Published Research

Published or Submitted Peer Reviewed Scientific Papers by Dr. Amen and Amen Clinics Team


Dr. Amen and the researchers at Amen Clinics have published with distinguished scientists from:

Brain Spect Scan Cost


    1. Brumleu K, Haydn-Myer, A Functional Brain Imaging Can Provide Better Diagnosis And Treatment Monitoring In Persons With Traumatic Brain Injury , — Link to full article COSTA MESA, Calif., March. 19, 2014 –Traumatic brain injury (TBI) is a devastating problem with serious physical and emotional consequences. Nick Bell, former Oakland Raider running back, suffered for many years with depression, pain, irritability and isolation as the result of repetitive traumatic brain injuries as a football player. Seeking treatment, he received a brain scan as part of his care. Looking at his brain made a significant difference to Bell. He said, “Brain SPECT imaging helped me see the physical damage to my brain in a way which overwhelmingly explained my past behaviors and emotional issues. The SPECT scan motivated me to be aggressive with my treatment, which has made a wonderful difference for both me and my family.” Brain SPECT, which stands for Single Photon Emission Computed Tomography, is a functional brain imaging modality that produces images of blood flow to the brain, showing areas of over or under-activity.


    1. Willeumier K, Taylor DV, Amen, DG. Neurobiological correlates of Introversion-Extraversion with activation-state brain SPECT imaging , submitted for publication. AB — Here we explored the relationship between personality and regional cerebral blood flow using the introversion-extraversion subscale of the Keirsey temperament scale (KTS-II) and brain single-photon computed emission tomography (SPECT) in former professional American football players. We administered the KTS-II to a cohort of 78 (mean age ± SD) retired professional football players who underwent a comprehensive evaluation in an outpatient psychiatric clinic which included SPECT imaging as part of a study measuring the effects of repetitive subconcussive impacts on brain function. Using SPSS, whole brain average and region of interest (ROI) analysis were performed on the subscale of introversion-extraversion (introversion, n=26; extraversion, n=38; mixed, n=8; neither, n=6). Introverts show elevated metabolic activity across multiple brain regions including the anterior cingulate gyrus, caudate, temporal lobes, hippocampus, inferior parietal lobe and the cerebellar vermis IX. Alternatively, extraverts show lower overall global activity, with reductions in the inferior orbital and prefrontal cortices. The present study demonstrates distinct regional activity profiles unique to extraversion and introversion during a brain activation-task which has not been previously reported. Further exploration into mapping the neural pathways that are associated with introversion-extraversion may extrapolate meaningful correlations between these personality dimensions and brain physiology.


    1. Harcourt S, Amen DG, Willeumier, K, Golden, C. Regional Cerebral Blood Flow in Schizophrenia While in Attention Task. Presented at the American Psychological Association 2014 AB – Introduction Blood perfusion patterns may be useful in identifying specific deficits in persons with schizophrenia. This exploratory study uses data from high-resolution single-photon emission computed tomography (SPECT) analysis of regional cerebral blood flow (rCBF) in brain regions of interest (ROI) to seek relationships between rCBF and a clinical diagnosis of schizophrenia while participants are engaged in a selective and sustained attention task. The amygdala, hippocampus, and temporal lobe were chosen as focal points of this study based on prior research. Method Clinical participants were adults presenting for psychiatric care at 8 clinics on both U.S. coasts (n=74; age 18-84, M=40.8; 59% male, 65% White, 42% West Coast) who consented to participation; historical diagnosis was confirmed clinically prior to study. Healthy participants (defined as persons having no mental health disorder, neither historically nor upon clinical assessment) were solicited from a West Coast university (n=46; age 18-84, M=40.8; 46% male, 46% White, 100% West Coast). SPECT scans were made of the left- and right-sided ROIs of the amygdala, hippocampus, and temporal lobe, in a resting state, for baseline values of rCBF. Second, SPECT was conducted in the same areas under a concentration task in which the participant engaged in the Conners’ CPT. Z-scores were computed in each lobe of each ROI (z-scores were used rather than raw scores, due to each ROI having unique statistical descriptors), representing rCBF as an index above or below the mean rCBF for the entire sample. The difference of the concentration z score and the baseline z score was computed, representing net magnitude and direction of change in blood flow. Positive differences represent increases in flow of blood or rCBF, while negative values are decreases in flow. The full procedure is described elsewhere (Amen, Hanks, & Prunella, 2008). Results Six t-tests were performed (3 ROIs in each hemisphere) comparing rCBF in concentration condition minus rCBF at baseline, of participants with schizophrenia to healthy participants; all calculations used a significance criterion of p=.01. The t-tests were significant for: the left amygdala with schizophrenia (M=.053, SE=.072) versus healthy (M=-.54, SE=.20), t(56.921)=-2.8; the right amygdala (M=.082, SE=.077) versus healthy (M=-.62, SE=.19), t(60.011)=-3.4; the left hippocampus with schizophrenia (M=.032, SE=.071) versus healthy (M=-.57, SE=.20), t(56.659)=-2.9; the right hippocampus (M=.082, SE=.065) versus healthy (M=-.65, SE=.19), t(55.583)=-3.6; the right temporal lobe (M=-.098, SE=.064) versus healthy (M=.74, SE=.064), t(59.049)=4.8. Discussion This exploratory analysis found that the ROIs of the amygdala and hippocampus experienced a decrease in rCBF in moving from baseline to a concentration task, in persons with schizophrenia. In the healthy participants, the flow rate instead increased very slightly. The opposite effects were observed in the temporal lobes, with the schizophrenia group showing small decreases in flow rate, and healthy participants showing increases of up to three-quarters of an sd unit in blood flow. In all cases, the right-side flow increased or decreased from 20% to 900% more than the left side; lateral rate differences were greater in the diagnosed group than the healthy group, and in the temporal lobes more so than the amygdala and hippocampus.


    1. Silverman, Daniel H., Willeumier, Kristen, Torosyan, Nare, Mallam, Sravya, Raji, Cyrus, Dahlbom, Magnus, Amen, Daniel G. Regional cerebral blood flow patterns during performance of an attention-focused cognitive task in patients resistant and responsive to antidepressant therapy (accepted by the SNM Annual Meeting 2014) AB — OBJECTIVES: To assess regional patterns of cerebral blood flow (rCBF) predictive of therapy-resistant versus therapy-responsive unipolar depression. METHODS: Forty patients with a clinical diagnosis of depression and Beck Depression Inventory (BDI) II score= 25 underwent 99mTc-HMPAO SPECT. Brain images were acquired on a Picker 3-headed camera at rest and during an attention-focusing cognitive task. Half (n=20; av. age 43, range 20-66) were responsive (BDI =13 or reduced by 50% 6 months post-treatment) to therapy, and half (n= 20; av. age 41, 19-59) were non-responsive to therapy. The regional pattern of blood flow in the brain of each patient was assessed by quantification of mean activity in each of 47 standardized volumes of interest, relative to mean whole brain activity, and differences between therapy-resistant and therapy-responsive groups were statistically assessed by two-tailed Student t-test. Results: There were no significant differences (p>0.3) in BDI II scores between responders (32.6±1.6) and non-responders (30.7±1.0) before therapy. At the end of 6 months of treatment, however, the BDI II score was significantly lower (p<0.00000000003) in responders (7.4±1.0) versus non-responders (26.5±1.8). During the attention-focusing task, the left lentiform nucleus (LN) was the region having rCBF that differed most significantly between responders and non-responders (1.19±0.01 and 1.16±0.01 respectively, p<0.02). No difference was seen in the lLN at resting when comparing responders to non-responders (1.18±0.01 for each). Correspondingly, the lLN was also the region in which the change between the resting and attention-focusing task was most significantly different between therapy-resistant and therapy-responsive groups (p<0.03). CONCLUSIONS: Higher level of lentiform nucleus blood flow during an attention-focusing task is predictive of clinical response to anti-depressant therapy.


    1. Raji, Cyrus; Amen, Daniel G.; Torosyan, Nare; Willeumier, Kristen; Mallam, Sravya; Dahlbom, Magnus; Silverman, Daniel H. Altered regional cerebral blood flow patterns in NFL offensive linemen and defensive backs (accepted by the SNM Annual Meeting 2014) AB: Objectives: To examine regional patterns of cerebral blood flow (rCBF) associated with offensive line and defensive back positions played by professional football players. Methods: A total of 71 men (mean age 57 y.o, range 26-82) with a history of playing in the NFL as offensive linemen (OL, n=44) or as defensive backs (DB, n=27) underwent 99mTc-HMPAO SPECT with a Picker 3-headed camera as they performed the Conners’ Continuous Performance Task-II, an attention-focusing cognitive task. A sex-matched control group of non-players (NC, age range 19-84) was studied under identical conditions. The regional pattern of blood flow in the brain of each player and control subject was assessed by quantification of mean activity in each of 47 standardized volumes of interest, relative to mean whole brain activity, and between-group differences were considered statistically significant after Bonferroni-type correction for multiple comparisons (p = 0.001 before adjustment) by two-tailed Student t-test. Results: In comparing all players to NC, significant diminished rCBF was seen in the right medial anterior temporal (rMAT, p=0.0007) and left anterior cingulate (lGCa, p=0.0002) regions, and significant elevated rCBF was seen in left lentiform nucleus (lLN, p=0.0000006). The significance of diminished rCBF in lGCa was primarily driven by a 3% decrease among OL (p=0.0002), while only 1% decrease (p>0.10) was seen among DB; significance of diminished rCBF in rMAT was primarily driven by a 4% decrease in DB (p=0.0007). The magnitude of rCBF in lLN reflected significant increases of 2-3% in both DB (p=0.0006) and OL (p=0.000002). Conclusions : History of NFL play is associated with alterations in cerebral blood flow in a regionally specific manner, with significant decreases seen in a medial frontal region important for executive functions in offensive linemen, and in a medial temporal region important for memory function especially in defensive backs.


    1. Newberg AB, Serruya M, Gepte A, Intenzo C, Lewis T, Amen, Russell D, Wintering N: Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury, PLOS One January 24, 2014 DOI: 10.1371/journal.pone.0087009 AB — Background: This study evaluated the clinical interpretations of single photon emission computed tomography (SPECT) using a cerebral blood flow and a dopamine transporter tracer in patients with chronic mild traumatic brain injury (TBI). The goal was to determine how these two different scan might be used and compared to each other in this patient population. Methods and Findings: Twenty-five patients with persistent symptoms after a mild TBI underwent SPECT with both 99mTc exametazime to measure cerebral blood flow (CBF) and 123I ioflupane to measure dopamine transporter (DAT) binding. The scans were interpreted by two expert readers blinded to any case information and were assessed for abnormal findings in comparison to 10 controls for each type of scan. Qualitative CBF scores for each cortical and subcortical region along with DAT binding scores for the striatum were compared to each other across subjects and to controls. In addition, symptoms were compared to brain scan findings. TBI patients had an average of 6 brain regions with abnormal perfusion compared to controls who had an average of 2 abnormal regions (p<0.001). Patient with headaches had higher CBF in the right frontal lobe, right thalamus, and left basal ganglia compared to patients without headaches. Lower CBF in the left frontal lobe and right temporal lobe correlated with poorer reported physical health. Higher DAT bindings was associated with more depressive symptoms and overall poorer reported mental health. There was no clear associations between CBF and DAT binding in these patients. Conclusions: Overall, both scans detected abnormalities in brain function, but appear to reflect different types of physiological processes associated with chronic mild TBI symptoms. Both types of scans might have distinct uses in the evaluation of chronic TBI patients depending on the clinical scenario.


    1. Raji, Cyrus, Tarzwell, Robert, Pavel, Dan, Schneider, Howard, Uszler, J., Thornton, John, van Lierop, Muriel, Cohen, Philip, Amen, Daniel, Henderson, Theodore. Clinical Utility of SPECT in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review. Accepted for publication PLOS One, February 9, 2014 AB — Traumatic brain injury (TBI) is a devastating problem with serious morbidity and mortality. This systematic review evaluated the global literature for single photon emission computed tomography (SPECT) use in TBI. From 1600 studies identified, 71 articles, 19 longitudinal and 52 cross-sectional studies, met rigorous standardized inclusion criteria. Of these, 100% of longitudinal and 98% of cross sectional studies showed SPECT lesion localization not detected by CT or MRI. Almost 80% of longitudinal and 81% of cross sectional articles showed significant correlation between SPECT and neuropsychological or neurological outcomes. This review highlights the extensive literature base for SPECT in evaluating TBI.


    1. Amen, DG, Taylor, DV, Ojala, K, Willeumier, K: Effects of a Brain-Directed Nutrient System on rCBF and Neuropsychological Testing: A Randomized, Double Blind, Placebo Controlled, Cross-Over Trial, Advances in Mind-Body Medicine, SPRING 2013, VOL. 27. NO. 2, pgs 18-27. AB: Introduction: In a prior study of professional football players with the effects of traumatic brain injury we reported significant improvements in clinical symptoms, neuropsychological testing, and regional cerebral blood flow (rCBF) as assessed by single photon emission computed tomography (SPECT) in an open trial comprised of brain-directed nutrients (BDNs) and lifestyle interventions. Here, we extend this investigation in healthy individuals using the same BDNs, with a more rigorous design, without lifestyle interventions. Method: We utilized a randomized, double-blind, placebo-controlled, cross-over trial of 25 individuals to determine whether supplementation with BDNs improves rCBF and neuropsychological function. Primary outcome measures include changes in rCBF using SPECT, differences in cognitive and emotional function assessed using the MicroCog and Webneuro, and psychological inventories (Beck Depression Inventory, BDI-II; Brief Symptom Inventory, BSI; Quality of Life Inventory, QOLI). Results: Region of Interest analysis showed significant improvement in rCBF compared to placebo in the prefrontal cortex, anterior and posterior cingulate gyrus, hippocampus, and cerebellum. Significant improvements were observed on the Microcog (executive function (0.002), reasoning (0.008), memory (0.014), information processing efficiency (0.015) and accuracy (0.027)), Webenuro, (depressed mood (0.017) and emotional identification (0.041)), and BSI (Positive Symptom Total (0.024) and reduced hostility (0.018)). Conclusions: This study demonstrates the potential effectiveness of BDNs to enhance rCBF and neuropsychological function across various cognitive and psychological domains.


    1. Amen, DG, Trujillo, M, Keator, D, Taylor, DV, Willeumier, K: rCBF Gender Differences in a Sample of 46,034 SPECT Scans (under submission).


    1. Amen, DG, Jourdain, M, Taylor, DV, Pigott, HE, Willeumier, K: Multi-Site, Six Month Outcome Study of Complex Psychiatric Patients Evaluated with Addition of Brain SPECT Imaging, Advances in Mind-Body Medicine, Spring 2013, Vol. 27, No. 2, pgs 4-14 AB — Background: Psychiatric diagnoses are made primarily through clinical histories searching for DSM driven symptom clusters, and outcomes for patients have not substantially improved in decades for many disorders. Primary Study Objective: In this study we examine the outcome impact of the addition of SPECT to the assessment of complex patients. Methods/Design/ Setting/Participants: In this multi-site, prospective study, all new outpatients from four psychiatric clinics were entered into a 6 month outcome study between January 2011 and August 2012. The study was completed after final outcome measures were obtained on 500 patients. Primary Outcome Measures: Evaluations included histories, mental status examinations, Structured Clinical Interview for DSM-IV (SCID-IV), Beck Depression Inventory-II (BDI-II), Brief Symptom Inventory (BSI), Quality of Life Inventory (QOLI) and rest and concentration brain SPECT scans. At 6 months standardized outcome measurements were re-administered (BDI-II, BSI, QOLI), along with questions about improvement and compliance. Results: 75% of patients reported significant clinical improvement; 55% reported being “very compliant”, 41% “somewhat compliant” and 4% “non-compliant”. Significant improvements were observed across all 3 assessments (BDI mean difference = -6.92, 360 (72%) subjects decreased; BSI mean difference = -0.38, 367 out of 461 (79%) subjects decreased; QOLI mean difference = +1.65, 427 (85%) subjects improved) at 6 months (Hotelling’s T2 = 460, p < 0.0001). Net improvement was measured at 81% (n=405). Conclusions: To authors’ knowledge this is the first outcome study in complex psychiatric patients using SPECT as an additional diagnostic tool, demonstrating significant improvement. Further studies comparing the addition of brain SPECT to “treatment as usual” groups are warranted.


    1. Amen DG: It’s Time to Stop Flying Blind: How Not Looking at the Brain Leads to Missed Diagnoses, Failed Treatments, and Dangerous Behaviors, Alternative Therapies, Epub ahead of print January 14, 2013.


    1. Amen, DG and Burnett, L: Daniel Amen, MD: The Impact of Brain Imaging on Psychiatry and Treatment for Improving Brain Health and Function, Alternative Therapies, Mar/Apr 2012, Vol. 18, No. 2, 52-58.


    1. Amen, D, Highum, D, Licata, R, Annibali, J, Somner, L, Pigott, HE, Taylor, DV, Trujillo, M, Newberg, A, Henderson, T, Willeumier, K: Specific Ways Brain SPECT Imaging Enhances Clinical Psychiatric Practice, (2012): Specific Ways Brain SPECT Imaging Enhances Clinical Psychiatric Practice, Journal of Psychoactive Drugs, 44:2, 96-106 AB — Introduction: Our objective was to ascertain in a prospective case series how often brain single photon emission computed tomography (SPECT) neuroimaging adds relevant information for diagnosis and/or treatment beyond current standard assessment tools in complex psychiatric cases. Method: Charts of 109 consecutively evaluated outpatients from four psychiatrics clinics which routinely utilize SPECT imaging for complex cases were analyzed in two stages. In stage one, psychiatrists reviewed detailed clinical histories, mental status exams, and the Structured Clinical Interview for DSM-IV, but not the results of SPECT studies, and assigned a diagnosis, based on DSM-IV criteria, and then developed a comprehensive treatment plan. In stage two, evaluators were given access to the SPECT studies for each patient. They then determined if the scans added new information to the diagnosis and/or treatment plan recorded in stage one. If SPECT added value, the evaluators categorized it as either 1) additions and/or changes to the diagnoses and/or 2) additions and/or changes to the clinical management. Results: The addition of SPECT modified the diagnosis or treatment plan in 78.9% (n=86; rated level 2 or 3 change) of cases. The most clinically significant changes were undetected brain trauma (22.9%), toxicity patterns (22.9%) and the need for a structural imaging study (9.2 %). Specific functional abnormalities were seen as follows that potentially could impact treatment: temporal lobe dysfunction (66.1%) and prefrontal hypoperfusion (47.7%). CONCLUSION: SPECT has the potential to add clinically meaningful information to enhance patient care beyond current assessment tools in complex or treatment resistant cases.


    1. Amen, D, Willemier, K and Johnson, R: The Clinical Utility of Brain SPECT Imaging in Process Addictions. Journal of Psychoactive Drugs, March 2012 issue. AB – Brain SPECT imaging is a nuclear medicine study that uses isotopes bound to neurospecific pharmaceuticals to evaluate regional cerebral blood flow (rCBF) and indirectly metabolic activity. With current available technology and knowledge SPECT has the potential to add important clinical information to benefit patient care in many different areas of a substance abuse practice, including in the area of process addictions. This article explores the ways brain SPECT has the potential to be useful to clinicians in helping to understand and direct treatment for complex cases of obesity and sexual addictions. Areas where SPECT can add value include helping clinicians ask better questions, helping them in making more complete diagnoses, evaluating underlying brain systems pathology, decreasing stigma and increasing compliance, and visualizing effectiveness via follow-up evaluations. In particular, SPECT can help identify and assess the issue of brain trauma and toxicity in process addictions, which may be significant contributing factors in treatment failure. Three illustrative case histories will be given.


    1. Amen D, Willeumier, K: Brain SPECT Imaging: A Powerful, Evidence-Based Tool for Transforming Clinical Psychiatric Practice. Minerva Psichiatrica 2011 September;52(3):109-23 AB — Over the past 20 years brain single photon emission computed tomography (SPECT) imaging has developed a substantial, evidence-based foundation and is now recommended by professional societies for numerous indications relevant to psychiatric practice, including dementia, brain trauma, cerebrovascular disease, seizures and complex neuropsychiatric presentations. Unfortunately, SPECT in clinical practice is utilized by only a very small fraction of psychiatric clinicians. This invited article presents a rationale for a more widespread use of SPECT in clinical practice, especially for complex cases, and includes seven clinical applications where it may be immediately helpful in clinical cases.


    1. Harch PG, Andrews SR, Fogarty EF, Amen D, Pezzullo JC, Lucarini J, Aubrey C, Taylor DV, Staab PK, Van Meter KW. A Phase I Study of Low Pressure Hyperbaric Oxygen Therapy for Blast-Induced Post Concussion Syndrome and Post Traumatic Stress Disorder, Journal of Neurotrauma, October 2011 Epub 2011 Oct ahead of print. AB — This is a preliminary report on the safety and efficacy of 1.5 ATA HBOT in military subjects with chronic blast-induced mild-moderate traumatic brain injury (TBI)/post-concussion syndrome (PCS) and post-traumatic stress disorder (PTSD). Method: 16 military subjects received forty 1.5 ATA/60 minute HBOTs in 30 days. Symptoms, physical and neurological exams, SPECT brain imaging, neuropsychological and psychological testing were completed before and within one week after treatment. Results: subjects experienced reversible middle ear barotrauma (5), transient deterioration in symptoms (4), and reversible bronchospasm (1); one subject withdrew. Post treatment testing demonstrated significant improvement in: symptoms, neurological exam, Full scale IQ (+14.8 points; p=.001), WMS IV Delayed Memory (p<.026), WMS-IV Working Memory (p=.003), Stroop Test (p=.001), TOVA Impulsivity (p=.041), TOVA Variability (p<.045), Grooved Pegboard (p=.028), PCS symptoms (Rivermead PCSQ: p=.0002), PTSD symptoms (PCL-M: p<.001), Depression (PHQ-9: p<.001), Anxiety (GAD-7: p<.007), quality of life (MPQoL: p<.003), and self-report of percent of normal (p<.001),SPECT coefficient of variation in all white matter and some gray matter ROI’s after the first HBOT, and in half of white matter ROIs after 40 HBOT’s, and SPECT statistical parametric mapping analysis (diffuse improvements in regional cerebral blood flow). CONCLUSION: Forty 1.5 ATA HBOTs in 1 month was safe in a military cohort with chronic blast-induced PCS and PTSD. Significant improvements occurred in symptoms, abnormal physical exam findings, cognitive testing, and quality of life measurements, with concomitant significant changes/normalization of SPECT. Further study of the efficacy and safety of 1.5 ATA HBOT is underway in a larger group of subjects.


    1. Harch P, Andrews SR, Fogarty E, Amen DG, Lucarini J, Van Meter KW. Response to Wortzel, et al Letter to the Editor. J Neurotrauma. 2012 Jul 24. [Epub ahead of print]


    1. Willeumier, K, Taylor, D, Amen, D: Decreased cerebral blood flow in the limbic and prefrontal cortex using SPECT imaging in a cohort of completed suicides. Translational Psychiatry (2011) 1, e28; doi:10.1038/tp.2011.28; published online 9 August 2011, 1-8. AB – Suicide has a high comorbidity with impulsivity and depression, and finding imaging biomarkers indicative of patients at high-risk for suicidal behavior is invaluable to the clinician. Using single-photon emission computed tomography (SPECT) imaging, we have previously reported regional cerebral blood flow (rCBF) decreases in the medial prefrontal cortex, ventral tegmental area, and subguneal cingulate cortex (Brodmann Area 25), a region found to be hypoperfused with treatment-resistant depression. From 2007-2010, we have extended our analysis to include nine additional completed suicides. Twenty-seven healthy, age-gender matched subjects from a previously acquired healthy brain study served as controls to our twenty-one completed suicides. All twenty-one suicides had been previously diagnosed with depression according to DSM-IV criterion. Voxel-by-voxel analyses were performed using statistical parametric mapping (SPM) to compare the differences in 99mTc-HMPAO brain uptake between the groups. Factor analysis of the data identified the top ten regions of hypoperfusion in the suicidal group including the bilateral superior frontal lobes, the right precuneus, the rolandic operculum, postcentral gyrus, left caudate and insular cortex. We also demonstrate more focal decreases in rCBF in the subguneal cingulate cortex (BA 25) in eighteen subjects, supporting our previous hypothesis that hypoperfusion of BA 25 may be a risk factor for suicide in depressed patients. This work suggests that SPECT might be useful in predicting suicidal tendencies in subjects with depression or treatment-resistant depression. Further investigation of this work is necessary to better understand the predictive value of this finding.


    1. Amen DG, Trujillo M, Newberg A, Willeumier K, Tarzwell R, Wu JC, Chaitin B. Brain SPECT Imaging in Complex Psychiatric Cases: An Evidence-Based, Underutilized Tool, Open Journal of Neuroimaging,, 2011; 5:40-8, July 28 AB — Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has developed a substantial, evidence-based foundation and is now recommended by professional societies for numerous indications relevant to psychiatric practice. Unfortunately, SPECT in clinical practice is utilized by only a handful of clinicians. This article presents a rationale for a more widespread use of SPECT in clinical practice for complex cases, and includes seven clinical applications where it may help optimize patient care.


    1. Amen DG, Wu JC, Taylor D, Willeumier K. Reversing Brain Damage in Former NFL Players: Implications for TBI and Substance Abuse Rehabilitation. Journal of Psychoactive Drugs, 43 (1), 2011 Online publication date: 08 April 2011 AB — Objectives: Brain injuries are common in professional American football players, and their incidence has been associated with mild cognitive impairment, dementia, substance abuse and depression. Finding effective brain rehabilitation strategies is essential to helping retired players live more effective lives. In addition, if brain injury rehabilitation strategies can be found, it potentially has widespread implications for the traumatic brain injury and substance abuse communities whose patient also experience long standing brain damage. Setting/Location: Outpatient neuropsychiatric clinic Design: Open label, “pragmatic,” clinical intervention Subjects: 30 retired NFL players, a subset of a larger group of 100 players in a brain imaging and neuropsychological testing study Interventions: An open-label, pragmatic, clinical intervention study, which included weight loss (if appropriate); fish oil (5.6 grams a day); a high-potency multiple vitamin; and a formulated brain enhancement supplement that included nutrients to enhance blood flow (ginkgo and vinpocetine), acetylcholine (acetyl-l-carnitine and huperzine A), and antioxidant activity (alpha-lipoic acid and n-acetyl-cysteine). The trial average was 6 months. Outcome Measures: Microcog Assessment of Cognitive Functioning and brain SPECT imaging. Results: In the retest situation, corrected for practice effect, there were statistically significant increases in scores of attention, memory, reasoning, information processing speed and accuracy on the Microcog. The brain SPECT scans, as a group, showed increased brain perfusion, especially in the prefrontal cortex, parietal lobes, occipital lobes, anterior cingulate gyrus and cerebellum. CONCLUSION: This study demonstrates that cognitive and cerebral blood flow improvements are possible in this group with multiple interventions. Randomized, placebo-controlled studies evaluating the individual interventions are warranted in this population.


    1. Amen DG, Newberg A, Thatcher R, Jin Y, Wu J, Keator D, Willeumier K. Impact of Playing Professional American Football on Long Term Brain Function. Journal of Neuropsychiatry and Clinical Neurosciences, J Neuropsychiatry Clin Neurosci 23:1, Winter 2011, 98-106. AB — We recruited 100 active and former NFL players, representing 27 teams and all positions. Players underwent a clinical history, brain SPECT imaging, qEEG, and multiple neuropsychological measures, including Microcog. Compared to a normal control group players showed global decreased perfusion, especially in the prefrontal, temporal lobe, parietal, occipital and cerebellar regions. qEEG findings were consistent, showing elevated slow waves in the frontal and temporal regions. Significant decreases from normal values were found in most neuropsychological tests. This is the first large-scale brain-imaging study to demonstrate significant differences consistent with a chronic brain trauma pattern in professional football players.


    1. Amen D: Brain SPECT Imaging in Clinical Practice. Am J Psychiatry. 2010. Sep:167(9): 1125


    1. Khalsa DS, Amen D, Hanks C, Money N, Newberg A. Cerebral Blood Flow Changes During Chanting Meditation. Nucl Med Commun. 2009 Dec;30(12):956-61. PURPOSE: To examine changes in brain physiology during a chanting meditation practice using cerebral blood flow single-photon emission computed tomography. METHODS: Single-photon emission computed tomography scans were acquired in 11 healthy individuals during either a resting state or meditation practice randomly performed on two separate days. Statistical parametric mapping analyses were conducted to identify significant changes in regional cerebral blood flow (rCBF) between the two conditions. Results: When the meditation state was compared with the baseline condition, significant rCBF increases were observed in the right temporal lobe and posterior cingulate gyrus, and significant rCBF decreases were observed in the left parieto-temporal and occipital gyri. CONCLUSION: The results offer evidence that this form of meditation practice is associated with changes in brain function in a way that is consistent with earlier studies of related types of meditation as well as with the positive clinical outcomes anecdotally reported by its users.


    1. Amen DG, Prunella JR, Fallon JH, Amen B, Hanks C. A Comparative Analysis of Completed Suicide using Hign h Resolution Brain SPECT Imaging. The Journal of Neuropsychiatry and Clinical Neurosciences 2009; 21:430–439. AB — The authors compared regional cerebral blood flow in the brains of 12 psychiatric patients who completed the act of suicide with groups of healthy and nonsuicidal depressed subjects using statistical parametric mapping. Results were consistent with prior imaging studies on depression and were indicative of impaired impulse control and limbic dysregulation, including significant perfusion deficits in the medial prefrontal and subgenual areas (Brodmann’s areas 11, 25) and ventral tegmentum. These results warrant further research.


    1. Boersma, N, Wiersma, J, Hanks, C, Huijsmans, M, van Isselt, H and Amen D: Cerebral blood flow in TBI patients: SPM analysis of HMPAO-SPECT. Presented at the World Congress Brain Injury in Lisbon, Portugal April 2008


    1. Amen DG, Hanks C, Prunella, J: Predicting Positive and Negative Treatment Responses to Stimulants with Brain SPECT Imaging. Journal of Psychoactive Drugs, 2008 Jun;40(2):131-8 Abstract — The goal of this study was to test whether clinician-rated regional cerebral blood flow (rCBF) as rendered by SPECT imaging is a meaningful predictor of patient response to CNS stimulants. Chart reviews were used to identify patients who reported prior significant positive and negative responses to CNS stimulants. Each patient in the study had received resting and concentration SPECT scans using Tc99m exametazime. Differences in cerebral blood flow for frontal regions of interest were assessed in three conditions (resting, concentration, and their difference, or “delta”) using ANCOVAs and age-matched ANOVAs. Prefrontal pole deltas were found to be highly sensitive and specific predictors of response to CNS stimulants, with pole activation predicting adverse responses and pole deactivation predicting good responses. Positive and negative predictive values were greater than .75 for both poles. We conclude that SPECT renderings of rCBF, particularly in the prefrontal cortex, are a potentially powerful clinical tool for anticipating response to stimulant medications, both positive and adverse.


    1. Amen DG, Hanks C, Prunella, J: Preliminary Evidence Differentiating AD/HD from Healthy Controls Using Brain SPECT Imaging in Older Patients. Journal of Psychoactive Drugs, 2008 Jun;40(2):139-46. AB — The objective of this study was to differentiate ADHD patients from a healthy comparison group using high resolution brain SPECT imaging in older patients. Using extensive chart reviews of structured interviews, DSM-IV criteria, and psychiatrist-given diagnoses, we identified 27 patients over age 50 with ADHD, either combined or inattentive types. Patients were compared to an age-matched group of healthy subjects with brain SPECT imaging at rest and during concentration using semiquantitative visual readings. Significantly lower cortical activity is noted in the ADHD group, particularly in the prefrontal poles, orbits, and parietal lobes. Older ADHD patients can be discerned from healthy subjects using brain SPECT. The results support the executive dysfunction model of ADHD.


    1. Shankle WR, Hara J, Bjornsen L, Gade GF, Leport PC, Ali MB, Kim J, Raimo M, Reyes L, Amen D, Rudy L, O’Heany T. Omentum transposition surgery for patients with Alzheimer’s disease: a case series. Neurol Res. 2008 Apr;30(3):313-25. AB — OBJECTIVE: To examine effect of omentum transposition surgery (OT) in Alzheimer’s disease (AD). METHODS: Within-subjects design, also known as repeated-measures design, was used. OT was performed on six biopsy-confirmed AD patients (three to the left and right hemispheres each). Follow-up was conducted over 16-50 months. Outcome measures included the sum of the sub-scores of the clinical dementia rating scale (CDRSS), dementia severity rating scale (DSRS), mini-mental status exam (MMSE) and neuropsychiatric inventory (NPI), all normalized to 0-1.0. Outcomes were compared to baseline values and to expected decline with and without cholinesterase inhibitors therapy (ChEI). Results: Compared to baseline and to expected decline with ChEI, CDRSS scores were 22 and 39% less impaired at means of 14 and 25 months post-OT, and DSRS scores were 12 and 22% less impaired at means of 14 and 19 months post-OT (p<0.0001). Compared to baseline and expected course with and without ChEI, the MMSE scores of the left hemisphere OT patients were not significantly different for 11, 17 and 22 months respectively (p>0.49), while those of the right hemisphere OT patients more rapidly declined. The two patients with significant pre-operative behavioral problems markedly improved; NPI severity scores decreased by 23 (16%) and 78 (54%) points and were sustained for 22 and 42 months. DISCUSSION: OT yielded cognitive, functional or behavioral improvement for up to 3.5 years in these AD patients. Compared to randomized ChEI clinical trials, OT was 34 times more likely to produce clinically significant improvement. Basic research to identify the mechanisms underlying the therapeutic effect of omentum is warranted.


    1. Amen DG, Hanks C, Prunella, JR, Green, A: An Analysis of Regional Cerebral Blood Flow in Impulsive Murderers Using Single Photon Emission Computed Tomography. J Neuropsychiatry Clin Neurosci 2007 Summer;19(3):304-9. Abstract — The authors explored differences in regional cerebral blood flow in 11 impulsive murderers and 11 healthy comparison subjects using single photon emission computed tomography. The authors assessed subjects at rest and during a computerized go/no-go concentration task. Using statistical parametric mapping software, the authors performed voxel-by-voxel t tests to assess significant differences, making family-wide error corrections for multiple comparisons. Murderers were found to have significantly lower relative rCBF during concentration, particularly in areas associated with concentration and impulse control. These results indicate that nonemotionally laden stimuli may result in frontotemporal dysregulation in people predisposed to impulsive violence.


    1. Amen DG: Brain Imaging In Clinical Practice: Pro/Con: Pro Position. Clinical Psychiatry News September 2006


    1. Lansing, K, Amen, DG, Hanks, C and Rudy, L. High Resolution Brain SPECT Imaging and EMDR in Police Officers with PTSD. J Neuropsychiatry Clin Neurosci. 2005 Fall;17(4):526-32. AB — Eye movement desensitization and reprocessing (EMDR) has been shown to be an effective treatment for posttraumatic stress disorder (PTSD). In this study, the authors evaluated the effectiveness and physiological effects of EMDR in police officers involved with on-duty shootings and who had PTSD. Six police officers involved with on-duty shootings and subsequent delayed-onset PTSD were evaluated with standard measures, the Posttraumatic Stress Diagnostic Scale, and high-resolution brain single photon emission computed tomography (SPECT) imaging before and after treatment. All police officers showed clinical improvement and marked reductions in the Posttraumatic Stress Diagnostic Scale Score (PDS). In addition, there were decreases in the left and right occipital lobe, left parietal lobe, and right precentral frontal lobe as well as significant increased perfusion in the left inferior frontal gyrus. In our study EMDR was an effective treatment for PTSD in this police officer group, showing both clinical and brain imaging changes.


    1. Amen, DG, Wu, JC, Carmichael, B: The Clinical Use of Brain SPECT Imaging in Neuropsychiatry. Alasbimn Journal 5(19): January 2003.,1206,SCID%253D3212,00.html This article reviews the literature on brain SPECT imaging in brain trauma, dementia, and temporal lobe epilepsy. Brain SPECT allows clinicians the ability to view cerebral areas of healthy, low, and excessive perfusion. This information can be correlated with what is known about the function or dysfunction of each area. SPECT has a number of advantages over other imaging techniques, including wider availability, lower cost, and high quality resolution with multi-headed cameras. There are a number of issues that compromise the effective use of SPECT, including low quality of some imaging cameras, and variability of image rendering and readings.


    1. Amen DG: Why Don’t Psychiatrists Look At The Brain: The Case for the Greater Use of SPECT Imaging in Neuropsychiatry. Neuropsychiatry Reviews. February 2001, Vol. 2, No. 1, 19-21. AB — Psychiatrists are the only medical specialists who rarely look at the organ they treat. The odds are that if a patient is having serious problems with feelings (eg, depression), thoughts (eg, schizophrenia), or behavior (eg, violence), the psychiatrist will never order a brain scan. He or she will prescribe medication, psychotherapy, electroconvulsive therapy, or a host of other treatments that will change brain function—but will not know which areas of the patient’s brain work well, which areas work too hard, and which do not work hard enough. In my opinion, the lack of brain imaging has kept psychiatry behind medicine’s other specialties, reducing our effectiveness with patients and hindering our efforts to reduce stigma and improve compliance.


    1. Amen DG: Brain SPECT imaging in the assessment and treatment of aggressive behavior: A putative “Reward Deficiency Syndrome (RDS)” behavioral subtype. Abstract of presentation at the First Conference on “Reward Deficiency Syndrome:” Genetic Antecedents and Clinical Pathways, San Francisco, November 12-13, 2000, in Molecular Psychiatry, Volume 6 Supplement 1, February 2001, page S7


    1. Amen, DG. Attention, doctors. Newsweek. 2001 Feb 26;137(9):72-3.


    1. French, AP, Amen DG: Criminal recidivism as a neurobehavioral syndrome. J Am Acad Child Adolesc Psychiatry. 1999 Sep;38(9):1070-1.


    1. Amen DG. Regional Cerebral Blood Flow In Alcohol Induced Violence: A Case Study. Journal of Psychoactive Drugs, Volume 31:4, October-December 1999. A case is presented of a 20-year-old man who became violent on many occasions after ingesting alcohol. On one occasion he committed an armed robbery. Two brain SPECT studies were performed: one when he was alcohol free, and one after he ingested alcohol in the same pattern as the night of the crime. The “alcohol free” study revealed marked hyperactivity in the cingulate gyrus, right and left lateral frontal lobes, right and left lateral parietal lobes and the right lateral temporal lobe. The “alcohol intoxication” study showed an overall dampening effect on the hyperactive areas of the brain, with only the anterior cingulate gyrus showing excessive activity. In addition, the right and left prefrontal cortex became hypoperfused, decreasing impulse control and judgment, as did the left and right temporal lobes, increasing the likelihood for aggression. This study suggests that this man may have been “self-medicating” an overactive brain, but in the process induced a state that increased the likelihood for aggressive behavior. This case study suggests the need for further research in the area of alcohol-induced violence and the potential usefulness of SPECT imaging, although no conclusions can be drawn from one case.


    1. Amen, DG. Brain SPECT Imaging in Psychiatry. Primary Psychiatry, Vol. 5, No. 8, 83-90, August 1998.


    1. Amen, DG. Attention Deficit Disorder: A Guide for Primary Care Physicians. Primary Psychiatry, Vol 5, No. 7, 76-85, July 1998.


    1. Amen, DG, Waugh, M: High Resolution Brain SPECT Imaging in Marijuana Smokers with AD/HD, Journal of Psychoactive Drugs, Volume 30, No. 2 April-June 1998, 1-13. Marijuana abuse is common among young Americans and even more common among teenagers and adults with attention deficit/hyperactivity disorder (AD/HD). Many teenagers and young adults believe that marijuana is a safe substance to use despite a number of studies demonstrating cognitive impairment with chronic or heavy usage. Brain single photon emission computer tomography (SPECT) imaging is being used increasingly in psychiatry to study underlying functional brain problems, including AD/HD. SPECT provides information on cerebral blood flow and metabolic function. Brain SPECT studies were performed on 30 heavy marijuana users (who had used on at least a weekly basis for a minimum of one year) with AD/HD from an outpatient psychiatric clinic and 10 AD/HD control group subjects matched for age and sex who had never used drugs. The three-dimensional surface images were used in the analysis of the scans, and were blindly interpreted without knowledge of the clinical data. Decreased perfusion in the prefrontal cortex was the only abnormality seen in the AD/HD control group (80%). In the marijuana group, there was a similar decrease in the perfusion of the prefrontal cortex while performing the same concentration task (83%). However, the marijuana group also demonstrated marked decreased activity in the right and left temporal lobes. The severe and moderate ratings were found in the heaviest users, but not necessarily the longest users. This study demonstrates decreased cerebral perfusion in the temporal lobe regions of the brain on SPECT imaging from chronic marijuana usage.


    1. Amen DG, Yantis S, Trudeau J, Stubblefield MS, Halverstadt JS. Visualizing the Firestorms in the Brain: An Inside Look at the Clinical and Physiological Connections between Drugs and Violence Using Brain SPECT Imaging, Journal of Psychoactive Drugs, Vol. 29 (4), 1997, 307-319. AB — The connection between drugs and violence has been well documented. Understanding the intricacies of this connection is essential to finding effective interventions. Much has been written about the psychosocial causes of these problems, but there have been few studies exploring the biophysiological interface between drug effects, violent behavior and brain metabolism. Over the past eight years, The Amen Clinic has been extensively involved in the clinical use of brain SPECT imaging to evaluate complicated neuropsychiatric problems, especially related to the issues of both violence and substance abuse. From this work several clinical patterns, as well as brain SPECT imaging patterns, have been recognized that may help further our understanding of these problems. In this article, following a brief review of the literature on drugs, violence and the brain, five clinical examples are explored; the authors show how these support the clinical utility of incorporating SPECT imaging into psychiatric assessment of drug abuse and violence. Finally, a model is proposed to help explain the complex interaction between the brain, violence and drug abuse.


    1. Amen DG. Oppositional Children Similar To OCD on SPECT: Implications for Treatment Journal of Neurotherapy, August 1997, 1-8.


    1. Amen, DG, Waugh, ME: Three Years On Clomipramine: Before and After Brain SPECT Study. Ann Clin Psychiatry, Vol. 9, No. 2, 1997, 113-116. AB — A case is presented of a patient diagnosed with attention deficit disorder, obsessive thinking, anger outbursts, and depression who had a SPECT study prior to treatment and after 3 years of treatment on clomipramine. The follow-up SPECT study showed marked improvement overall in the cerebral perfusion of the brain. At rest marked overactivity was noted in the anterior medial aspects of the frontal lobes, along with “patchy” (increased and decreased) uptake throughout the cortical and subcortical areas of the brain. After treatment for 3 years on clomipramine at 225 mg a day, the follow-up SPECT study revealed a normalization of activity in the anterior medial aspects of the frontal lobes as well as no patchy uptake cortically and subcortically as noted in the study prior to treatment. The clinical usefulness of the SPECT study as it relates to this case is discussed.


    1. Amen DG, Carmichael, B. High Resolution Brain SPECT Imaging in Attention Deficit Hyperactivity Disorder. Ann Clin Psychiatry, Vol. 9, No. 2, 1997, 81-86. AB — Children and adolescents with ADHD were evaluated with high-resolution brain SPECT imaging to determine if there were similarities between reported PET and QEEG findings. Fifty-four children and adolescents with ADHD by DSM-III-R and Conners Rating Scale criteria were evaluated. A non-ADHD control group was also studied with SPECT. Two brain SPECT studies were done on each group, a resting study and an intellectual stress study done while participants were doing a concentration task. Sixty-five percent of the ADHD group revealed decreased perfusion in the prefrontal cortex with intellectual stress, compared to only 5% of the control group. These are findings consistent with PET and QEEG findings. Of the ADHD group who did not show decreased perfusion, two-thirds had markedly decreased activity in the prefrontal cortices at rest.


    1. Amen DG. Windows into the A.D.D. Mind: Essential Knowledge Base for Educators. School of Education Journal, California State University Stanislaus, December 1997, 23-29.


    1. Amen DG. Brain SPECT Imaging In Psychiatric Practice. Advance for Radiological Professionals, Vol. 9 No. 16, August 5, 1996, 12-13.


    1. Amen, DG, Stubblefield, M, Carmichael B, Thisted, R: Brain SPECT Findings and Aggressiveness. Ann Clin Psychiatry, Vol. 8, No. 3, 1996, 129-137. AB — Forty adolescents and adults who exhibited aggressive behavior within the six months prior to evaluation by physically attacking another person or destroying property were evaluated with brain SPECT imaging. A control group of 40 psychiatric patients who had never been reported to exhibit aggressive behavior were also studied. The brain SPECT studies were read blind to aggressiveness by nuclear physician on two separate occasions. The inter-reading reliability was very high. The brain SPECT patterns of the group with aggressive behavior showed significant differences from the control group in several areas of brain. These findings were most often seen in the following combination: decreased activity in the prefrontal cortex, increased activity in the antero-medial portions of the frontal lobes, left-sided increased activity in the basal ganglia and/or limbic system in comparison to the whole brain and focal abnormalities in the left temporal lobe. These findings indicate a possible cerebral perfusion profile for those who exhibit violent or aggressive behavior. Several case studies and the implications for treatment are discussed.


    1. Amen DG, Paldi, F, Thisted, RA. Brain SPECT Imaging and ADHD. J. Am. Acad. Child Adolesc. Psychiatry, 32:5, 1079-1080 (Letter), September 1993


    1. Amen DG, Jellen L, Merves E, Lee RE. Minimizing the Impact of Deployment Separation on Military Children: Stages, Current Preventive Efforts, and System Recommendations. Military Medicine. 153(9):441-6, 1988 Sep. Link to Full Article


    1. Amen DG. The Target Theory of Suicide: Ideas on Evaluating the Need for Hospitalization. Resident and Staff Physician Oct. 1987. This paper was awarded the General William C. Menninger Memorial Award for the best paper presented by a psychiatric resident at the annual General William C. Menninger Military Psychiatry Course 1985. The award was presented by Karl Menninger, M.D.


    1. The Psychiatrist At Work. Published by Psychiatry in Industry committee of the Group for the Advancement of Psychiatry. Dr. Amen served on this committee and contributed to the writing of this monograph.


    1. Wain HJ, Amen D, Jabbari B. The effects of hypnosis on a parkinsonian tremor: a case report with polygraph/EEG recordings. Am J Clin Hypn 1990 Oct;33(2):94-8 AB — Although Parkinsonian tremors typically disappear during sleep and are reduced during relaxation periods, the effects of hypnosis on this type of movement disorder have been generally ignored. We observed a patient’s severe Parkinsonian tremor under hypnosis and monitored it with EEG and EMG studies. The patient was taught self-hypnosis and performed it three to four times daily in conjunction with taking medication. The results suggest that daily sessions of self-hypnosis can be a useful therapeutic adjunct in the treatment of Parkinsonian tremors.


    1. Amen DG. AB –Emotional Aspects of Surgery. Resident & Staff Physician, Jan 1986, Vol. 32, No. 1, 76-87.


    1. Harden J, Hales RE, Amen D, Lewis G, Miliken C, Orman D. Inpatient participation in treatment planning: a preliminary report. Gen Hosp Psychiatry 1986 Jul;8(4):287-90 with Harden J, Hales RE, Lewis G. AB — This study investigated the effect of patient participation in treatment planning conferences (TPCs) upon length of hospitalization and upon the frequency of military soldiers being returned to duty. Patients with major affective disorders and schizophrenic disorders showed an 8.2% decrease in hospital stay whereas patients with minor affective disorders, personality disorders, substance abuse, and adjustment disorders showed a 98.8% increase. Additionally, the percentage of active duty soldiers with a major depressive episode who were returned to duty increased significantly when they participated in their TPC.


    1. Wain HJ, Amen DG. Emergency Room Use of Hypnosis. General Hospital Psychiatry 8(1):19-22, 1986 Jan. AB — Myths about hypnosis have interfered with its use in emergency settings. Specifically, included are myths about who induces the hypnotic state, the length of induction time, and the traumatized patient’s inability to concentrate on a focal point. It is suggested, however, that altered states of awareness occur rapidly and spontaneously in the patient who has experienced acute trauma and/or pain. Two cases are presented that illustrate spontaneous trancelike states occurring in traumatic situations. The cases also show how the recognition of these altered states can facilitate the patient’s care and treatment in an emergency setting.


    1. Wain HJ, Amen DG. The Use of Hypnosis in EPS-Associated Anxiety. Letter to the Editor in Journal of Clinical Psychiatry, Feb 1986, Vol. 47, No. 2, 98.


    1. Amen, DG. Post Vietnam Stress Disorder: A Metaphor for Current and Past Life Events. First Prize winner of the Baltimore-D.C. Institute for Psychoanalysis essay contest Nov 1984. Published in the American Journal of Psychotherapy, Oct 1985, Vol. 43, No. 4, 580-586 AB — Delayed posttraumatic stress reactions are often triggered by events that echo the original trauma. It is not uncommon, however, for these delayed reactions to represent a metaphor for other current or past life events. A case is presented that illustrates the diagnostic and therapeutic significance of understanding these reactions as a metaphor.


    1. Wain HJ, Amen, DG, Oetgen, WJ. Cardiac Arrhythmias and Hypnotic Intervention: Advantages, Disadvantages, Precautions, and Theoretical Considerations. American Journal of Clinical Hypnosis, Vol. 27, No. 1, July 1984, 70-75.


    1. Willeumier, K, Taylor, D, Amen, D: Effects of Elevated Body Mass in Professional American Football Players on rCBF and Cognitive Function, Transl Psychiatry (2012) 2, eK, doi:10.1038/tp.2011.67 AB — Obesity is a risk factor for neurodegenerative disease and has been shown to adversely affect cognitive function. Professional athletes who participate in sports which expose them to repetitive concussions may be at heightened risk for cognitive impairment. Here, we investigated the effects of body mass as measured by waist to height ratio (WHtR) on regional cerebral blood flow using SPECT imaging in 38 healthy weight (WHtR mean 49.34% ± 2.8; age 58 ± 9.6) and 38 overweight (WHtR mean 58.7% ± 4.7; age 58 ± 13.3) retired NFL football players. After matching for age and position, we used a 2 sample t-test to determine the differences in blood flow in healthy versus overweight subjects. Statistical parametric mapping (SPM) revealed a higher WHtR ratio is associated with decreased blood flow in Brodmann Areas 8, 9, 10 brain regions involved in attention, reasoning and executive function (P<0.05, family-wise error) along with deficits in the temporal pole. Moreover, overweight athletes had significant decreases in attention (P = 0.01326), general cognitive proficiency (P = 0.012; Microcog: Assessment of Cognitive Functioning (MACF)) and memory (P = 0.005; Mild Cognitive Impairment Screen (MCIS)). The association between elevated WHtR percentage and decreased blood flow in the prefrontal cortex and temporal pole may be correlated with the decreased performance on tests of attention and memory. These findings suggest a weight management program may be critical to the health of athletes who have been exposed to mild brain trauma during their careers.


    1. Willeumier, K, Taylor, D, Amen, D: Elevated BMI is associated with decreased blood flow in the prefrontal cortex using SPECT imaging in healthy adults. Nature Obesity, published online February 19, 2011 AB – Context: Obesity is a risk factor for stroke and neurodegenerative disease. Excess body fat has been linked to impaired glucose metabolism, insulin resistance and impulsivity and may be a precursor to decline in attention and executive cognitive function. Objective: To investigate the effects of high body mass index on regional cerebral blood flow (rCBF) using SPECT imaging in healthy brain subjects. Design, setting, and participants: We used SPECT imaging data and analyzed changes in rCBF from 16 adult men and 20 adult women recruited from the community as part of a healthy brain study conducted at the Amen Clinics Inc., a private medical facility, from May 2008 to May 2010. Participants in the study were screened for neurological and psychiatric conditions, concussion history and substance use and excluded based on any conditions known to affect brain function. An additional inclusion criterion for the study was scoring normal on the Connor’s Continuous Performance Test (C-CPT II), an assessment of attention. Subjects were categorized as normal or overweight according to body mass index (BMI). We used a 2 sample t-test to determine the effects of BMI on rCBF. Subjects were matched for age and gender. Main outcome measure: Changes in rCBF in normal and overweight adults. Normal was defined as a BMI of 24.9 or lower. Overweight was defined as a BMI of 25.0 or higher. Results: Higher BMI in healthy individuals is associated with decreased rCBF in Broadmann Areas 8, 9, 10, 11, 32 and 44, brain regions involved in attention, reasoning and executive function (P<0.05, FEW). Conclusions: We found an elevated BMI is associated with decreased rCBF in the prefrontal cortex of a healthy, middle-aged cohort. These findings indicate that elevated BMI may be a risk factor for impaired executive function and planning, issues associated with the prefrontal cortex.


    1. Newberg AB, Wintering N, Waldman MR, Amen D, Khalsa DS, Alavi A. Cerebral blood flow differences between long-term meditators and non-meditators. Conscious Cogn. 2010 Dec;19(4):899-905. Epub 2010 Jun 8. AB — We have studied a number of long-term meditators in previous studies. The purpose of this study was to determine if there are differences in baseline brain function of experienced meditators compared to non-meditators. All subjects were recruited as part of an ongoing study of different meditation practices. We evaluated 12 advanced meditators and 14 non-meditators with cerebral blood flow (CBF) SPECT imaging at rest. Images were analyzed with both region of interest and statistical parametric mapping. The CBF of long-term meditators was significantly higher (p<.05) compared to non-meditators in the prefrontal cortex, parietal cortex, thalamus, putamen, caudate, and midbrain. There was also a significant difference in the thalamic laterality with long-term meditators having greater asymmetry. The observed changes associated with long-term meditation appear in structures that underlie the attention network and also those that relate to emotion and autonomic function.


    1. Amen DG. High Resolution Brain SPECT Imaging in Psychiatry Provides Real Help For Patients. Diagnostic Imaging, November 1996, pages 85-88.

Published Book Chapters

      1. Brain scanning and therapeutics: How Do You Know Unless You Look? Neuroimaging Guided Treatment in a Forensic Setting. Daniel G. Amen, M.D. and Kristen Willeumier, Ph.D. In Neuroscience and offending: building biological resources with general and sexual offenders
      2. Aging and the Brain: A4M Testbook 2013
      3. Cognitive Decline in Food and Nutrients in Disease Management, Second Edition: Advancing Nutritional Medicine, edited by Ingrid Kohlstadt MD, MPH. CRC Press 2012
      4. Functional neuroimaging in clinical practice (co-author with Joseph C. Wu and H. Stefan Bracha) in The Comprehensive Textbook of Psychiatry Edited by Kaplan and Sadock 2000
      5. Brain SPECT Imaging and ADD in Understanding, Diagnosing, and Treating AD/HD in Children and Adolescents: An Integrative Approach. Eds Incorvaia, JA, Mark-Goldstein BS, and Tessmer D. Jason Aronson, Inc, Northvale, New Jersey, 1999, 183-196.
      6. New Directions in the Theory, Diagnosis, and Treatment of Mental Disorders: The Use of SPECT Imaging in Everyday Clinical Practice. In The Neuropsychology of Mental Disorders. Ed Koziol, LF and Stout, CE. Charles C. Thomas, Springfield, IL 1994, 286-311.
      7. Brain SPECT Imaging: Encyclopedia entry. Encyclopedia of Special Education edited by Cecil Reynolds and Elaine Fletcher-Janzen, published by Wiley in Winter 2006.


    • Brain and Mind Expo, Hong Kong 2012
    • High Performance Brains, Grace Financial, Hong Kong 2012
    • Yoga Hub Seminar Series 2012
    • The Annual Meeting of the American Psychiatric Association, Pros and Cons of SPECT Brain Imaging: Brain SPECT Imaging Is Immediately Useful In Clinical Practice, Philadelphia, 2012
    • High Performance Brains, Army National Guard, Arlington, VA December 2011
    • Jim Kwik’s Super Hero You Conference, November 2011
    • Brendon Burchard’s High Performance Academy, November 2011
    • Chief Learning Officer Summit, High Performance Brains, Hosted by Franklin Covey, Laguna Beach, CA October 2011
    • Change Your Brain, Change Your Life, Brain Fitness Module, American Association of Anti-Aging Medicine, October 2011
    • Daniel Plan Rally, Saddleback Church, October 2011
    • Salvation Army Drug Treatment Conference, Anaheim October 2011
    • Kamloops School District, October 2011
    • ADDDocs Conference, Boca Raton, Florida, October 2011
    • Use Your Brain to Change Your Age National Tour, Fall 2011, Chicago, Minneapolis, Baltimore, Washington, DC, Berkeley, Newport Beach, Seattle and Portland
    • IDEA Fitness Conference, Magnificent Mind At Any Age, Los Angeles, August 2011
    • Kripalu, The Amen Solution, July 2011
    • US Journal Conference, Unchain Your Brain June 2011
    • The Annual Meeting of the American Psychiatric Association, Pros and Cons of SPECT Brain Imaging: Brain SPECT Imaging Is Immediately Useful In Clinical Practice, Honolulu, Hawaii May 2011
    • TEDx talk on Innovation — May 2011
    • The Amen Solution PBS Special 20 city tour March to June 2011
    • Experts Academy with Brendon Burchard March 2011
    • The Daniel Plan Part 2 Rally Event, Saddleback Church, March 2011
    • The Daniel Plan Kickoff Event, Saddleback Church, January 2011
    • Wired for Success, Franklin Covey Interview, January 2011
    • The Daniel Plan, Saddleback Church, November 2010
    • Change Your Brain, Change Your Body, Kripalu, MA October 2010
    • Wired for Success, EXIT Realty, Dallas, TX October 2010
    • Change Your Brain, Change Your Body, Mission Viejo Library Event, September 2010
    • Creating Brain Healthy Treatment Centers, Hanley Center, West Palm Beach, FL September 2010
    • The Rational Use of Supplements in Psychiatry, UC, Irvine Department of Psychiatry Grand Rounds September 2010
    • Wired for Success and Magnificent Mind At Any Age, Centarus Financial, Bellevue, WA July 2010
    • Creating Brain Healthy Schools, Gurian Institute, Colorado Springs, CO, July 2010
    • Creating Brain Healthy Schools, Oral Roberts University Educational Foundation, Tulsa, OK, July 2010
    • Brain SPECT Imaging in Clinical Practice, All Day Conference, Lion’s Gate Hospital, Department of Psychiatry and Nuclear Medicine, Vancouver, British Columbia, Canada, May 2010
    • Supermind Conference, Santa Barbara April 2010, Keynote Speaker
    • Brain SPECT Imaging in Clinical Practice, Grand Rounds, Lion’s Gate Hospital, Department of Psychiatry and Nuclear Medicine, Vancouver, British Columbia, Canada, January 2010
    • Change Your Brain, Change Your Body, Change Your Life, Evolution of Psychotherapy Conference, Anaheim, December 2009
    • Town Hall Meeting at Howard University with Dr. Bill Cosby on Nutrition and Poverty September 2009
    • American Association of Christian Counselors, Nashville, TN, Change Your Brain, Change Your Body and Magnificent Mind At Any Age, September 2009, Addiction Track Co-Leader
    • Change Your Brain, Change Your Body, Brain Health Symposium, Commonwealth Club, San Francisco, August 2009
    • Magnificent Mind At Any Age, Invited 3 Day Retreat, Kripalu, MA
    • Brain Imaging In Court: SPECT Uses and Controversies, International Association of the Law and Mental Health, NYC, July 1, 2009
    • The 12 Most Important Steps of Your Life, Creating brain Healthy Lives, Families, Schools and Businesses, PBS WLIW, NYC, June 30, 2009
    • The Million Dollar Roundtable, June 2009, Change Your Brain, Change Your Life, Indianapolis
    • Retired NFL Players Summit, May 2009, The Impact of Brain Trauma on Retired NFL Players
    • National Public Television, The Brain In Love, 2009
    • National Public Television, Magnificent Mind At Any Age, 2008
    • National Public Television, Change Your Brain, Change Your Life, 2008
    • Creating Brain Healthy Treatment Centers, Promises, Malibu, 3/09
    • Creating Brain Healthy Treatment Centers, Sierra Tucson, Tucson, Arizona, 3/09
    • Brain SPECT Imaging In Clinical Practice, 5 Day Conference, Newport Beach 7/07 and Reston, VA 12/07, Newport Beach 2/09
    • Neuroscience and Spirituality Conference, Monterrey, Mexico 2008
    • Sex On The Brain, 8 Cities 2007
    • National Security Agency, Millennial Mind Conference, Hiring and Managing Brains for the NSA, Fort Meade, Maryland, 10/04
    • American Psychiatric Association, Annual Meeting, Chairman of two workshops, Uses and Controversies of Using Functional Imaging in Court and Using Imaging to Evaluate Treatment, New York City 5/04
    • Harvard Learning and the Brain Conference, Making A Good Brain Great, Boston, MA 4/04
    • Association of Christian Counselors, Imaging, Healing The Hardware of the Soul – Imaging, Addictions, Eating Disorders and ADD, Houston, 3/03
    • National Science Foundation, Advances in Technology Education, Keynote Address, 10/03
    • Learning Annex, Brain Day, Change Your Brain, Change Your Life, San Francisco, Los Angeles, San Diego, Fall 2003
    • Preventing Alzheimer’s Disease National Conference, Phoenix, AZ 10/03
    • EMDRIA Conference, Plenary Speaker on PTSD, EMDR and Brain SPECT Imaging, Denver 9/03
    • Strategies For Assessing Faith-Based Approaches to Substance Abuse Treatment and Prevention, Vanguard University 5/03
    • Opening The Mind: The Use of Brain SPECT Imaging in Clinical Practice, Irvine, CA 5/03 Co-Chair of Conference, co-sponsored by UC, Irvine and The Amen Clinics
    • Healing ADD, CHADD Organization, San Juan Puerto Rico 2/03
    • Brain Imaging and Psychiatry, Student Health Center, University of Southern California 1/03
    • Brain Imaging in Court, Contra Costa Bar Association, 10/02
    • Subtyping Neuropsychiatric Disorders with Brain SPECT Imaging, Grand Rounds, Department of Psychiatry, University of California, Irvine, 10/02
    • Brain SPECT Imaging In Psychiatry, In-Patient Grand Rounds, University of Southern California, 7/02
    • Brain SPECT Imaging In The Courtroom, American Association of Psychiatry and the Law, S. California Chapter, 6/1/02
    • Brain SPECT Imaging in Brain Injury, Salt Lake City, UT, Utah Brain Injury Association 3/14
    • American Neuropsychiatric Association, Controversies in ADHD 3/02
    • The Learning Annex, Change Your Brain, Change Your Life, 2/21/02
    • Loyola Marymount University – address to student body on Drug Abuse Is Brain Abuse 11/6/01
    • Behavior, Clinical Neuroscience, Substance Abuse and Culture, Sponsored by Charles Drew University/UCLA on Neuroimaging of Co-Occurring Mental Disorders, Implications for Treatment 10/25/01
    • National CHADD Meeting, invited lecture, Change Your Brain, Change Your Life 10/19/01
    • UC, Irvine, Department of Psychiatry Grand Rounds on Behavioral Neuroanatomy and Brain SPECT Imaging 10/16/01
    • California Psychiatric Association, Plenary Session on Brain SPECT Imaging 10/06/01
    • Orange County Psychiatric Society, Brain SPECT Imaging in Psychiatry, 8/01
    • Delaware Judges Conference, Healing ADD 6/01, Sponsored by the Supreme Court of Delaware
    • Ohio Judges Conference, Healing ADD 6/01, Sponsored by the Juvenile and Family Court of Ohio
    • National Council of Juvenile and Family Court Judges, San Francisco, Healing ADD 4/01
    • California State Conference on Domestic Violence, Firestorms Into The Brain: An Inside Look At Family Violence 9/00
    • National Council of Juvenile and Family Court Judges on ADD, Snowbird, Utah 7/00
    • Southern California Psychiatric Society: Firestorms Into The Brain: Brain Imaging and Violence 4/00
    • California Judges Education and Research Institute 2/00, Napa, California
    • Oregon School Counselor Association, Salem, Oregon 8/99
    • National EMDR Conference, Change Your Brain, Change Your Life, Las Vegas 6/99
    • Drugs, ADD, and Crime: Department of Alcohol and Drugs, Santa Clara County 6/99
    • Change Your Brain, Change Your Life, Healing ADD, Northslope Rural Health Department, Barrow, Alaska, 5/99
    • A Clinician’s Guide To Functional Brain Imaging, Course Chairperson, Annual Meeting of the American Psychiatric Association, Washington, DC, 5/99
    • Second International ADD Conference, Tel Aviv, Israel, 4/99
    • Pacific Northwest Nuclear Medicine Society, Bellevue, Washington 4/99, invited lecture
    • Southern California Chapter of Society of Nuclear Medicine, Phoenix 3/99, invited lecture
    • Training for Professionals at the Kineitsi Indian Tribe, Kenai, Alaska, 8/98
    • Tourette’s Association of Canada, Victoria, British Columbia, 5/98
    • San Jose Mayor’s Gang Task Force, 4/98
    • Learning Disability Association of Alabama, 3/98
    • National Adult ADD Conference, Los Angeles, 10/97
    • Tourette’s Association of Canada, Toronto, Ontario, Images, ADD Mind, 6/97
    • National Adult ADD Conference, St. Louis, ADD: The Reality, the Pain and the Incredible Joy, 5/97
    • Children’s Hospital Oakland, Brain SPECT Imaging in Psychiatry, 12/96
    • Prince Albert School System, Saskatoon, Canada, The ADD Mind, 10/96
    • The National Institutes of Health, sponsored by the Lab School, Washington, DC: Images into the Mind, 10/96
    • Brain SPECT Imaging in Child and Adolescent Psychiatry, State-of-the-Art Lecture in Medicine, Society of Developmental Pediatrics, 10/96
    • National AHEAD Conference, Windows into the ADD Mind, Adult ADD, Images Into the Mind, 7/96
    • US Department of Health and Human Service/LDA of Washington Public Policy Seminar on ADD and Learning Disabilities Conference, Seattle, WA 4/96
    • American Psychiatric Association Annual Meeting, Workshop on SPECT in ADD, 4/96
    • Santa Clara County Judicial Education Program, Windows Into The ADD Mind, 3/96
    • SF Psychiatric Society, Differential Diagnosis/Treatment of ADD in Adults, 4/96
    • California Orton Dyslexic Society, Windows Into The ADD Mind, 3/96
    • University of Delaware, 6 Hour ADD Seminar for Clinicians, 12/95
    • California Conference on Alcohol Problems, Yosemite, ADD Mind, Healing The Chaos Within, Co-dependency, ADD, and Alcoholism, 11/95
    • Learning Disability Association of Canada, Windows into The ADD Mind, Healing The Chaos Within, Overcoming the Intimacy Gap: ADD in Intimate Relationships, A Physician’s Guide to ADD, 10/95
    • California State Foster Parent Association, San Francisco, Understanding and Treating the Difficult Child, 11/94
    • University of Colorado Medical Center Grand Rounds, Denver, CO Brain SPECT Imaging, 3/94
    • University of SF Medical Center Child Psychiatry Grand Rounds, Brain SPECT Imaging in Psychiatry, 1/94
    • The Commonwealth Club in San Francisco, Windows Into The ADD Mind, 12/93
    • UC Davis, Psychiatric Grand Rounds: Brain SPECT Imaging In Psychiatry, 9/93
    • Evaluating ADHD With Brain SPECT Imaging, presented at the 1993 Annual Meeting of the American Psychiatric Association in San Francisco, CA, the 1993 Annual Meeting of the Society for Biological Psychiatry in San Francisco, CA and 1996 Annual Meeting of the American Psychiatric Association in New York, NY.
    • Brain SPECT Findings In Aggressiveness, presented at the 1993 Annual Meeting of the Society for Biological Psychiatry in San Francisco, CA.