT scans open the information gates, the evidence paths, as we often discuss here at CorePsychBlog, to the entire universe of inquiries regarding brain and body biology, brain and body molecular and cellular physiology, pharmacology, and, good patient care.

The Future of Psychiatry
Applied comprehensive evidence, over time, evolves the future practice of psychiatry.

Next post more comments on the Carlat report and Amen's response: See these references below for an easy review of the discussion thus far -

The Debate References:
The article  by Dr Carlat in Wired, and comments following.
The blog post in The Carlat Psychiatry Blog with interesting comments.
The blog post by Dr Amen in Dr Amen's Brain Blog with more comments
My previous post on this debate at CorePsychBlog and some extensive comments

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