Brain imaging gives new insight into mental disorders - Baylor College

[lbjnltx]

Brain imaging gives new insight into mental disorders -

Baylor College

HOUSTON -- (August 25, 2010) -- A new kind of psychiatry built on objective measures derived from functional magnetic resonance imaging (or fMRI) of the brain performed while patients play economic games could provide new insight into the diagnosis and, eventually, treatment of mental disorders, said researchers from Baylor College of Medicine in a review in the current issue of the journal Neuron.

New tools, new field

These new tools will not only help produce new brain "signatures" associated with disorders such as autism, schizophrenia and borderline personality, they will also help identify the nature of normal variation in human decision making and the brain, said Dr. P. Read Montague, professor of neuroscience and director of the Computational Psychiatry Unit at BCM, and Dr. Kenneth T. Kishida, a postdoctoral fellow in the area.

Montague is a pioneer in a discipline that uses powerful fMRI machines to measure how blood flows in the brain while individuals play economic games that always involve choice and sometimes require cooperation between participants – a growing paradigm that has come to be known as neuroeconomics. The areas of greatest blood flow reveal what parts of the brain are involved during the decision-making process.

The two, along with Dr. Brooks King-Casas, assistant professor of neuroscience at BCM, describe a number of studies involving people with and without mental disorders in a review of the beginning of a new field – computational psychiatry.

Identifying disorders, defining "normal"

In a crucial prior study, King-Casas and others at BCM identified a characteristic fMRI "signal" that distinguished borderline personality disorder – a disorder that is extremely hard to diagnose – from psychologically healthy controls.

Not only do Montague and his colleagues seek to build a more concrete or objective method of diagnosis for mental disorders, they also seek to determine the range of what is considered healthy or "normal".

"What is the nature of normal variation in these games," said Kishida. "Can this help us measure the difference between what is considered healthy and what is pathologic?"

Augmenting assessment

Currently, most psychiatric diagnoses are descriptive, based on a cluster of symptoms recognized by professionals and codified in a standard guide called the Diagnostic and Statistical Manual of Mental Disorders. (It is now known as the DSM-IV, and the DSM-V is scheduled for release in three years.)

Montague said their aim is not to replace psychiatrists or psychologists but "to augment their way of assessing people."

Once scientists identify the brain signals associated with a particular pathology and the areas or tissues involved, they can then start to look for the genes associated with those patterns, said Montague and Kishida. That will involve scanning the brains of thousands of people, both those who are healthy and those with known pathologies.

www.bcm.edu/news/item.cfm?newsID=2660&r=1

[lbjnltx]

here is the link to the "previous study":

www.bcm.edu/news/item.cfm?newsID=1177

lbjnltx

[nothinleft]

I totally agree with the direction and the reasoning behind this type of study. I have had a great deal of first hand experience in dealing with my BPD SO. My comments are based on many years of living day to day with this syndrome, being face to face with just about all of it's major manifications and consequences. It has run the gap from a sense of something not being quite right under the surface, to full-blown , long lasting psychotic episodes, whether based on anger, exceedingly deep sorrow, or total loss of reality, etc. One constant that I have observed in my bpo SO is that there is absolutely no understanding (or desire to, for that matter), and I am starting to believe conception, of certain issues and constructs. The facts, the explainations or the outcomes make absolutely no difference. It does not matter how many times or what the consenses, she still thinks and feels, and thus acts in the same manner. There is simply such a strong denial, that nothing can impact a change, at this point.  I realize that the brain is quite unique in that it is both physical and mental in it's functioning, responding to both oral and chemical-physical input (to use layman's terms). In the absence of any change being brought about by the oral stimuli processes of idea exchange, and the learning through consequence of actions, I am convinced that there must be an anomoly in the chemical-physical activity of the bpo brain. The bpo's physical brain must be lacking some inherent capabilities based on it's physical-chemical nature being sub par (not normal). That is one of the few probabilities that actually gives a plausable reason, in my opinion, for the bpo's destructive mental and emotional makeup, which is completely resistant to any therapy, irregardless of what the results. So, i believe that this type of research is extremely vital to unraveling the many of the frustrations of dealing with and helping those with this sickness.

[goldstar]

There was a show on last night about brain imaging. This dr. could tell if a person was a murderer by his brain image.  The front portion of the brain was low functioning -- bluish instead of a vibrant orange/yellow.  He was a desendant from the Cornells (as in the University) in which Lizzie Borden is also his ancestor. He did his brain and his entire families'. His brain was the only one that had this "murderer" brain image. His reasoning was that the love and support that he received throughout his childhood countered "what he could have been."

It was fascinating.

[lbjnltx]

goldstar,

sounds similar to SPECT scans done by the amen clinic and clements clinic, etc... .

[Demeter]

This is fascinating. The brain is such a mystery. I think it would be a great tool. Like Goldstar said, some people may be able to compensate for what is their "destiny". Is this a diagnosis tool or is this a tool to see what will be? If it is a brain issue, will their be a treatment?

Demeter

[greenlove]

Studies like this, and the tools which may result from it, can make things so much simpler, even easier.  Can you imagine a diagnosis from a test, a picture of how the brain works?  This would be clear and without judgement, for the most part.  It takes away the stigma of the mental illness as well, because... .although we know now there are physical factors involved in mental illness, it is a supposition for the most part.  Having the physical demonstrated before our eyes, or our loved ones who may not understand how their behaviors affect others, could be really helpful.  People might not be as defensive and might actually be more willing to get help.  I also think this could lead us to better treatment options.   

[innerspirit]

Studies like this, and the tools which may result from it, can make things so much simpler, even easier.  Can you imagine a diagnosis from a test, a picture of how the brain works?  This would be clear and without judgement, for the most part.  It takes away the stigma of the mental illness as well, because... .although we know now there are physical factors involved in mental illness, it is a supposition for the most part.  Having the physical demonstrated before our eyes, or our loved ones who may not understand how their behaviors affect others, could be really helpful.  People might not be as defensive and might actually be more willing to get help.  I also think this could lead us to better treatment options.   

AMEN!

[qcarolr]

I haven't read the entire article, and will reply again after I can do that. My initial feelings about this research area is  . This is extremely valuable research. The key for me is what we do with the results that will lead to a positive result in individual lives. What new treatments can come from this? What kinds of support for families coping with the extremes and stresses of life with BPD can evolve? And it will be an evolution over time. The fear is to substitute one stigma for another. It is really important to remind ourselves this is another tool, not the miracle answer. And I hestitate to use this as a way to pre-diagnosis an individual's potential for having problems outside the normal range of behavior without other criteria being met and evaluated by a qualified professional. The environment a person's brain develops in can make such a gigantic difference in how they respond to their world.

Thanks lbj for this contribution to our tool bag. qcr xoxox

[Skip]

It is really important to remind ourselves this is another tool, not the miracle answer. And I hestitate to use this as a way to pre-diagnosis an individual's potential for having problems outside the normal range of behavior without other criteria being met and evaluated by a qualified professional.

I believe that theses developments are more significant to the research community than to the clinicians that treat us.  The practical value of this work is not there yet. 

One of the biggest benefits of this type of basic research is that it is potentially a very good tool for the development of pharmaceutical solutions to the disorder.  Once researchers can see and measure the disorder they have a way to evaluate the effectiveness of different compounds (drug candidates).

For there to be any meaningful advancement in treatment, advances also have to occur in the development of cures (diagnosing only helps if you have a reliable cure/treatment).

The ideal future outcome is to have specific treatments for these disorders (and different levels of severity) and a test that can direct who gets which treatment - this guy is bipolar (treat with tricyclics, MAOIs, or lithium), this guy is BPD (reliable treatment to be developed), this guy is skizophrenic (reliable treatment to be developed).

[snowrose]

Once scientists identify the brain signals associated with a particular pathology and the areas or tissues involved, they can then start to look for the genes associated with those patterns.

I think they might be barking up the wrong tree with this part.  This is the old nature versus nurture debate, and honestly I think BPD is more a factor of having been raised in a very distressing environment rather than the genes that you're carrying around.  They need to test in both directions rather than assuming it's genetic.

[roni-nator]

I agree with greenlove.  I think it will help to reduce stigmas.  I grew up in a church that was so fundamentalist and judgmental that my whole family will be scarred for life by their attempts to convince us my BPD father was evil and therefore bound straight for hell if he couldn't change his ways, but with the tools they gave him, he couldn't change his ways.  Imagine the impact that had on us children, hearing that from the time we were old enough to understand that meaning comes from the formation of sentences from the words we'd been learning.  My father is a very old man now and wants to change so badly.  He is in counseling and on meds, and just last week he told me that he was going to go to hell if he didn't change his ways, but he knew even as he said it he couldn't change any faster than he was cuz he has a daunting task ahead of him.  But, with some people, it probably won't matter any way, because Billy Graham's daughter came out a while ago and shared her story of her own clinical depression and said she was coming out cuz she was tired of being a plastic Christian and the world was tired of seeing plastic Christians, and it still has opened very few minds.

The other part is that if we have te physical cause of any ailment, we can better treat it.  The past few years it has been proven that the meds we have available to us for depression are not very effective and booster meds to supplement them have come out.  If we know the true physical cause, we can better treat it.  I think the lack of appropriate medicines has increased the stigma, so I think having a better foundation for coming up with the best treatments will also decrease stigma.

[greenlove]

Roni-nater:  I am so glad your father is attempting to get help and change, after such a long life.  I don't want to go into too much on this, but I'm sure Jesus' example would be for him to do that, so he's doing great!  I got all warm inside just reading what you wrote about him. 

And as far as nature vs nurture goes, my read of more recent literature is that BPD is more likely biological/genetic, with environment playing a part, some of the time.  In fact, with the examples I see in my work with mental illness overall, biology appears to be the greater factor. 

We, as a culture, don't have the same issues with physical health issues that we do with mental health issues, and once the physical is more clear, it will pave the way for better understanding, better treatments, etc.

[roni-nator]

greenlove - thank you.  It helps me to know that BPD is more a biological cause.  I do hope that our culture is soon able to come to an understanding that mental disease is physical, so people with mental disease can be treated better.

I worked with a lady a few years back whose mother had been admitted into a mental hospital months before.  She kept telling everyone that she was not crazy but she was sick.  After months of begging for medical tests, they found out she had thyroid disease and it was causing her to have mood swings that had been labeled as mental disease.  I met several people along the way who had PMDD that was diagnosed as mental disease.  Now, they have drugs to treat PMDD and it is recognized as physical.  I have a severe case of hypoglycemia.  My blood sugar frequently drops into the low 40's, which is very low.  Early on, I was diagnosed as having anxiety disorder and panic attacks due to the shaking that came from low blood sugar.  When no meds they tried me on made a difference at all and the only thing that stopped the shaking was food - I noticed it always stopped after meal time after going on for sometimes several hours - I did some research and learned about hypoglycemia and asked for a 6 hour Glucose Tolerance Test.  I had to fight all the way up to the top to get the test approved only to find out that at 3.5 hours my blood sugar dropped to 42.  An endocrinologist I went to after that gave me the book "Hypoglycemia:  A Better Approach".  I don't know if it is still in print, but in that book it talked about how when hypoglycemia was first discovered as a valid illness that many people were released from mental hospitals because their symptoms went away when they learned to treat the shaking by ingesting something that would raise blood sugar.  Even if it doesn't all prove to be brain chemistry, I think ALL mental disease has a physical root.

[greenlove]

Hi Roni-nater,

I know we are getting a little off the posted topic, but I understand what you are talking about with the hypoglycemia.  I have worked with a naturopath, who has identified some issues for me in regard to anxiety.  Magnesium deficiencies can cause tension and headaches in addition to muscle aches.  B12 deficiencies have psychiatric effects.  There is so much to look into.  TTYL.

[lbjnltx]

I met several people along the way who had PMDD that was diagnosed as mental disease

i saw dr. phil yesterday.  the topic of discussion was menapause and pms.  one husband actually said "i walk on eggshells for most of the month". 

lbjnltx

[william3]

I just read this interesting article:

Determining 'Brain Age' With A Simple Scan.

www.npr.org/templates/story/story.php?storyId=129754434

Has someone used this technique on BPD?

It would be interested in seeing if DBT affects brain age as measured by this scanner.

[Alastor]

I'll play devil's advocate here. Does anyone remember phrenology? www.en.wikipedia.org/wiki/Phrenology It's where they used to take measurements and proportions of your head to determine if you were good at math, a criminal, etc. Obviously that's been completely debunked now.

Is fMRI the modern equivalent of phrenology?

I don't think it is and I believe the science seems sound (my colleague works with fMRI). However, as with all things, the relationships between brain function and behavior are super complicated, often confounded with all sorts of environmental and personal factors. Unfortunately, we tend to grab on to these technologies at their simplest level and apply them across the board, and fMRI is still an emerging technique.

My point is that fMRI is just one more research and diagnostic tool in understanding and diagnosing things like BPD. There will be a lot more techniques in the future, of which fMRI will likely just be one part of the puzzle.