Ellen Harrell

Mr. Conway
Diverse Learners
11 April 2017
Outline

Purpose: The purpose of this paper is to evaluate the prospects of medical imaging in psychiatric
diagnoses and treatments. The paper will analyze the misdiagnosis and mistreatment of bipolar
disorder in the current system in relation to the prospects of medical imaging for diagnosing and
treating this disorder. This examination will help formulate an understanding of the broader
implications of medical imaging in psychiatry.
Thesis: Neuroimaging may not be the most developed way to diagnose and treat mental illness
currently, but psychiatrists need to begin the shift towards neuroimaging for diagnosing and
treating mental illness.This shift would ultimately prevent the rampant misdiagnosis and
mistreatment that is currently taking place with many disorders, including Bipolar Disorder.

1. Theory behind brain imaging as a diagnostic tool for mental disorders

a. Because mental illness results from dysfunction in the brain itself, pioneering
psychiatrists are beginning to look to new methods, like brain imaging, to
diagnose, and reevaluate their old methods.
a. Amen, D. “The most important lesson from 83,000 brain scans.”
i. This Ted Talk advocates for the use of brain scans to diagnose
disorders, examining brain activity and structure. He is the pioneer
in brain imaging and mental illness. He argues that the use SPECT
technology is the best method to diagnosing disorders.
b. Abrams, L. “Study: most people diagnosed with depression do not actually
meet criteria.”
i. Provides facts and statistics showing that most people w/
depression diagnosis don’t meet the criteria when they’re
reevaluated. It shows that more educated people are more likely to
have correct diagnoses along with other demographics. It discusses
how the diagnosis process is subjective, and you walk away with a
guess or opinion rather than a diagnosis.

b. While many experts have faith in brain imaging playing a large role in future diagnoses
and treatments, others suggest that imaging will not be as useful as we think.
1. Carey, B. “Can brain scans see depression?”
a. Source talks about how imaging research hasn’t come far enough
yet to start using it, that the biomarkers aren’t clear enough. It
criticises brain imaging b/c brains can vary a lot just out of normal
 changes (like brain volume varying by 10% from person to
person). So brain volume cannot be used as a biomarker, even
though schizophrenic patients lose a lot of brain volume. Also talks
about how placebos work well
2. Sproonteen, E. et al.
a. Discusses difficulty in using fMRI because patients get anxious
when they are being studied.

Misdiagnosis of bipolar disorder as unipolar depression

1. To illustrate how the current diagnosis process frequently fails to paint an accurate
picture, this paper will examine the misdiagnosis of bipolar disorder, alongside how brain
imaging may be able to fix this problem.
c. Singh, T, & Rajput, M. “Misdiagnosis of Bipolar Disorder.”
i. Numbers on how many people are misdiagnosed with bipolar
disorder. Reviews how a large number of people are misdiagnosed
with unipolar depression. It discusses the DSM-IV criteria and how
it was overly restrictive in diagnosing bipolar disorder.
d. Keener, M. T. “Neuroimaging in Bipolar Disorder.. A critical review of
current findings.”
i. There are “endophenotypic markers” that distinguish bipolar from
depression, and who will develop bipolar depression, allowing for
early intervention.
e. Fung, G., et al. Distinguishing bipolar and major depressive disorders by
brain structural morphometry: a pilot study.
i. People with bipolar have larger cortical surface area than those
with major depressive disorder. Talks about genetic factors. People
with bipolar have more “white matter abnormalities, grey matter
volume reductions, different aberrant functional connectivity in
neural circuits responsible for brain regulation.”

Brain structure biomarkers in different mental disorders

1. Similarly to Bipolar Disorder, other disorders can be differentiated from each other based
off of imaging.
f. Sprooten, E., Ragson, A. Goodman, M. Carlin, A. Leibu, E. Lee, W. H. &
Frangou S. Addressing Reverse interference in psychiatric neuroimaging:
Meta-analysis of task related brain activation in common mental disorders.
i. Study analyses differences in brain imaging among five mental
illnesses (bi-olar, schizophrenia, mdd, anxiety, OCD). reveals that
disorders are concentrated in limbic system. Also shows cerebral
 cortex is less related to illnesses at hand. Discusses difficulty in
imaging
g. Drysdale, A. T. et. al. Erratum: Resting-state connectivity biomarkers
define neurophysiological subtypes of depression.
i. Different types of depression based on brain structure
h. Sankar, A. et. al. Diagnostic potential of structural neuroimaging
i. This study found that people with depression have different white
and grey matter than people without depression regardless of
ethnicity

Treatment methods based on biomarkers

i. The effectiveness of treatment can also be evaluated using medical
imaging, which will allow for more specialized and individualized
responses to different mental illnesses illness.
j. Chen-hua C., et al.
i. How antidepressants change brain matter. Study gave patients 20
mg of prozac a day and noted that when doing this, their symptoms
changed significantly when their grey matter in their brain also
changed. The study indicated that the anterior cingulate cortex can
predict the response to antidepressant treatments.
k. Keener, M. T. & Phillips, M. L. Neuroimaging in Bipolar Depression: a
critical review of current findings.”
i. How medications affect people with bipolar. Study about how
people who use certain medications have brains that more closely
resemble those of a healthy person.