Posted by Elizabeth on November 30, 2001, at 16:58:20
In reply to SPECT imaging has its place in psychiatry » Elizabeth, posted by manowar on November 30, 2001, at 15:51:17
> Unless Dr. Amen is lying about his work, which could very well be the case, but I doubt it-- SPECT imaging is a VERY useful tool in HELPING to diagnose a psychiatric or neurological problem.
Read what I said again. I am well aware that Dr. Amen and some other physicians have reported excellent results from using SPECT and PET scans in a clinical context to predict treatment response in psychiatric disorders. I certainly don't believe they are lying about their results; rather, I think that such "real world" results can be *misleading* because of the absense of clear scientific evidence supporting the use of these tests for the purpose of making such diagnoses. They functional brain scans are an experimental tool, not a proven one, so while I think they can be useful under certain circumstances (which is why I had one). They're not appropriate for general use. We don't all need to be rushing out to get a SPECT or PET scan!
In Peter's case in particular, I think the use of functional neuroimaging would be inappropriate because it sounds like simpler, inexpensive methods are working fine for him.
> I think information is power as long as we know what the limitations to the information may be, which in the case of SPECT I'm sure the doctors know.
Doctors are smart, of course, but they're human beings just like the rest of us. Doctors who are interested in experimental methods often get very excited when something seems promising. Sometimes
they can get overly excited and forget that their impressive results are only the beginning of the study of their new technique.> SPECT could play a very important role in Neurology and Psychiatry if more doctors and patients could set aside their skepticism and look at the facts.
IMO, the need is not for doctors and patients to "set aside their skepticism and look at the facts," but for researchers to do the necessary studies to determine what the facts *are* so the rest of us (i.e., doctors and patients) can benefit from them.
> In my case, I was not diagnosed with ADD until I had the SPECTs done. Earlier I suspected that I had ADD, but the doctors disagreed. I would have never had a chance to try a psychostimulant (which in my case has been VERY beneficial) if I didn't have the SPECTs done.
Our situations have a great deal of similarity, and indeed, many of my doctors have been very impressed by my SPECT results, which are apparently "abnormal." I also have a hunch that I might have ADD (or at least, that amphetamine might be helpful for some of my problems). I am fairly sure I could find a professional who would be able to make an argument that my SPECT result shows that I have ADD. I'm glad I don't have to go to all that effort, but also, I'd feel like I was being dishonest if I abused someone's excitement over a new diagnostic procedure to get someone to give me what I wanted.
> By the way, when I went to my local pdoc and gave him the 10 page report from the Amen Clinic, he completely and without question accepted the diagnosis and recommendations.
That doesn't mean much to me, sorry.
> Furthermore, I don’t think my insurance would have reimbursed me for the procedure if it were not helpful.
Again, I'm not willing to conclude anything from that. Insurance companies are strange beasties.
> I found out later that SPECT evaluations can be highly regarded evidence in insanity cases in the state of CA.
[Insert California joke here]
> I don’t completely understand why more physicians are not doing it.
I do -- the equipment is bloody expensive. Hospitals have it; doctors in private or group practices generally don't. What I don't understand is why more researchers aren't trying to pin down the psychiatric implications of SPECT and PET scans.
> I know that in Dr. Amen’s case, he had to get extensive training to be certified in the technology before he could use it in his practice.
Well, sure; this is heavy-duty equipment. That doesn't have anything to do with interpreting the results, though.
> After a doctor goes into practice, I would assume that he would be very reluctant to go back to school, purchase a lot of very expensive equipment, hire a technician and plan to open a psychiatric clinic that specializes in an obscure imaging technology that is not widely accepted.
But in fact, many people are flocking to these clinics. Why? Because the excitement about the technology is contagious. Like Peter, patients everywhere want to get "proof" that they have a "neurological disorder." It's not that puzzling.
> What if his present doctor is wrong and he doesn’t have ADD?
A SPECT scan is not going to show that he does or doesn't have ADD. It sounds to me like what Peter wants is to have his condition "validated," to feel like he's justified in taking drugs that have abuse potential after having been addicted to similar drugs. A SPECT scan may give him that sense of comfort, but it would be a false sense. I'd prefer to see him come to terms with his need for medication, to feel comfortable taking his meds without feeling like he doesn't deserve to feel well because of his addiction history. This isn't what a SPECT result would give him; rather, it would make him feel that what he really has should be considered a "neurological disorder" and that for *that* reason, he deserves to feel well (as though a mere drug addict would not deserve to feel well). No, I don't think that using the SPECT scan for the "ray of hope" reason is a good thing at all.
And there's something important to consider: what if the SPECT scan "showed" that Peter doesn't have ADD and thus made his doctor decide that he shouldn't be taking Adderall (even though it's working)? Would that be a good thing? You don't have to have ADD to have a positive response to stimulants. They help many people with depression and other conditions as well.
The functional brain scans may well become an important part of psychiatric diagnosis in the future. For now, let's not get carried away.
-elizabeth
poster:Elizabeth
thread:85484
URL: http://www.dr-bob.org/babble/20011123/msgs/85661.html