Multi-site, six month outcome study of complex psychiatric patients evaluated with addition of brain SPECT imaging.

ABSTRACT:

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.

Objective: In this study we examine the outcome impact of the addition of SPECT to the assessment of complex patients.

Methods: 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).

Conclusion(s): 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.