![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 37 to 61 of 68. Go back in thread:
Posted by manowar on January 12, 2002, at 1:40:35
In reply to Re: Old School nailed it » manowar, posted by bob on January 10, 2002, at 23:14:22
Hi Bob,
Thank you for your post and I'm glad you raised these concerns.
> I'm not so convinced about SPECT imaging, or any other imaging to help in out *treatment* of our diseases. For example, say a person consults a psychiatrist complaining of classic OCD behavior and depression. Then the patient is referred for a SPECT scan and it is confirmed that, indeed, the specific areas of the brain involved in those aberrations are indeed not functioning properly. How would that change the treatment?
First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.
My point is that in 'treatment resistant' cases, functional brain imaging can be very beneficial. Instead of a doctor solely relying on what a patient tells him – which-let’s face it- can be erroneous, misleading and downright confusing-- not only to the doctor but for the patient, also-- he now has another tool to help diagnose and pinpoint the problems so that he can devise a better and more aggressive plan towards treatment.
BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.
For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.
My attitude also changed. I wasted fifteen years of my life thinking I just needed to go to church more, listen to Tony Robbins, and meet some new people, yada, yada, yada. Don’t get me wrong, good psychology and a balanced lifestyle are necessary to a healthy life. The problem was, I was just lukewarm about psychiatry for many years.
The last three years of my life were a living hell. Thank God, last summer, I took the GIANT STEP and decided that I would spare no expense towards getting better. Now, because I’m a better informed consumer, I’m a hell of a lot more vigilant about psychiatric treatment than I EVER was before. I take complete responsibility for my condition. I don’t just rely on a doctor’s opinion anymore. The way I look at it—I pay my doctor as a consultant, just like I pay consultants in my business. Some consultants I’ve hired in business are more expensive than doctors. I DEMAND cooperation and respect from consultants I HIRE in business, so why should this be any different with my doctors? Because he has a PHD? I don’t think so. If I feel that my doctor is not working for me, and treating me like he thinks I’m a lowlife, I won’t hesitate going somewhere else (which I did recently).
And when I gave the new doctor the 10-page report with scans from the Amen clinic, he knew I meant business, and he listened.
I used to be one of those poor saps that bumbled into my pdocs office without a clue, completely and utterly dependant on his experience, compassion and grace to help me with my DISEASE. Not anymore. I come prepared- and because of places like Psychobabble- I’m armed, not with lame propaganda that we get from television commercials, but good, rock solid data (My pdoc just eats it up!) And I refuse to listen to the propaganda that drug reps feed to so called doctors (e.g. That Effexor is “Prozac with a punch”-BS)
>What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.
Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)
Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.
Examples of subtypes of depression:This is from Dr. Amen’s web page www.brainplace.com:
Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression. The severity of depression is often related to the degree of frontal hypometabolism. Several studies have indicated that the hypometabolism normalizes after treatment if the patient's mood improved. Researchers have also seen increased limbic system activity as well in depression (thalamus, amygdala, cingulate gyrus and deep temporal lobes). When depressed patients perform a concentration task the left prefrontal cortex often activates to normal levels, differentiating depression from attention deficit disorder which often shows normal activity at rest and decreased prefrontal cortex activity with concentration.
SPECT can be helpful in the diagnosis and treatment in complex or resistant depressive disorders by differentiating it from other disorders, enhancing compliance by the patient being able to "see the changes in the brain," and by subtyping depression. Here are three subtypes that one of the authors has identified.
· Decreased prefrontal cortex activity with increased deep limbic system (thalamus) activity. This subtype is often associated with moodiness, negativity, low energy, sleep and appetite problems and poor concentration. It often responds best to dopaminergic or noradrenergic interventions such as buprion, imipramine or desipramine.
· Increased anterior cingulate (this part of the brain is heavily innervated with serotonergic nerve fibers), thalamus and basal ganglia activity. This subtype is often associated with sadness, negativity, irritability, worrying, cognitive inflexibility, worrying and getting stuck or locked into negative thought patterns. It often responds best to the serotonergic antidepressants such as fluoxetine, sertraline, paroxetine and venlafaxine.
· Decreased prefrontal cortex activity with increased or decreased temporal lobe activity. This is often the most serious subtype and it is often associated with sadness, irritability, rage (toward others or self in suicidal behavior), mild paranoia, atypical pain (atypical headaches or abdominal pain) and insomnia. We have seen this subtype often made significantly worse by serotonergic medications and it is often helped by anticonvulsants, such as gabapentin or divalproate.God Bless
--Tim
Posted by BarbaraCat on January 12, 2002, at 2:10:52
In reply to Why I think we all need our heads examined » bob, posted by manowar on January 12, 2002, at 1:40:35
Tim,
Great post! This is the stuff that changes things. My question to you is, how did you go about getting these tests? Did you contact Dr. Amen's clinic on your own? Pay for it on your own? What sources would you suggest for getting the best info on this to present as evidence to my own pdoc? If I have to pay for it myself, so be it, but I won't go down without a fight. You think a Pit Bull's got tenacity? This is one brain-battered gal on a mission!BTW, the Borna virus re-vivification is uncanny. I was also talking about this a few weeks ago to my husband wondering what ever happened to the research. He says maybe it should now be called the 'Bornagain' Virus. . .
Barbara
> Hi Bob,
>
> Thank you for your post and I'm glad you raised these concerns.
>
> > I'm not so convinced about SPECT imaging, or any other imaging to help in out *treatment* of our diseases. For example, say a person consults a psychiatrist complaining of classic OCD behavior and depression. Then the patient is referred for a SPECT scan and it is confirmed that, indeed, the specific areas of the brain involved in those aberrations are indeed not functioning properly. How would that change the treatment?
>
> First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.
>
> My point is that in 'treatment resistant' cases, functional brain imaging can be very beneficial. Instead of a doctor solely relying on what a patient tells him – which-let’s face it- can be erroneous, misleading and downright confusing-- not only to the doctor but for the patient, also-- he now has another tool to help diagnose and pinpoint the problems so that he can devise a better and more aggressive plan towards treatment.
>
> BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
>
>
> Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.
>
> In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.
>
> For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
>
> My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.
>
> My attitude also changed. I wasted fifteen years of my life thinking I just needed to go to church more, listen to Tony Robbins, and meet some new people, yada, yada, yada. Don’t get me wrong, good psychology and a balanced lifestyle are necessary to a healthy life. The problem was, I was just lukewarm about psychiatry for many years.
>
> The last three years of my life were a living hell. Thank God, last summer, I took the GIANT STEP and decided that I would spare no expense towards getting better. Now, because I’m a better informed consumer, I’m a hell of a lot more vigilant about psychiatric treatment than I EVER was before. I take complete responsibility for my condition. I don’t just rely on a doctor’s opinion anymore. The way I look at it—I pay my doctor as a consultant, just like I pay consultants in my business. Some consultants I’ve hired in business are more expensive than doctors. I DEMAND cooperation and respect from consultants I HIRE in business, so why should this be any different with my doctors? Because he has a PHD? I don’t think so. If I feel that my doctor is not working for me, and treating me like he thinks I’m a lowlife, I won’t hesitate going somewhere else (which I did recently).
>
> And when I gave the new doctor the 10-page report with scans from the Amen clinic, he knew I meant business, and he listened.
>
> I used to be one of those poor saps that bumbled into my pdocs office without a clue, completely and utterly dependant on his experience, compassion and grace to help me with my DISEASE. Not anymore. I come prepared- and because of places like Psychobabble- I’m armed, not with lame propaganda that we get from television commercials, but good, rock solid data (My pdoc just eats it up!) And I refuse to listen to the propaganda that drug reps feed to so called doctors (e.g. That Effexor is “Prozac with a punch”-BS)
>
> >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
>
> Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.
>
> Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)
>
> Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.
>
>
> Examples of subtypes of depression:
>
> This is from Dr. Amen’s web page www.brainplace.com:
>
> Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression. The severity of depression is often related to the degree of frontal hypometabolism. Several studies have indicated that the hypometabolism normalizes after treatment if the patient's mood improved. Researchers have also seen increased limbic system activity as well in depression (thalamus, amygdala, cingulate gyrus and deep temporal lobes). When depressed patients perform a concentration task the left prefrontal cortex often activates to normal levels, differentiating depression from attention deficit disorder which often shows normal activity at rest and decreased prefrontal cortex activity with concentration.
>
> SPECT can be helpful in the diagnosis and treatment in complex or resistant depressive disorders by differentiating it from other disorders, enhancing compliance by the patient being able to "see the changes in the brain," and by subtyping depression. Here are three subtypes that one of the authors has identified.
> · Decreased prefrontal cortex activity with increased deep limbic system (thalamus) activity. This subtype is often associated with moodiness, negativity, low energy, sleep and appetite problems and poor concentration. It often responds best to dopaminergic or noradrenergic interventions such as buprion, imipramine or desipramine.
> · Increased anterior cingulate (this part of the brain is heavily innervated with serotonergic nerve fibers), thalamus and basal ganglia activity. This subtype is often associated with sadness, negativity, irritability, worrying, cognitive inflexibility, worrying and getting stuck or locked into negative thought patterns. It often responds best to the serotonergic antidepressants such as fluoxetine, sertraline, paroxetine and venlafaxine.
> · Decreased prefrontal cortex activity with increased or decreased temporal lobe activity. This is often the most serious subtype and it is often associated with sadness, irritability, rage (toward others or self in suicidal behavior), mild paranoia, atypical pain (atypical headaches or abdominal pain) and insomnia. We have seen this subtype often made significantly worse by serotonergic medications and it is often helped by anticonvulsants, such as gabapentin or divalproate.
>
> God Bless
>
> --Tim
Posted by bob on January 12, 2002, at 2:22:10
In reply to Why I think we all need our heads examined » bob, posted by manowar on January 12, 2002, at 1:40:35
Tim:
I don't disagree for one moment that brain imaging is a valuable tool that will one day may lead to accurate *diagnoses* of depressive subtypes. However, I'm still not convinced at this point that going to the AMEN clinic and having my brain scanned will matter a hill of beans in my *treatment*. I've tried many, many, many med combos, and there are many more that I could try. I don't see where there is a one to one correlation between an abnormal brain scan, and what medecine(s) to prescribe for a certain individual to make it normal. There would still be trial and error, because we don't understand the underlying mechanisms by which the meds work, and what they are actually doing to the brain. I don't see a very black and white relationship between brain scans, and what medecines to pick, except in certain cases. I still think, however, that brain scan research is heading in the right direction.
>
> First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.I realize that scans don't treat depression, and I don't believe I stated that. How does a brain scan tell you why a person is not responding to a treatment if they've tried, say, 20 different combos of meds and haven't achieved satisfaction. Many on this board have been through the pharmacological ringer.
>> BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
I agree, it's pathetic that mental disorders have no diagnostic tests. I don't think brain scans are there yet though. They can help, but what we would eventually need is a distinct scan pattern for every subtype, an **understanding** of the subtypes, and then we would have to know how to fix it. Our ability to treat mental illness in many individuals falls far short of satisfaction. The fact that we can diagnose things like MS, haven't really improved the treatments much, if at all.
>
>
> Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.I wholeheartedly agree.
>
> In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.If your case was treatment resistant, I don't know why that didn't lead your doctors to try different approaches before the scans. My doctors have tried many approaches, and the only limit to my treatment has been my increasing inablility to go on and off of these meds.
>
> For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
>
> My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.It sounds to me like your pdoc was somewhat timid with the treatments before the scans, and that the scans gave him the impetus to be more creative.
>
> >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
>
> Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.I said refractory to meds, not "all therapies". I realize there are things like ECT available also. "Refractory depression" does exist, and is characterized by a lack of response to available treatments. All you have to do is type the phrase in any internet search engine, and all kinds of info will come up. There are also many situations where people cannot physically tolerate the meds for one reason or another. Say, for example, you only got a temporary response from your pstims, and then it faded?
>
> Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)It sounds to me like the doctor had was very narrow minded in his treatments. I don't think my doctor would resist much of anything I suggested, as long as it was available here in the US. If I wanted to try Microcurrent Stimulation, I don't think he'd have any problem with it.
>
> Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.I'm definitely not among the popular believers then, because it has severely impaired my existence. I agree.
>
>
It seems that you've found a suitable solution to your problems with a med combo, and I'm glad to hear that.Again, brain scans are definitely useful, and I wouldn't mind having them done... I'm just not sure at this point for me that it would change my treatment. There would still be trial and error inherent in the med trials.
Bob
Posted by manowar on January 12, 2002, at 2:56:22
In reply to Re: Old School nailed it, posted by BarbaraCat on January 10, 2002, at 23:11:16
Horse pucky! -- Such foul language:):):)> Very fascinating. Correct me if I'm wrong, but I didn't think that Dr. Amen was doing SPECT scans any longer but treated based on symptomatology, or gut reaction he arrived at after seeing so many SPECTs? At any rate, given the fact that many of us have insurance with brain imaging facilities on-site (I belong to Kaiser - lotsa neuroimaging stuff at their disposal), how does one go about demanding to receive realistic and beneficial tests? I've had MRI's done at the drop of a hat for a neck injury. I've brought up the subject about getting my brain scanned for my depression and my pdoc says "oh, the science isn't in for sure yet". Horse pucky! It's a lack of education, or buckling under to Management's financial dictates, but WE are the ones paying their bills! What are your opinions on how we, as big-buck paying subscribers, can go about getting what we NEED. I think that many of us in this group are more informed than our pdocs regarding the myriad issues that hit-or-miss psychopharmacology specialization does not address. How do we educate/work with them and insist upon getting tests that are available, right now, that could alleviate or at least provide good info on why we're suffering? It's not even a cost issue since proper diagnosis and treatment would save insurers beaucoup bucks.
************************************************
Regarding your question, "Correct me if I'm wrong, but I didn't think that Dr. Amen was doing SPECT scans any longer but treated based on symptomatology, or gut reaction he arrived at after seeing so many SPECTs?"Uh, I don't understand what you're saying. If you mean that in the beginning when he first started using the technology he was a bit skeptical, and had the attitude that most pdocs have today--you're right. He wouldn't order a scan normally. Only after lots of frustration using typical psychiatry for refractory patients with little benefit, he began to use scans. He really didn't think it would be much of a benefit, but he started noticing abnormalities, which completely changed his psychiatric paradigm.
If you mean that since he has so much experience and that he can arrive at a diagnosis of a problem and prescribe treatment without the use of SPECT, you're right. Normally though, people want to spend the money and have the scans done. Why not? The more information, the better. Most people that go to the Amen clinic INSIST on having scans done.
>How do we educate/work with them and insist upon getting tests that are available, right now, that could alleviate or at least provide good info on why we're suffering?
Bring books, journals, abstracts, reports, anything you can get you're hands on. For me it was very difficult to find a progressive, foward thinking doctor. It's hard work. But don't settle for second best.
If they don't listen, walk.
Out of total frustration, I called the Amen Clinic on my own. I talked to a person that basically interviewed me over the phone and told me how the procedure works and what the charges are etc. I didn't need a referral, even though my pdoc was happy to give me one if I needed it. I made a phone appointment with a doctor at the Amen Clinic before I made the decision to go there. It really didn't matter to me if the clinic was 200 miles or 2000 miles away; luckily I have lots of sky-miles. I'm in Knoxville TN.-- I could have called Emory in Atlanta or have even called the University of TN, which has an excellent program. There are a million options. You've just got to research, and make phone calls, and be vigilant. I ultimately decided on the Amen Clinic because I believed the guy, and I was at the point where I decided not to waste another minute.
Of course, the clinic filed for my insurance, but I had to pay then and there. But I knew that going in. When I got a check for $2,300 in the mail from my insurance company a month later- it was one of the happiest days of my life. I honestly never counted on it!
Have a great weekend,
Tim
> >
> > > ************************************************
> > > Old School,
> > >
> > > Don't be sad, be glad:)
> > >
> > > Actually, there are some Psychiatrist that are beginning to 'see the light' and recommend scans for patients with 'treatment resistant' depressions. Luckily, I had a pdoc that referred me to the Amen Clinic in CA last summer. The scans were a wake up call for my physicians and me. I've already written about my experiences before, but Dr. Bob’s server is running very slowly, and I can’t find my posts (it could be a conspiracy:)
> > >
> > > In brief:
> > > I'm a firm believer in the viability in using modern SPECT equipment to HELP diagnose and treat depression and other psychiatric ailments. It's my humble opinion (I’ve had the scans done) that it really works in showing what areas of the brain are not functioning correctly. The fact is-- when certain parts of your brain are not functioning correctly it is FAIRLY predictable how a patient functions (i.e. Schizophrenia, Major Depression, Parkinson’s, Alzheimer’s)
> > >
> > > There are many on this board that disagree and think that its use is only for 'testing purposes'. --I dissent. Modern SPECT imaging is absolutely unreal. You really 'see' a three dimensional FUNCTIONAL image of your brain on a computer screen. And BTW: Changing your thought patterns during the tests have very little impact, if any, on the completed image- that’s baloney- Well maybe if you’re thinking of sex or of eating you’re favorite food. But who in the hell does that when he is in a tube that turns every 15 seconds and makes weird noises?
> > >
> > > By using this type of technology, a pdoc can, in many cases, save a patient years of agony and frustration and actually 'target' treatment, instead of forcing a patient through endless trial and error with psychoactive drugs—which can in many cases makes problems worse, and can cause irreversible brain damage.
> > >
> > > And yes, I do think that people with hard to treat psychiatric disorders should all have ‘their heads examined’. Why not? I think most people in America that have heart ailments get either an MRI, SPECT, or any number of imaging studies for it. Why should the brain be any different?
> > >
> > > Again, I think most pdocs are fat and lazy. If they kept up with Neurology along with Psychiatry (which overlap-tremendously), we as patients would be much better off. I don’t think Psychiatrist and Neurologists mingle much at all. There are but a few exceptions. BTW: Dr. Amen is both a Psychiatrist and a Neurologist.
> > >
> > > There is a growing number of pdocs that are beginning to use this technology in their practices. Most of them are on the West coast, though.
> > >
> > > People, please don’t casually dismiss this argument, by saying, “Its just a scam”, or “Junk science” without putting effort into examining the information that’s out there! That’s just a cop out.
> > >
> > > Take care,
> > >
> > > --Tim
> >
> > Tim...I totally, absolutely 100% AGREE with everything you just said. I couldnt have put it better myself. You and I think exactly the same in regards to mental illness. Its your BRAIN, not your "mind" or some "psychological" problem.
> >
> > I didnt realize Dr. Amen is dually trained in both Psychiatry and Neurology. Thats good. I was in the rTMS clinical trials back in 99 at the Medical University of South Carolina. That program with rTMS, VNS, DBS, etc. is run by another guy who is board certified in both Psychiatry and Neurology, Dr. Mark George. And Dr. George is very heavily involved in this functional neuroimaging stuff. He is doing things like taking treatment resistant folks, giving them an initial brain scan using functional MRI, SPECT or PET. Then doing VNS implant, rTMS, DBS or some other depression treatment on them. And then giving a POST TREATMENT brain scan afterwards. The results of before treatment and after treatment show up on these functional neuroimaging scans. Its real neuroscience for a change, rather than the usual psychology/psychiatry subjective psychobabble.
> >
> > I think many are afraid or intimidated by these new ideas within Neuropsychiatry research. That is my personal opinion. Many people, including many with severe mental illness, just cannot get over the hump in regards to truly accepting that their problem is IN YOUR BRAIN!
> >
> > You are 100% correct Tim and Ive thought about getting a SPECT scan myself.
> >
> > Old School
Posted by OldSchool on January 12, 2002, at 10:58:33
In reply to Why I think we all need our heads examined » bob, posted by manowar on January 12, 2002, at 1:40:35
>
> First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.
>
> My point is that in 'treatment resistant' cases, functional brain imaging can be very beneficial. Instead of a doctor solely relying on what a patient tells him – which-let’s face it- can be erroneous, misleading and downright confusing-- not only to the doctor but for the patient, also-- he now has another tool to help diagnose and pinpoint the problems so that he can devise a better and more aggressive plan towards treatment.
>
> BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
>
>
> Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.
>
> In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.
>
> For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
>
> My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.
>
> My attitude also changed. I wasted fifteen years of my life thinking I just needed to go to church more, listen to Tony Robbins, and meet some new people, yada, yada, yada. Don’t get me wrong, good psychology and a balanced lifestyle are necessary to a healthy life. The problem was, I was just lukewarm about psychiatry for many years.
>
> The last three years of my life were a living hell. Thank God, last summer, I took the GIANT STEP and decided that I would spare no expense towards getting better. Now, because I’m a better informed consumer, I’m a hell of a lot more vigilant about psychiatric treatment than I EVER was before. I take complete responsibility for my condition. I don’t just rely on a doctor’s opinion anymore. The way I look at it—I pay my doctor as a consultant, just like I pay consultants in my business. Some consultants I’ve hired in business are more expensive than doctors. I DEMAND cooperation and respect from consultants I HIRE in business, so why should this be any different with my doctors? Because he has a PHD? I don’t think so. If I feel that my doctor is not working for me, and treating me like he thinks I’m a lowlife, I won’t hesitate going somewhere else (which I did recently).
>
> And when I gave the new doctor the 10-page report with scans from the Amen clinic, he knew I meant business, and he listened.
>
> I used to be one of those poor saps that bumbled into my pdocs office without a clue, completely and utterly dependant on his experience, compassion and grace to help me with my DISEASE. Not anymore. I come prepared- and because of places like Psychobabble- I’m armed, not with lame propaganda that we get from television commercials, but good, rock solid data (My pdoc just eats it up!) And I refuse to listen to the propaganda that drug reps feed to so called doctors (e.g. That Effexor is “Prozac with a punch”-BS)
>
> >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
>
> Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.
>
> Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)
>
> Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.
>
>
> Examples of subtypes of depression:
>
> This is from Dr. Amen’s web page www.brainplace.com:
>
> Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression. The severity of depression is often related to the degree of frontal hypometabolism. Several studies have indicated that the hypometabolism normalizes after treatment if the patient's mood improved. Researchers have also seen increased limbic system activity as well in depression (thalamus, amygdala, cingulate gyrus and deep temporal lobes). When depressed patients perform a concentration task the left prefrontal cortex often activates to normal levels, differentiating depression from attention deficit disorder which often shows normal activity at rest and decreased prefrontal cortex activity with concentration.
>
> SPECT can be helpful in the diagnosis and treatment in complex or resistant depressive disorders by differentiating it from other disorders, enhancing compliance by the patient being able to "see the changes in the brain," and by subtyping depression. Here are three subtypes that one of the authors has identified.
> · Decreased prefrontal cortex activity with increased deep limbic system (thalamus) activity. This subtype is often associated with moodiness, negativity, low energy, sleep and appetite problems and poor concentration. It often responds best to dopaminergic or noradrenergic interventions such as buprion, imipramine or desipramine.
> · Increased anterior cingulate (this part of the brain is heavily innervated with serotonergic nerve fibers), thalamus and basal ganglia activity. This subtype is often associated with sadness, negativity, irritability, worrying, cognitive inflexibility, worrying and getting stuck or locked into negative thought patterns. It often responds best to the serotonergic antidepressants such as fluoxetine, sertraline, paroxetine and venlafaxine.
> · Decreased prefrontal cortex activity with increased or decreased temporal lobe activity. This is often the most serious subtype and it is often associated with sadness, irritability, rage (toward others or self in suicidal behavior), mild paranoia, atypical pain (atypical headaches or abdominal pain) and insomnia. We have seen this subtype often made significantly worse by serotonergic medications and it is often helped by anticonvulsants, such as gabapentin or divalproate.
>
> God Bless
>
> --Tim
Tim...I agree with EVERYTHING you post about this neuroimaging stuff! You are 100% right on. The psychiatrists DO NOT know whats going on with us, particularly the treatment resistant folks.Psychiatry should in my personal opinion, be outlawed and done away with and totally replaced with Neurology. Mental illness should be treated like the real disease it is...a brain based PHYSICAL illness. Tests need to be developed and implemented, like the SPECT scans. We NEED this sort of thing in the diagnosis of severe mental illness.
I agree with your statements that some people are put on psychiatry drugs which worsen one's condition, due to a vague or incorrect diagnosis in the beginning. SPECT scans could help prevent that sort of thing from occurring.
The psychology aspects of psychiatry need to be ditched. It doesnt work a large percentage of the time. The psychology/psychiatry approach should be replaced by a high tech, modernized, neurological approach to mental illness. Bring on the SPECT scans and everything like it I say.
Hell, hire NASA to figure out severe mental illness. I bet NASA could figure this stuff out given the budget and goal. Psychiatry wont ever figure it out.
Old School
Posted by manowar on January 13, 2002, at 1:18:27
In reply to Re: Why I think we all need our heads examined, posted by OldSchool on January 12, 2002, at 10:58:33
> >
> > First of all, imaging doesn’t treat depression, it’s a tool that helps diagnose why severe treatment resistant depression along with other psychiatric ailments are NOT responding to conventional treatment.
> >
> > My point is that in 'treatment resistant' cases, functional brain imaging can be very beneficial. Instead of a doctor solely relying on what a patient tells him – which-let’s face it- can be erroneous, misleading and downright confusing-- not only to the doctor but for the patient, also-- he now has another tool to help diagnose and pinpoint the problems so that he can devise a better and more aggressive plan towards treatment.
> >
> > BTW: Can you imagine a person with chronic chest pains talking to his doctor, and his doctor deciding on what medications, operations, or other treatments are needed for his patient, based solely on what the guy tells him—COME ON PEOPLE!!! Unless the poor guy is in Siberia, the doctor is going to order up a whole battery of tests, scans, blood work, etc…
> >
> >
> > Clinical Depression is very complex disease and many areas of the brain can be involved which may necessitate a complex approach to therapy. I’ve yet to see two people with the exact same symptoms.
> >
> > In my case, the doctors found that not only did I have the normal malfunctioning areas of the brain for depression, but there were some other areas of the brain such as the Temporal Lobes and the ENTIRE Cortex that were under functioning + my Basil Ganglia was a bit over-active. I could go on and on, but to get to the point—AFTER the scans and the consultation, my home pdocs FINALLY took me off the SSRI merry-go-round and began to work with polypharmacy and use more aggressive meds, since my problem wasn’t so simple.
> >
> > For instance: pstims or Provigil was NEVER a consideration, until the doctors saw the scans. A person with above average intelligence (I guess I would be a good example) can limp around with cognitive impairment without a doctor EVER suspecting abnormal pre-frontal cortex under functioning.
> >
> > My local pdoc also refused to use a benzo to help me with my Cyclothymia. THANK-GOD his attitude changed! And it changed because, in part, THE RESULTS OF THE SCANS.
> >
> > My attitude also changed. I wasted fifteen years of my life thinking I just needed to go to church more, listen to Tony Robbins, and meet some new people, yada, yada, yada. Don’t get me wrong, good psychology and a balanced lifestyle are necessary to a healthy life. The problem was, I was just lukewarm about psychiatry for many years.
> >
> > The last three years of my life were a living hell. Thank God, last summer, I took the GIANT STEP and decided that I would spare no expense towards getting better. Now, because I’m a better informed consumer, I’m a hell of a lot more vigilant about psychiatric treatment than I EVER was before. I take complete responsibility for my condition. I don’t just rely on a doctor’s opinion anymore. The way I look at it—I pay my doctor as a consultant, just like I pay consultants in my business. Some consultants I’ve hired in business are more expensive than doctors. I DEMAND cooperation and respect from consultants I HIRE in business, so why should this be any different with my doctors? Because he has a PHD? I don’t think so. If I feel that my doctor is not working for me, and treating me like he thinks I’m a lowlife, I won’t hesitate going somewhere else (which I did recently).
> >
> > And when I gave the new doctor the 10-page report with scans from the Amen clinic, he knew I meant business, and he listened.
> >
> > I used to be one of those poor saps that bumbled into my pdocs office without a clue, completely and utterly dependant on his experience, compassion and grace to help me with my DISEASE. Not anymore. I come prepared- and because of places like Psychobabble- I’m armed, not with lame propaganda that we get from television commercials, but good, rock solid data (My pdoc just eats it up!) And I refuse to listen to the propaganda that drug reps feed to so called doctors (e.g. That Effexor is “Prozac with a punch”-BS)
> >
> > >What if the person was refractory to the meds, then what would the scan bring to the table? I agree that mapping out the specific areas associated with behavioral/psychological problems is a necessary part of the evolution of our treatment of these conditions, but it doesn't change what tools are currently at our disposal.
> >
> > Refractory to the meds? There are literally hundreds of medications and therapies available for depression. There is NO WAY that a person is refractory to all the meds and treatments for depression.
> >
> > Again, a doctor would be more vigilant in trying new and novel drugs to treat his patient (e.g. Amisulpride, Adrafinil, ECT, Microcurrent Stimulation)
> >
> > Contrary to popular belief, this is a VERY debilitating, deadly, complex disorder with many subtypes.
> >
> >
> > Examples of subtypes of depression:
> >
> > This is from Dr. Amen’s web page www.brainplace.com:
> >
> > Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression. The severity of depression is often related to the degree of frontal hypometabolism. Several studies have indicated that the hypometabolism normalizes after treatment if the patient's mood improved. Researchers have also seen increased limbic system activity as well in depression (thalamus, amygdala, cingulate gyrus and deep temporal lobes). When depressed patients perform a concentration task the left prefrontal cortex often activates to normal levels, differentiating depression from attention deficit disorder which often shows normal activity at rest and decreased prefrontal cortex activity with concentration.
> >
> > SPECT can be helpful in the diagnosis and treatment in complex or resistant depressive disorders by differentiating it from other disorders, enhancing compliance by the patient being able to "see the changes in the brain," and by subtyping depression. Here are three subtypes that one of the authors has identified.
> > · Decreased prefrontal cortex activity with increased deep limbic system (thalamus) activity. This subtype is often associated with moodiness, negativity, low energy, sleep and appetite problems and poor concentration. It often responds best to dopaminergic or noradrenergic interventions such as buprion, imipramine or desipramine.
> > · Increased anterior cingulate (this part of the brain is heavily innervated with serotonergic nerve fibers), thalamus and basal ganglia activity. This subtype is often associated with sadness, negativity, irritability, worrying, cognitive inflexibility, worrying and getting stuck or locked into negative thought patterns. It often responds best to the serotonergic antidepressants such as fluoxetine, sertraline, paroxetine and venlafaxine.
> > · Decreased prefrontal cortex activity with increased or decreased temporal lobe activity. This is often the most serious subtype and it is often associated with sadness, irritability, rage (toward others or self in suicidal behavior), mild paranoia, atypical pain (atypical headaches or abdominal pain) and insomnia. We have seen this subtype often made significantly worse by serotonergic medications and it is often helped by anticonvulsants, such as gabapentin or divalproate.
> >
> > God Bless
> >
> > --Tim
>
>
> Tim...I agree with EVERYTHING you post about this neuroimaging stuff! You are 100% right on. The psychiatrists DO NOT know whats going on with us, particularly the treatment resistant folks.
>
> Psychiatry should in my personal opinion, be outlawed and done away with and totally replaced with Neurology. Mental illness should be treated like the real disease it is...a brain based PHYSICAL illness. Tests need to be developed and implemented, like the SPECT scans. We NEED this sort of thing in the diagnosis of severe mental illness.
>
> I agree with your statements that some people are put on psychiatry drugs which worsen one's condition, due to a vague or incorrect diagnosis in the beginning. SPECT scans could help prevent that sort of thing from occurring.
>
> The psychology aspects of psychiatry need to be ditched. It doesnt work a large percentage of the time. The psychology/psychiatry approach should be replaced by a high tech, modernized, neurological approach to mental illness. Bring on the SPECT scans and everything like it I say.
>
> Hell, hire NASA to figure out severe mental illness. I bet NASA could figure this stuff out given the budget and goal. Psychiatry wont ever figure it out.
>
> Old SchoolRight on brother, now you're talking! When I first read you're post this afternoon, I laughed my ass off (BTW: I still am, and will for weeks to come--thanks Old School and thanks Provigil!) It seems that you don't like to pussyfoot around an issue much! Hehehehe
I have to say that psychology is also an important component to mental health. What good is having a perfectly functioning brain, without knowing how to socially interact, or plan for the future, or have values, beliefs, and goals in life?
But first and foremost, the hardware (brain) must work right before the software (i.e. goals, social interaction, planning) can run well at all.
Talk about scamarama:
Until modern imaging techniques are accepted and appreciated by the public, we as patients will be forced to visit our pdoc once a month, and put up with the same drill, over and over and over again! You chat for 25 minutes, then they politely tell you to shut up, and they write the scripts, you pay the cashier and you're out the door. We're nothing but cattle! There is something wrong with this picture! They rely solely on just what a person tells him, to make a diagnosis and prescribe drugs. They are drug dealers, with a license! This paradigm has to change!The problem seems to be that Neurologist are too busy dealing with trauma patients to be able to adequately deal with psychiatric disorders.
Therefore, after laughing for five or ten minutes after reading you're mighty bold statement that psychiatry should be outlawed, I thought to myself, he's right! --In it's present form-- it should be.
This is what I think:
When you visit a clinic for the first time, they should be required to do blood work. Also, there should be a requirement that every pdoc have certified imaging technology at his disposal-- either at his clinic or at a hospital near by.
Old School is right, what is everyone waiting for? Doctors-get aggressive—scan us, do blood work, poke and prod us, ALONG with doing a psychological profile on us- so that the BEST and most economical treatment can be prescribed, so we can get well sooner.
--And if a person does not get better within a certain time period, psychosurgery should become a consideration. Why mess around with the Vagus Nerve, when a Neurologist can get right to the source (brain) and plug in a pacemaker, just like they do for heart patients?
Let’s move on, we have the technology, and we can make it happen!
--Tim
Posted by bob on January 13, 2002, at 2:11:06
In reply to Psychiatry -in its present form-SHOULD BE OUTLAWED » OldSchool, posted by manowar on January 13, 2002, at 1:18:27
> --And if a person does not get better within a certain time period, psychosurgery should become a consideration. Why mess around with the Vagus Nerve, when a Neurologist can get right to the source (brain) and plug in a pacemaker, just like they do for heart patients?
>
> Let’s move on, we have the technology, and we can make it happen!
>
> --TimTim:
What type of psychosurgery are you suggesting, cingulotomy, or something else? What do you mean when you say we should plug a pacemaker straight into the brain?
Bob
Posted by sid on January 13, 2002, at 10:26:44
In reply to Psychiatry -in its present form-SHOULD BE OUTLAWED » OldSchool, posted by manowar on January 13, 2002, at 1:18:27
I'm seeing a doc (in contrast to a pdoc because my father was treated by pdocs and it was a traumatizing thing to witness) for dysthymia and anxiety, and I had to have blood and urine tests done before starting on any medication, to rule out other possible causes, such as thyroid, liver or kidney problems. I'm surprised presumably specialized clinics (and their pdocs) don't do the same. It seems to go without saying that this must be done first.
> This is what I think:
>
> When you visit a clinic for the first time, they should be required to do blood work. Also, there should be a requirement that every pdoc have certified imaging technology at his disposal-- either at his clinic or at a hospital near by.
Posted by spike4848 on January 13, 2002, at 13:10:11
In reply to Psychiatry -in its present form-SHOULD BE OUTLAWED » OldSchool, posted by manowar on January 13, 2002, at 1:18:27
Hey Guys,
Dr Bob may ban me for this one, but ..... when I was going through medical school and residency in medicine, I met alot of psychiatrists in training. They actually are forced to work on the medicine floors for 6 months.
I hate to generalize, but they were very lazy and unmotivated. Psychiatry attracts these types, because of all the fields of medicine .... psychiatry is by far the easiest in term of life style and academic challenge. I would say 75% of my medical school peers going into psychiatry said they were doing it because of the "Easy Life Style" "It is 9 to 5" etc. One individual actually said .... "Hey I can pretty much sit back and sleep during office sessions, nod to the patient occassionally and hand them a prescription for prozac at the end of the visit."
And many of them are too scared to prescribe anything but and ssri or effexor or buspar...... scared to try MAOI, stimulants, benzo, TCAs because their afraid a patient may OD and family will bring a lawsuit.
Sorry to any quality Psychiatry out there.
Spike
Posted by spike4848 on January 13, 2002, at 13:20:43
In reply to Re: Old School nailed it » OldSchool, posted by manowar on January 10, 2002, at 20:47:45
> And yes, I do think that people with hard to treat psychiatric disorders should all have ‘their heads examined’. Why not? I think most people in America that have heart ailments get either an MRI, SPECT, or any number of imaging studies for it. Why should the brain be any different?
>> Take care,
>
> --TimTo Anyone,
Do you have to be off all meds for a brain spect to be accurate? I still take 0.5 klonopin to prevent disabling anxiety and panic attack ....
Spike
Posted by Bekka H. on January 13, 2002, at 13:52:12
In reply to Most Psychiatrists are Lazy!, posted by spike4848 on January 13, 2002, at 13:10:11
> I hate to generalize, but they were very lazy and unmotivated. Psychiatry attracts these types, because of all the fields of medicine .... psychiatry is by far the easiest in term of life style and academic challenge. I would say 75% of my medical school peers going into psychiatry said they were doing it because of the "Easy Life Style" "It is 9 to 5" etc. One individual actually said .... "Hey I can pretty much sit back and sleep during office sessions, nod to the patient occassionally and hand them a prescription for prozac at the end of the visit."
> Sorry to any quality Psychiatry out there.
Spike*************************************************
I think the last line of your post is most significant because there are some quality psychiatrists out there, but you have to search for them, and that is often difficult to do, especially when you are in distress and feeling desperate. There are, indeed, some terrible psychiatrists out there who are lazy -- or worse; however, that is true of people in EVERY specialty, in every profession. In every field, there are a few top notch people, there are many average people, and then, at the bottom of the barrel, there are a few terrible, lazy, unethical bad apples who should have never been admitted to medical school (or whatever field it is you're talking about) in the first place.
Posted by spike4848 on January 13, 2002, at 14:05:45
In reply to Re: Most Psychiatrists are Lazy!, posted by Bekka H. on January 13, 2002, at 13:52:12
> I think the last line of your post is most significant because there are some quality psychiatrists out there, but you have to search for them, and that is often difficult to do, especially when you are in distress and feeling desperate. There are, indeed, some terrible psychiatrists out there who are lazy -- or worse; however, that is true of people in EVERY specialty, in every profession. In every field, there are a few top notch people, there are many average people, and then, at the bottom of the barrel, there are a few terrible, lazy, unethical bad apples who should have never been admitted to medical school (or whatever field it is you're talking about) in the first place.
Hey,
This is very true. Actually, I have had been treated by 3 psychiatrists during my life .... I changed because I moved to different schools and hospital for my career over the past 7 years. My first psychiatrist was compassionate and extremely dedicated to his field. I would actually say he was the hardest working and motivated doctor in ANY FIELD I have every met. He worked harder then most surgeons.
Granted, psychiatrists must be given some credit .... I hate to listen to me when I am depressed .... I can't image listening to me 10 hours a DAY! And the salary is the lowest amongst all physicians .... very difficult to pay off 150,000.00 of medical school debt on their salary.
Spike
Posted by bob on January 13, 2002, at 14:26:58
In reply to Re: Most Psychiatrists are Lazy!, posted by spike4848 on January 13, 2002, at 14:05:45
Another thing not to be overlooked about psychiatrists is that the prestige of that particular discipline simply doesn't compare to surgeons, trauma doctors, etc. It also must be extremely frustrating at times if the doctor honestly wants to help his more troubled patients. Just a couple of reasons why it might be so difficult to find an excellent pdoc.
Posted by Emme on January 13, 2002, at 14:37:29
In reply to Most Psychiatrists are Lazy!, posted by spike4848 on January 13, 2002, at 13:10:11
> Hey Guys,
>
> Dr Bob may ban me for this one, but ..... when I was going through medical school and residency in medicine, I met alot of psychiatrists in training. They actually are forced to work on the medicine floors for 6 months.
>
> I hate to generalize, but they were very lazy and unmotivated. Psychiatry attracts these types, because of all the fields of medicine .... psychiatry is by far the easiest in term of life style and academic challenge. I would say 75% of my medical school peers going into psychiatry said they were doing it because of the "Easy Life Style" "It is 9 to 5" etc. One individual actually said .... "Hey I can pretty much sit back and sleep during office sessions, nod to the patient occassionally and hand them a prescription for prozac at the end of the visit."
>
> And many of them are too scared to prescribe anything but and ssri or effexor or buspar...... scared to try MAOI, stimulants, benzo, TCAs because their afraid a patient may OD and family will bring a lawsuit.
>
> Sorry to any quality Psychiatry out there.
>
> Spike
Okay, I've had it with psychiatrist bashing. Generalizations are bad. Yes, I know, there are lazy incompetent psychiatrists who practice bad medicine and have no business being in medicine. And yes, I've heard some horror stories. The same can be said for every field. For what it's worth, wanna know my experience?? Three psychiatrists so far, all *good* (I've changed due me moving, and one doctor relocating). My current doctor checked my B-12 blood levels and has made sure my bloodwork (including thyroid) are up to date and that I've seen my internist to rule out other problems. She's consulted a neurologist and dermatologist with questions when needed. She goes to lectures and stays on top of the lit. Always returns calls. Lazy- I don't think so. I know, this is just one person's experience. But since I've had a few psychiatrists like this, I expect there's a few more good ones out there mixed in with the not-so-good ones. Not every drug that we've tried has worked out, but hasn't been for lack of careful thought and attentiveness. Folks, we *can* get quality care - it's possible.Emme
Posted by spike4848 on January 13, 2002, at 16:10:47
In reply to Re: Most Psychiatrists are Lazy!, posted by Emme on January 13, 2002, at 14:37:29
I am simply saying the rigor of psychiatry is far below many other medical fields. Therefore, we can not expect as many advances in treatment like in other fields. The etilogy of AIDS by the human immunodeficiency virus was uncovered in less then about 8 years .... 8 years! Yet we still only spectulate on the causes of depression after 6 decades. The irony is up to 10% of of society suffers from depression .... which can be a deadly disease ... and less than 1/10% suffer from HIV/AIDS. Some of the most effective treatments such as ECT, TCA meds, MAOI meds have been around for 50 years. Advances will be made ... but at a slow rate as we suffer.
I say let the neurologist treat us!
And you can't argue when many pdoc admit themselves they pursued careers in psychiatry because of the lifestyle.
Spike
Posted by akc on January 13, 2002, at 16:19:35
In reply to Re: Most Psychiatrists are Lazy!, posted by spike4848 on January 13, 2002, at 16:10:47
> And you can't argue when many pdoc admit themselves they pursued careers in psychiatry because of the lifestyle.
>My psychiatrist pursued the field because she wanted to treat kids with psychatric disorders (which she was already doing, but she went back for another residency in her late 40's to get more training so she would have the most knowledge she could have to do the best she could by her patients).
My psychiatrist has had to field more after-hours and weekend calls than any surgeon that has ever treated me. Or even any primary care physician. As Emme points out about her doctor, mine has sent me for tests, made sure I see other specialist when it is called for, and is sending me for a second consult because I am having a hard time remaining stabilized.
Most -- no way. Are there bad apples in the bunch -- definitely. If you don't like your doctor, spike4848, go get yourself a neurologist, but lay off the slap in the face you are giving pyschiatrists. It is no better than lawyer bashing. It is not fair to the profession and those who work hard for their patients.
akc
Posted by manowar on January 13, 2002, at 16:31:49
In reply to Do You Have To Be Off all Meds For Spect Scan, posted by spike4848 on January 13, 2002, at 13:20:43
> > And yes, I do think that people with hard to treat psychiatric disorders should all have ‘their heads examined’. Why not? I think most people in America that have heart ailments get either an MRI, SPECT, or any number of imaging studies for it. Why should the brain be any different?
> >
>
> > Take care,
> >
> > --Tim
>
> To Anyone,
>
> Do you have to be off all meds for a brain spect to be accurate? I still take 0.5 klonopin to prevent disabling anxiety and panic attack ....
>
> SpikeIt's not a big deal. They would like it if a patient not have caffienated beverages, any nicotine, or be on any med THAT DAY. Of course, if someone has to be on one, it's not that big deal. .5 mg of Klonipin is a pretty small dose.
Posted by manowar on January 13, 2002, at 16:58:09
In reply to Re: Most Psychiatrists are Lazy!, posted by Emme on January 13, 2002, at 14:37:29
> > Hey Guys,
> >
> > Dr Bob may ban me for this one, but ..... when I was going through medical school and residency in medicine, I met alot of psychiatrists in training. They actually are forced to work on the medicine floors for 6 months.
> >
> > I hate to generalize, but they were very lazy and unmotivated. Psychiatry attracts these types, because of all the fields of medicine .... psychiatry is by far the easiest in term of life style and academic challenge. I would say 75% of my medical school peers going into psychiatry said they were doing it because of the "Easy Life Style" "It is 9 to 5" etc. One individual actually said .... "Hey I can pretty much sit back and sleep during office sessions, nod to the patient occassionally and hand them a prescription for prozac at the end of the visit."
> >
> > And many of them are too scared to prescribe anything but and ssri or effexor or buspar...... scared to try MAOI, stimulants, benzo, TCAs because their afraid a patient may OD and family will bring a lawsuit.
> >
> > Sorry to any quality Psychiatry out there.
> >
> > Spike
>
>
> Okay, I've had it with psychiatrist bashing. Generalizations are bad. Yes, I know, there are lazy incompetent psychiatrists who practice bad medicine and have no business being in medicine. And yes, I've heard some horror stories. The same can be said for every field. For what it's worth, wanna know my experience?? Three psychiatrists so far, all *good* (I've changed due me moving, and one doctor relocating). My current doctor checked my B-12 blood levels and has made sure my bloodwork (including thyroid) are up to date and that I've seen my internist to rule out other problems. She's consulted a neurologist and dermatologist with questions when needed. She goes to lectures and stays on top of the lit. Always returns calls. Lazy- I don't think so. I know, this is just one person's experience. But since I've had a few psychiatrists like this, I expect there's a few more good ones out there mixed in with the not-so-good ones. Not every drug that we've tried has worked out, but hasn't been for lack of careful thought and attentiveness. Folks, we *can* get quality care - it's possible.
>
> EmmeEmme,
You said the magic word-- that word being "she".Guys, you're going to hate me for this (and I hate saying this because I'm a guy), but I have to say it:
Sorry, and I know I am generalizing here, but quite frankly women make better doctors than men do. They tend to be a hell of a lot more compassionate and more caring than their male counterparts.
I especially like Nurse Practitioners (NPs). They're the best! They have the bedside manner of a wonderful nurse (because they have been nurses), with the same amount of knowledge that a regular doctor has. I think that NPs are better qualified to treat patients than doctors. I also think it wouldn't be a bad idea to pay them more money than regular doctors.
My family doctor is a NP, and she's 100% better than any other male GP I've ever dealt with. On my last visit, I asked her a million and one questions, and she answered every one of them.(Women smell a lot better too- and in her case look WAY better!)
I'm also lucky that my pdoc has a big staff of nurses and NPs. When I call to ask about a med or whatever, they are wonderful.
Let's face it-- and I hate to admit this, but it's a no-brainer: In general, women are better caregivers than men.
--Tim
Posted by OldSchool on January 13, 2002, at 17:19:15
In reply to Re: Most Psychiatrists are Lazy! » Emme, posted by manowar on January 13, 2002, at 16:58:09
> Guys, you're going to hate me for this (and I hate saying this because I'm a guy), but I have to say it:
>
> Sorry, and I know I am generalizing here, but quite frankly women make better doctors than men do. They tend to be a hell of a lot more compassionate and more caring than their male counterparts.
>
> I especially like Nurse Practitioners (NPs). They're the best! They have the bedside manner of a wonderful nurse (because they have been nurses), with the same amount of knowledge that a regular doctor has. I think that NPs are better qualified to treat patients than doctors. I also think it wouldn't be a bad idea to pay them more money than regular doctors.
>
> My family doctor is a NP, and she's 100% better than any other male GP I've ever dealt with. On my last visit, I asked her a million and one questions, and she answered every one of them.(Women smell a lot better too- and in her case look WAY better!)
>
> I'm also lucky that my pdoc has a big staff of nurses and NPs. When I call to ask about a med or whatever, they are wonderful.
>
> Let's face it-- and I hate to admit this, but it's a no-brainer: In general, women are better caregivers than men.
>
> --Tim
Now Ive gotta disagree with you on this one. I agree women are better caregivers in many ways than men. However in my particular case I prefer male doctors. Because I have a gruff personality, particularly when depressed and a fairly strong irritability component to my depression. I dont do well with female doctors because of this. I was even told point blank a few times by other male psychiatrists Id probably be best off avoiding female mental health workers due to my personality, gruffness, etc. This one psychiatrist, a quite good one BTW, just flat out came out and told me this. That I should probably try to avoid female mental health workers in the future cause of the way I am, gruff, irritable, strongminded, etc.If you have like a sappy, soppy kind "my puppy dog died" of depression sure women make great mental health workers. But if youre a guy and are irritable and agitated and stuff, um I dont feel comfortable using women doctors because I think they tend to be more tuned in to this irritability stuff than male psychiatrists. They make a bigger deal out of that than male doctors do.
Women are also more likely to dx you psychotic just for being irritable or agitated than male doctors.
Old School
Posted by manowar on January 13, 2002, at 18:00:22
In reply to Re: Psychiatry -in its present form-SHOULD BE OUTLAWED » manowar, posted by bob on January 13, 2002, at 2:11:06
>
> > --And if a person does not get better within a certain time period, psychosurgery should become a consideration. Why mess around with the Vagus Nerve, when a Neurologist can get right to the source (brain) and plug in a pacemaker, just like they do for heart patients?
> >
> > Let’s move on, we have the technology, and we can make it happen!
> >
> > --Tim
>
> Tim:
>
> What type of psychosurgery are you suggesting, cingulotomy, or something else? What do you mean when you say we should plug a pacemaker straight into the brain?
>
> Bob
Bob, yes- cigulotomy is one—though seems to be a last resort and I don’t know how effective it is.Electrode implants is another.
Its been a while, and being that it's Sunday and I want to watch football- I'm too lazy to try to find the articles on the electrode thing, so I'll do my best with the poor memory I have.
This may be and probably is pretty inaccurate, but here goes:
I read somewhere that way back after the James Olds findings about wire heading rats (back in the 50's), scientist and doctors began to perform psychosurgery by surgically implanting electrodes in the brains of humans. They experimented on just a few very, very ill patients (Extreme Schizophrenics, Catatonic depressives, etc...). All they did is implant an electrode to a certain area of the brain. The electrode had a wire that lead to like a nine-volt battery that the guy had in his pocket or something. The electrode automatically fired every few seconds or so, causing a cascading of neurotransmitter activity. I think there were some minor complications that were easily dealt with, but for the most part, these patients got better immediately.
I think, though, that a law was passed, outlawing this type of surgery. I guess the idea of multitudes of wire headed people repulsed enough doctors that they decided not to go down that road.
It is quite spooky, but so what if it works?
I also think that doctors can remove just a tiny bit of brain tissue, which completely relives depression. Isn't that basically what cigulotomy is?
Cigulotomy could be a very viable option for refractory depressives.
If anyone is interested in having this done, check out this website:
http://neurosurgery.mgh.harvard.edu/
Here is an article from the Harvard site:
**********************************************
Surgical intervention to treat a psychiatric illness
by G. Rees Cosgrove, M.D., F.R.C.S. (C.)
Neurosurgical Service
Massachusetts General Hospital--------------------------------------------------------------------------------
We at the Massachusetts General Hospital perform a type of limbic system surgery called bilateral stereotactic cingulotomy. The primary indications for which this prodedure is considered is medically intractable obsessive compulsive disorder. Certain patients with chronic pain syndromes, refractory depression, and addictive disorders may also be candidates for the procedure.
Since it is our opinion that this operation is an adjunct to, but not a substitute for, ongoing psychiatric care, we require that a patient be referred by a letter from the treating psychiatrist. This letter should summarize the patient's history including the various treatments which have been tried. It should also provide evidence that (a) the patient has had all reasonable forms of non-operative treatment without benefit and (b) that the psychiatrist continue post-operative psychiatric care and supervision for as long as necessary. The patient and a close family member must give consent to the operation.
We are eager to be helpful to patients with obsessive-compulsive disorders, but it is our policy that those patients with obsessive and ritualistic behaviors have an adequate trial of exposure and response prevention behavior therapy before they are accepted for evaluation and that they are prepared to undergo similar behavioral therapy post-operatively.
A copy of the Behavior Therapy Guidelines for OCD written by Dr. Baer is available by contacting the MGH Cingulotomy Unit at the address below. If a patient has undergone such a trial, psychiatric records describing the type of therapy and the response to it should be supplied. But if the patient has not had this trial, it should be emphasized that this is an essential part of the treatment for OCD, that it has been proven to be as effective as medication and that ordinarily, both behavior therapy and medication must be used simultaneously (before operation and after operation) to help patients badly afflicted with OCD.
If you need assistance in arranging for this specific therapy, please contact the national headquarters which can be reached by writing P.O.Box 70, Milford, CT 06460 or calling 203/878-5669.
Before a patient can be considered for cingulotomy at MGH a refering physcian's form for cingulotomy needs to be completed. It can be obtained from the MGH Cingulotomy Unit at the address below. It should be returned with pertinent copies of hospital and treatment records.
After all of this necessary information is received, it will be reviewed by the MGH Cingulotomy Assessment Committee which consists of three MGH psychiatrists, two neurosurgeons and one neurologist. This Committee meets once a month, usually on the last Wednesday. The Committee may decide: 1. That the patient is a suitable candidate for cingulotomy or 2. That further information is needed to clarify the diagnosis and need for operation or 3. Additional non-operative treatment would be helpful or 4. That, regrettably, the patient is not a suitable candidate for surgery. The treating psychiatrist will be informed of the Committee's decision by one of its members.
If the patient is considered to be a possible candidate, he/she will be seen and interviewed by one psychiatrist, the two neurosurgeons and the neurologist. This evaluation is concerned with being certain about the diagnosis and that the patient and his/her family are fully informed about the risks and possible benefits of surgical intervention. On rare occasions these personal interviews yield further information that will cause the patient to be rejected for cingulotomy.
An account of our experience with stereotactic cingulotomy was published in Biological Psychiatry 1987; 22:807-819.
Referring physicians, the patient, or the patient's family should contact:
The MGH Cingulotomy Committee or
Dr. G. Rees Cosgrove for further information:
MGH Cingulotomy Committee
Neurosurgical Service--Edwards 410
Massachusetts General Hospital
Boston, MA 02114
phone: (617) 726-3407--Tim
Posted by Dr. Bob on January 13, 2002, at 18:29:47
In reply to Re: Most Psychiatrists are Lazy!, posted by OldSchool on January 13, 2002, at 17:19:15
> Now Ive gotta disagree with you on this one. I agree women are better caregivers in many ways than men...
I'd like the discussion here of caregivers (as opposed to tests or treatments) to continue at Psycho-Social-Babble:
http://www.dr-bob.org/babble/social/20020112/msgs/16720.html
Thanks,
Bob
PS: And of course discussion of posting policies should take place at Psycho-Babble Administration.
Posted by OldSchool on January 13, 2002, at 19:17:46
In reply to Psychosurgery in the new millennium » bob, posted by manowar on January 13, 2002, at 18:00:22
> Bob, yes- cigulotomy is one—though seems to be a last resort and I don’t know how effective it is.
>
> Electrode implants is another.
>
> Its been a while, and being that it's Sunday and I want to watch football- I'm too lazy to try to find the articles on the electrode thing, so I'll do my best with the poor memory I have.
>
> This may be and probably is pretty inaccurate, but here goes:
>
> I read somewhere that way back after the James Olds findings about wire heading rats (back in the 50's), scientist and doctors began to perform psychosurgery by surgically implanting electrodes in the brains of humans. They experimented on just a few very, very ill patients (Extreme Schizophrenics, Catatonic depressives, etc...). All they did is implant an electrode to a certain area of the brain. The electrode had a wire that lead to like a nine-volt battery that the guy had in his pocket or something. The electrode automatically fired every few seconds or so, causing a cascading of neurotransmitter activity. I think there were some minor complications that were easily dealt with, but for the most part, these patients got better immediately.
>
> I think, though, that a law was passed, outlawing this type of surgery. I guess the idea of multitudes of wire headed people repulsed enough doctors that they decided not to go down that road.
>
> It is quite spooky, but so what if it works?
>
> I also think that doctors can remove just a tiny bit of brain tissue, which completely relives depression. Isn't that basically what cigulotomy is?
>
> Cigulotomy could be a very viable option for refractory depressives.
>
> If anyone is interested in having this done, check out this website:
>
> http://neurosurgery.mgh.harvard.edu/
>
> Here is an article from the Harvard site:
>
> **********************************************
>
> Surgical intervention to treat a psychiatric illness
>
>
> by G. Rees Cosgrove, M.D., F.R.C.S. (C.)
> Neurosurgical Service
> Massachusetts General Hospital
>No old style psychosurgery for me, thank you. Id rather be a catatonic depressed bum on the street, eating out of garbage cans than have an old style psychosurgery. F*ck that. That is WAY too invasive for me. I prefer this modern stuff, like the SPECT scans. Thats why functional neuroimaging is so great...its totally noninvasive and very safe. It uses remote sensing technology to image the function of your brain and improve diagnosing.
Psychosurgery like you are talking about while it may get rid of your depression (for a while) that kind of psychosurgery also permanently changes your personality. Cingulobotomy is just a variation on a theme of the old frontal lobotomy.
WHY WOULD YOU WANT TO MESS WITH THAT?!!!?
Now some of these newer psychosurgeries like Deep Brain Stimulation are a totally different story. I can go with these modern, high tech psychosurgeries. DBS is considered to be a "MIBS" treatment for refractory depression. MIBS stands for "Minimally Invasive Brain Stimulation." The whole point of it is that its high tech and minimally invasive to your brain and body. But it gets the job done.
Thats the kind of stuff I like. The old style "psychosurgery" you can have that. NO THANK YOU.
Here is a website that talks about MIBS modalities for refractory depression:
http://www.musc.edu/psychiatry/fnrd/tms.htm
Old School
Posted by Blue Cheer 1 on January 13, 2002, at 23:40:47
In reply to Re: Psychosurgery in the new millennium, posted by OldSchool on January 13, 2002, at 19:17:46
> > Bob, yes- cigulotomy is one—though seems to be a last resort and I don’t know how effective it is.
> >
> > Electrode implants is another.
> >
> > Its been a while, and being that it's Sunday and I want to watch football- I'm too lazy to try to find the articles on the electrode thing, so I'll do my best with the poor memory I have.
> >
> > This may be and probably is pretty inaccurate, but here goes:
> >
> > I read somewhere that way back after the James Olds findings about wire heading rats (back in the 50's), scientist and doctors began to perform psychosurgery by surgically implanting electrodes in the brains of humans. They experimented on just a few very, very ill patients (Extreme Schizophrenics, Catatonic depressives, etc...). All they did is implant an electrode to a certain area of the brain. The electrode had a wire that lead to like a nine-volt battery that the guy had in his pocket or something. The electrode automatically fired every few seconds or so, causing a cascading of neurotransmitter activity. I think there were some minor complications that were easily dealt with, but for the most part, these patients got better immediately.
> >
> > I think, though, that a law was passed, outlawing this type of surgery. I guess the idea of multitudes of wire headed people repulsed enough doctors that they decided not to go down that road.
> >
> > It is quite spooky, but so what if it works?
> >
> > I also think that doctors can remove just a tiny bit of brain tissue, which completely relives depression. Isn't that basically what cigulotomy is?
> >
> > Cigulotomy could be a very viable option for refractory depressives.
> >
> > If anyone is interested in having this done, check out this website:
> >
> > http://neurosurgery.mgh.harvard.edu/
> >
> > Here is an article from the Harvard site:
> >
> > **********************************************
> >
> > Surgical intervention to treat a psychiatric illness
> >
> >
> > by G. Rees Cosgrove, M.D., F.R.C.S. (C.)
> > Neurosurgical Service
> > Massachusetts General Hospital
> >
>
> No old style psychosurgery for me, thank you. Id rather be a catatonic depressed bum on the street, eating out of garbage cans than have an old style psychosurgery. F*ck that. That is WAY too invasive for me. I prefer this modern stuff, like the SPECT scans. Thats why functional neuroimaging is so great...its totally noninvasive and very safe. It uses remote sensing technology to image the function of your brain and improve diagnosing.Neuroimaging technologies far outpace their application in psychiatric disorders, and they're of no clinical value in diagnosis and treatment. 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. 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. :)
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.
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.
Blue
>
> Psychosurgery like you are talking about while it may get rid of your depression (for a while) that kind of psychosurgery also permanently changes your personality. Cingulobotomy is just a variation on a theme of the old frontal lobotomy.
>
> WHY WOULD YOU WANT TO MESS WITH THAT?!!!?
>
> Now some of these newer psychosurgeries like Deep Brain Stimulation are a totally different story. I can go with these modern, high tech psychosurgeries. DBS is considered to be a "MIBS" treatment for refractory depression. MIBS stands for "Minimally Invasive Brain Stimulation." The whole point of it is that its high tech and minimally invasive to your brain and body. But it gets the job done.
>
> Thats the kind of stuff I like. The old style "psychosurgery" you can have that. NO THANK YOU.
>
> Here is a website that talks about MIBS modalities for refractory depression:
>
> http://www.musc.edu/psychiatry/fnrd/tms.htm
>
> Old School
Posted by Dinah on January 14, 2002, at 8:46:43
In reply to Re: Psychosurgery in the new millennium, posted by Blue Cheer 1 on January 13, 2002, at 23:40:47
Thank you for the information. It isn't really what I would like to hear, but since traveling for a SPECT would be a significant financial investment, I'm glad to have the information to make an informed decision.
It is so appealing to think that, after numerous diagnoses and multiple medications, there would be an objective test that could at least tell me what was wrong with me. It's become something of a quest for me, although I'm close to giving up because psychiatric diagnosis seems so amorphous anyway.
Posted by Blue Cheer 1 on January 14, 2002, at 20:41:52
In reply to Re: SPECT » Blue Cheer 1, posted by Dinah on January 14, 2002, at 8:46:43
> Thank you for the information. It isn't really what I would like to hear, but since traveling for a SPECT would be a significant financial investment, I'm glad to have the information to make an informed decision.
> It is so appealing to think that, after numerous diagnoses and multiple medications, there would be an objective test that could at least tell me what was wrong with me. It's become something of a quest for me, although I'm close to giving up because psychiatric diagnosis seems so amorphous anyway.I know what you mean. I've had at least a dozen diagnoses since 1964, and I'm still picking up new ones. :) I drove up and back to McClean last March for a fMRI. (I just *had* to have it.) I was scheduled for admission there, but when I was told that neuroradiology would only be a consideration as part of my evaluation, I left. It was really a misunderstanding and lack of communication. Now I just keep trying whatever meds I can tolerate (mostly anticonvulsants), and keep hoping for better drugs. My feeling about neuroimaging is that it should be discussed with the psychiatrist who knows you best,and then if s/he thinks there's an indication for it -- they'll refer you to a neurologist.
Just today, I was reading a recent Reader's Digest in a waiting room, and started to read an article about a young doctor, Andrew Newberg, at Penn, and how he was using SPECT scans in neurotheology. I forget the exact name of the book, but the article told about him giving Tibetan Monks and other highly spiritual people SPECT scans at the peaks of their highs. He was actually able to show the areas of the brains that involved "visions" -- something like that. So even imaging doesn't yet diagnose, it otherwise has some interesting applications.
Good luck to you.
Blue
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