Posted by manowar on November 30, 2001, at 15:51:17
In reply to Re: ex drug-addicts and psychopharmocology » Peter, posted by Elizabeth on November 30, 2001, at 2:01:34
> Hi. I don't think that ADD and bipolar d/o are generally considered "neurological" disorders (that is, a neurologist usually isn't the person to treat them, and neurological methods aren't the best way to diagnose them).
>
> In regard to the Klonopin and Adderall: if you're not abusing your meds, I wouldn't worry about what other people think or get bogged down in whether you really have a "chemical imbalance" or whatever. You know if you're abusing the meds or not; if you're not, then what's the problem?
>
> I'm skeptical of the value of functional brain imaging (e.g., SPECT and PET scans) for diagnostic purposes, for a few reasons; the simplest of these reasons is that any distinct state of mind you're in will produce a unique image. A SPECT scan may give you the *feeling* of "absolute certainty" that you want, but for me it's hard to get past the lack of evidence supporting the use of these tests for diagnosing these kinds of conditions. Some clinicians claim to have spectacular results using functional imaging to diagnose psychiatric disorders, but such claims can be very misleading (not necessarily intentionally, of course).Hello again Elizabeth,
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. It is only a "tool" or another piece of information that can help a doctor better diagnose, therefore better treat a condition. What harm is that? 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. 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.Dr. Amen has spotted problems using SPECT that have saved people's lives. In his book he cites at least a couple cases in which MRI didn't show a problem (like evidence of strokes) that SPECT did.
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. 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. Furthermore, I don’t think my insurance would have reimbursed me for the procedure if it were not helpful.
When finding out I had been to the Amen clinic, my new doc (he specializes in ADD) said to me “I see you’ve been to Mecca!” People come from all over the world to go to his clinics and get evaluations from him. I even saw a guarded prisoner in chains come to the clinic for an evaluation. I found out later that SPECT evaluations can be highly regarded evidence in insanity cases in the state of CA.
I don’t completely understand why more physicians are not doing it. I’m pretty sure that in CA, AZ, WA and other western states there are several clinics that specialize in SPECT besides Dr. Amen’s clinic. 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. Even though he has at least four of five pdocs that work for him he personally has to evaluate each and every scan. 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.
It seems to me that most doctors want to be 110% clear about a patient’s medical condition before he treats the patient. The more information he has the better. But it doesn’t seem to be that way in psychiatry. Now if the data is misleading then certainly the evaluation can be counterproductive. I don’t think it is. And just because a technology isn’t used often or it’s not widely accepted or it hasn’t been “proven” does not mean that the technology is not effective.
In Peter’s case, by having a multitude of problems (being diagnosed as bipolar, ADD, addiction and substance abuse issues and SP-- whatever that is), I think he would be a perfect candidate to have such an evaluation. What if his present doctor is wrong and he doesn’t have ADD? As you know, treating someone with pstims that doesn’t need them can make depression worse and I’m sure can make other problems worse too. Even if the scans do not change a doctor’s decision on a diagnosis and treatment plan, it could certainly help a patient accept his diagnosis and become more compliant with his doctor and his treatment.
Again, what harm is that other than a few days off, a little dose of radiation, and a lot of money. If a person is willing to do those things, I think the procedure can be VERY beneficial. A tiny ray of hope may give someone a reason to live that they didn’t have before. It did me.
Have a nice day:)
--Tim
poster:manowar
thread:85484
URL: http://www.dr-bob.org/babble/20011123/msgs/85651.html