How Can a Brain SPECT Scan Help Me Get Better Faster?
While most psychiatrists continue to diagnose patients based on “symptom clusters”—similar to the way Abraham Lincoln was diagnosed with “melancholia,” or depression, over 150 years ago—a growing number are embracing sophisticated brain imaging technology to aid in the diagnosis and treatment of psychiatric, cognitive, and behavioral issues. A functional brain imaging technology called SPECT (single photon emission computed tomography) has emerged as one of the most helpful tools in clinical practice.
In 2021, the Canadian Association of Nuclear Medicine (CANM) unanimously endorsed SPECT for the assessment of a wide array of issues, including:
- Neuropsychiatric disorders, such as ADD/ADHD, bipolar disorder, depression, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD)
- Suspected dementia, including Alzheimer’s disease, mild cognitive impairment, vascular dementia, and frontal temporal lobe dementia
- Substance abuse
- Traumatic brain injury
- Strokes
With brain SPECT imaging, the future of psychiatry is here now.
To clarify, a SPECT scan is not a stand-alone diagnosis; the data it provides must be analyzed together with other assessments and pertinent information about a patient. However, by looking at the brain—the organ being treated—this advanced imaging technology can reveal blood flow and activity patterns that align with many different types of mental health disorders. In addition, SPECT scans can help identify the root causes of psychiatric symptoms and prompt physicians to ask better questions to get to the source of those symptoms.BRAIN SPECT IMAGING HELPS IN THE DIAGNOSIS OF THESE 9 PSYCHIATRIC CONDITIONS
In a nutshell, brain SPECT imaging reveals 3 important things:- Areas of the brain that work well
- Areas of the brain that are overactive, meaning there is abnormally high blood flow
- Areas of the brain that are underactive, indicating lower than normal blood flow to those areas
ADD/ADHD:
SPECT scans reveal that ADD/ADHD is not a single or simple disorder. Brain scans show there are 7 types of ADD/ADHD and each type has a unique pattern of cerebral blood flow, however, they all share one pattern in common. During concentration, blood flow decreases in the prefrontal cortex, which makes it difficult to stay focused and avoid distractions. Anxiety: Findings from the scans typically show overactivity in the basal ganglia, which are deep structures in the brain involved with motivation, movement, and setting the body’s “idle.” When they are overactive, it leads to feeling anxious, nervous, and worried, and can cause physical symptoms such as a pounding heart and muscle tension.Bipolar Disorder:
Although the exact cause of this condition is still not known, it is associated with changes in the function and structure of the brain. SPECT imaging studies have shown that in addition to focal areas of increased activity in the deep limbic system, there is often high activity in other parts of the brain.Dementia:
Not only can SPECT scans show the specific patterns of the different types of dementia, but it can also identify them years before noticeable symptoms emerge. In Alzheimer’s disease, the temporal and parietal lobes will have lower-than-normal activity, as will the posterior cingulate. In frontotemporal dementia, there will be low blood flow in the frontal and temporal lobes, while in vascular dementia, low blood flow in the areas of the brain that are affected by blood vessel damage will be apparent.Depression:
On SPECT scans, a person who is depressed usually has too much overall activity in the deep limbic system, which is the emotional center of the brain. In some cases, depressive symptoms also arise from low blood flow in the frontal lobes, which can make it difficult to put the brakes on negative or sad thoughts and feelings. SPECT is also helpful in the diagnostic process when depression and anxiety are seen together, which occurs in patients about 75% of the time. Plus, there are 7 types of anxiety and depression, each of which has its own signature pattern and set of symptoms that need different treatment strategies—yet another reason why it is so critical to look at the brain to get a correct diagnosis.Obsessive-Compulsive Disorder:
With this often-debilitating condition, the scans usually show very high activity in the basal ganglia (described above) and an area called the anterior cingulate gyrus (ACG), which is involved with attention. The increased blood flow to this part of the brain makes it very difficult for people to shift their attention from one thing to the next. Consequently, they get stuck on obsessive thoughts and compulsive rituals. Interestingly, the overactivity in the ACG can also be seen in some patients who have autism spectrum disorder, people who are very inflexible and rigid, and those with the oppositional defiant disorder.Posttraumatic Stress Disorder (PTSD):
Whether from childhood trauma, military combat, sexual assault, or other experiences that were life-threatening or felt like it, people suffering from PTSD often have multiple areas in the brain that are overactive. These usually include abnormally high blood flow in the deep limbic system, basal ganglia, and ACG. The overactivity in all of these areas drives many of the distressing symptoms caused by the emotional impact of the trauma.Traumatic Brain Injury (TBI):
SPECT scans show that nearly 40% of the patients at Amen Clinics have experienced a physical injury to the brain from some type of head trauma. When asked, many people initially don’t remember hitting their head! Injuries from childhood, such as falling out of a tree or crashing on a bike, or concussions from sports, car accidents, and other common causes often get dismissed and forgotten unless they had a cracked skull. Unhealed injuries to the brain can lead to myriad mental health symptoms that can persist for years because they are never properly diagnosed or treated, including:- Difficulty with concentration
- Moodiness
- Memory problems
- Depression
- Anxiety
- Anger issues
- Brain fog
- Poor judgment
- Impulsivity
- Risky behavior
- Addiction
Toxic Exposure:
Similarly, toxins can be harmful to the brain. Again, many people don’t know that they have been or are being exposed to toxic substances that are causing serious problems. On SPECT scans, toxicity shows an overall pattern of decreased activity, affecting many areas of the brain. Among other things, it can be caused by- Drug or alcohol abuse
- Environmental toxins such as solvents, pesticides, heavy metals, and mold
- General anesthesia and chemotherapy
- Carbon monoxide poisoning
WITHOUT SPECT, GETTING AN ACCURATE PSYCHIATRIC DIAGNOSIS CAN BE DIFFICULT
In all these conditions—and many others—there are symptoms that can overlap with those in other mental health disorders which can make the diagnostic process very difficult. An explosive 2019 study in Psychiatric Research confirms the fact that making psychiatric diagnoses based solely on symptom clusters is scientifically meaningless and disingenuous. The study, led by University of Liverpool researchers, focused on a meticulous analysis of five chapters in the Diagnostic and Statistical Manual (DSM-5): anxiety disorders, depressive disorders, trauma-related disorders, bipolar disorder, and schizophrenia. Their main findings highlight many of the shortcomings of the current diagnostic paradigm:- There is a major overlap of symptoms among diagnoses.
- Many diagnoses overlook the role of psychological trauma and head trauma.
- The current approach rarely takes the individual in mind.
