Posted by Blue Cheer 1 on January 19, 2002, at 16:45:22
In reply to Re: Psychosurgery in the new millennium, posted by OldSchool on January 19, 2002, at 13:25:54
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> > Neuroimaging technologies far outpace their application in psychiatric disorders, and they're of no clinical value in diagnosis and treatment.
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> Oh yeah? Keep in mind nobody has said that functional neuroimaging is being used at the clinical levels of psychiatry yet. I already clearly stated that SPECT/PET/functional neuroimaging for psych disorders is still experimental.
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> However functional neuroimaging IS already being used in Neurology to aide the diagnosis of Neurological diseases like parkinsons, dementia, Alzheimers, etc. Why just today I was reading that brain scans are have potential use in early dx of MS.
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> Why in Neurology but not in psychiatry? HUH? Why? Why is that? Is it this double standard we have in our culture that mental illness is not a real disease? Id like to know.
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> Parkinsons disease, dementia and Alzheimers are "real" Neurological diseases. While severe clinical depression, bipolar manic depression and schizophrenia are only psychological or emotional disorders. I say BULL to that.
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> Mental illness is a neurological disease and should be treated like one. Bring on the brain scans.
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> Bad attitudes is what is keeping the mentally ill down. As long as so many have these ideas that mental illness is in the mind and not the brain, the idea of using functional neuroimaging in psychiatry will be criticized. "Oh this technology isnt clinically useful, its only experimental." BULL!!!
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> Get on the stick, spend the money and put some smart researcher people on it. There are very few smart people in psychiatry. Most of the smart people go into other branches of medicine. If given the budget, the leadership and the objective youd be surprised what could be done. If we can send a man to the mood, mental illness could be figured out.
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> Come to think of it, we probably know more about outer space and the moon than we do the human brain. Pathetic!!
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> >Even in bipolar disorder, an illness with many physiological features, functional neuroimaging isn't diagnostic of anything. I've had two SPECT scans and three MRI's (1990 to 2001). The most recent SPECT showed global, diffuse diminished cortical blood flow, and that when compared to the SPECT in 1990, basal ganglia dysfunction and increased activity in the tips of the temporal lobes had resolved. The diminished cortical blood flow was a reflection of the mood state at that time (depression), and in any case the findings weren't useful because multiple psychiatric drugs can also render the results inconclusive (no clinical significance). When beginning pharmacotherapy, neuroimaging is useful in order to rule out any brain pathology (e.g., tumors). Leading researchers such as Godfrey Pearlson, M.D. from Johns Hopkins and Perry Renshaw, M.D. from McClean Hospital will tell you it's not yet a diagnostic tool.
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> Not yet a clinical diagnostic tool, but its improving diagnosis. Its giving neuropsychiatrists new insights into mental illness. BTW, I never heard of these guys...who are they? In science you can always find one scientist or doctor to criticize the results of another scientist or doctor.
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> > A psychiatrist once told me that the state of neuroradiology today is comparable to going down into a subway concourse and tapping on various pipes leading to street level -- listening for different sounds that would tell you just what was happening up on the street (i.e., the brain). Well, it just doesn't work that way. :)
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> Who is this psychiatrist? They dont sound very knowledgeable to me. Many psychiatrists are not up on these new experimental technologies being developed in Neuropsychiatry. Ive run into several psychiatrists who never even heard of rTMS before and I had to give them the scoop on rTMS. I thought they were idiots.
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> I disagree with you and I think brain neuroimaging while far from being perfect, its certainly more advanced than the analogy you just gave.
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> > It's the nature of mental illness and the complexity of the brain; comparing it to AIDS is absurd. When do you suppose a vaccine will be found to cure AIDS? Not for a long time, I suspect. To think that "mental illness", given the countless variables in its expression, should be any different doesn't make sense to me. An _enormous_ amount of funding has gone into psychiatric research, including the 20 million dollar STEP-BD 5-year study.
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> Yeah but look at all the heavy duty, aggressive research going on in AIDS. Just in fifteen years science has gone from 0 MPH in being able to treat AIDS (if you caught HIV youd probably develop AIDS and die almost for sure) to now where AIDS is more of a manageable condition. Where you can stay alive. Thats because of heavy political pressure by gay groups to create hyperactive amounts of AIDS research and develop AIDS drugs fast.
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> AIDS research, which has accomplished a hell of a lot in a short period of time has occurred because of one simple reason. That reason is there is a strong will to stop AIDS. There is heavy political and cultural pressure to stop AIDS.
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> You dont see ANY real political pressure to fix the severe mental illness problem. We are medicine's forgotten redheaded stepchild that nobody gives a damn about.
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> AIDS research is done in a totally different manner than mental illness research. AIDS research is done in an expeditious manner...drugs are pushed thru the FDA fast and they cut thru the crap. In AIDS research, scientists get the job done and they get it done fast. The bull is cut thru there.
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> In psychiatry "research" things are notoriously slow and there is much lipservice. There is no sense of expedition to improve things, to get new treatments and methods of diagnosis fielded.
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> I think the AIDS research people would actually be a good model for the psychiatry research people. In short, get on the stick and cut thru the crap and start getting things done! People are sick, people are disabled! Why does it take FOREVER to get a new treatment?
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> I bet you this new Selegiline MAOI patch wont even be FDA approved because it causes "skin irritation." Give me a break. But I bet you AIDS drugs will continue to be passed thru the FDA which have a much worse side effect profile than the MAOI patch. And you know why? Because there is HEAVY pressure on the FDA to cut thru the crap with AIDS. Lipservice is not tolerated with AIDS research.
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> > >I couldn't think of a more exciting field for a medical student to pursue right now. The psychiatrists I've had in the past and the present are the most acccessible and hard-working professionals I've known -- period.
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> Ive had very few hard working psychiatrists and most of the ones Ive had were full of sh*t. Ive also run into so many attitudes in psychiatry, where the psychiatrist seemed to almost have an aversion or something to the whole idea of trying to modernize psychiatry and merge it into Neurology.
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> I no longer have any faith in psychiatry and havent had any faith in psychiatry for years. I do not think the present state of psychiatry will ever fix the millions of people with resistant or hard to treat mental illness.
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> I am 100% FOR new developing technologies like functional neuroimaging and despite all the naysayers who bad mouth it, I think there is much potential in it. I am all for trying to improve the ability to accurately diagnose psychiatry illnesses. Its long overdue.
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> Anytime you try to do something new, there are gonna be people who badmouth you for it. With mental illness with all the attitudes surrounding it, this is going to be even more of a problem.
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> Because of all the attitudes surrounding mental illness (it aint real) Im very skeptical about the future surrounding psychiatry research. Nobody cares.
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> Old School
I agree with most of what you're saying. However, as much as I believe, too, that psychiatric disorders have neurological underpinnings, the precise mechanisms by which they're expressed (in addition to psychosocial determinants) are still too complex to be explained by neuroimaging. Still, there are many journals (e.g., _Psychiatry Research: Neuroimaging_; published by the International Society for Neuroimaging, _Journal of Neurology, Neurosurgery, and Psychiatry_, etc.) devoted to psychiatry and neuroimaging. I suggest you do a Google search using the terms "neuroimaging psychiatry usefulness" and go to www.fmri-network.com for more information. I've emailed Dr. Pearlson about neuroimaging for BD and OCD, and he was talking about how there were only some research studies being done at Johns Hopkins. Dr. Renshaw is at Harvard. One of my treating psychiatrists is both a neurologist and psychiatrist (MGH-trained). Former psychiatrists involved in my care (one active in rTMS; formerly PET imaging in OCD, and the other, a TRD specialist who took a 6-month sabbatical to study neuroimaging have told me the same.Neuroimaging will be a valuable diagnostic tool in the future, for sure, but now its use is mostly in neurodevelopmental disorders (as you mentioned). I agree with the inordinate funding dollars allocated to AIDS research, but AIDS is an infectious disease and *the* leading cause of death in some countries. (I was surprised to hear that the University of Pittsburgh recently did a liver transplant on an elderly AIDS patient -- until I heard he was a leading AIDS activist. :)
I really don't think psychiatry research is getting short shrift; maybe 10 years ago.
Blue
poster:Blue Cheer 1
thread:88953
URL: http://www.dr-bob.org/babble/20020116/msgs/90788.html