Brain Imaging in Affective Disorders (Medical Psychiatry Series)

400 Pages·2002·58.34 MB·English

by  Jair C. Soares

Brain Imaging
in Affective
Disorders
edited by
lair C. Soares
UniversityofTexasHealth Science CenteratSanAntonio
SanAntonio, Texas, U.S.A.
1MAR1CEL
MARCEL DEKKER, INC. NEW YORK· BASEL
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Series Introduction
In 1609, Galileo Galilei received rumors of a new Dutch curiosity called a
spyglass, which could make faraway objects appear closer. He calculated the
propershapeandplacementofglassand groundandpolishedthelenseshimself.
In autumn Galileo focused his instrumenton the face ofthe Moon. Thefollow
ing spring he discovered "four planets never seen from the beginning of the
world right up to ourday," in orbit around the planetJupiter. ByMarch, acopy
ofthe book in which he published his findings was on its way to King James
in Venice.* Our image of the world we live in, and our place in it, has never
been the same.
In the late 1600s, Antony van Leeuwenhoek, after learning to use lenses
in examining cloth as a draper's assistant, assembled a configuration oflenses
he had ground, turnedthemonthehithertoinvisibleworldofbacteria,protozoa,
and red cells, and made a detailed observation of capillary circulation. Word
quickly spreadto London, where he was elected aFellowofTheRoyalSociety.
Through Pasteur, Koch, and many others, we now have an understandingofthe
interplay oforganisms that helps us to understand how they, and we, work. We
*For a delightful exposition on this and Galileo's life and relationship to his family and
surrounding political world, seeDavaSobel's Galileo'sDaughter(Walker& Co., 1999).
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iv Series Introduction
also now know how to intervene in helpful ways, such as the use of vaccines
in the conquest of smallpox and penicillin in the treatment of pneumococcal
pneumonia.
Advances in the technologies of science broaden and deepen our under
standing of our biologies and pathologies. They also often provide useful
weapons in the battle against disease and disability. For those of us who are
interested in whatgoes on inside ourbony crania, the brain and its accompany
ing mind have remained inside apreviously unpenetrable "blackbox."Thelast
two decades ofadvances in neuroimaging have provided an expanding capacity
to explore the anatomic, chemical, and functional aspects of the brain. New
techniques havebeen appliedto both normalpatients andpatients with avariety
ofneuropsychiatric problems.
Dr. Soares has brought together a stellar group ofinvestigators to help us
understand the latest findings in patients with affective and/or anxietydisorders.
All clinicians need to master this material-itis the future ofour field.
William A. Frosch
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Foreword
Affective disorders represent amajorcauseofdisability worldwide. Bytheyear
2020, itis estimated that unipolar affective disorders will bethe secondleading
cause ofdeath worldwide. Therefore, improving our understanding ofthe cause
ofaffective disorders, enhancing diagnostic methodology, and developing ways
of selecting and monitoring treatment are central priorities in medical practice.
At the presenttime we standonthe verge ofseeingtheimplementationofbrain
imaging techniques to study both the structure and function of the brain in
psychiatry and neurology. This book brings together both the range ofthe most
promising imaging methods, as well as the most current information in terms
of structural, functional, and neurotransmitter abnormalities in affective disor
ders. The development ofnew treatments for affective disorders, which involve
rapid transcranial magnetic stimulation to alter brain function in a favorable
manner as well as classical pharmacological approaches, can be studied using
brain imaging techniques. At the same time, these techniques can playacrucial
role in treatment development. This book provides clinicians and researchers
witharich sourceofinformationon whatbrainimagingtechniquesareavailable
andwhattheyhaveyielded. Structuralstudiesusingmagneticresonanceimaging
and functional studies using functional magnetic resonance spectroscopy, single
photon emission tomography, and positron emission tomography imaging tech
niques have begun to yield important insights into the circuitry and neurotrans-
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vi Foreword
mitter dysfunctions in the brain of patients with affective disorders. Early in
fonnation ondifferencesinbrainfunctionbetweenbipolarandunipolaraffective
disorders lends a biological basis to the clinical differences. The application of
these imaging techniques to study key neurotransmitter systems, such as the
dopaminergic, serotonergic, and GABAergic systems, arethe subjectofindivid
ual chapters. Spectroscopyhas proventobe avaluable tool, notjustinthestudy
ofthe GABAergicsystem,butalsointhestudyofenergypathwaysandavariety
oflipid membrane indices. Two chapters have been devoted to the applications
of brain imaging for the monitoring of treatment responses, as well as the de
velopment of new treatments.
Thisbookisanextremelyvaluablevolumefor the readerand animportant
reference for the clinician who wants to know the state of the art, as well as
the researcher.
J. John Mann, M.D.
Professor ofPsychiatry and Radiology
Columbia University
Chief, Division ofNeuroscience
New York State Psychiatric Institute
New York, New York
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Preface
Overthe pasttwo decades, the methodsfor in vivobrainimaginginvestigations
have advancedsubstantially. Newerandmore sophisticatedtoolsforanatomical,
chemical, and functional in vivo studies ofthe human brainhave become avail
able and have increasingly been applied to the study of brain mechanisms in
volved in major neuropsychiatric disorders.
Affective disorders are amajorgroup ofpsychiatric illnesses that arevery
common in clinical practice and pose a considerable burden to patients, their
families, andsocietyingeneral. Despitetheenormousimportanceofthesemajor
health problems, their causation remains largely unknown. There has been sub
stantial interest in attempting to elucidate the brain mechanisms involved in
these disorders. In recent years, some of the newly developed brain imaging
methodologies have been applied to investigations on the brain mechanisms
involvedinthesedisorders andthemechanismsofactionofavailabletreatments.
As the causation ofthese majorpsychiatric disorders remains largely unknown,
there isconsiderablehope that this newergenerationofstudieswillsubstantially
contribute to major advances linked to developments in the fields of genetics,
pharmacology, and neurosciences.
The applications of brain imaging methods to study affective disorders
have initially involved anatomical computed tomography (CT) and magnetic
resonance imaging (MRI) studies. Subsequently, single photon emissiontomog
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viii Preface
raphy (SPECT) and positron emission tomography (PET) began to examine
possible abnormalities in brain blood flow and metabolism. More recent inves
tigations with functional magnetic resonance imaging (fMRI) have contributed
to higher-resolution studies of brain networks possibly involved in the patho
physiology of these disorders. Developments in chemical imaging with SPECT
and PET radiotracer studies as well as magnetic resonance spectroscopy have
allowedunprecedentedin vivo neurochemicalinvestigationsofthehumanbrain.
The emerging findings from available studies suggest anatomical, functional,
and chemical abnormalities in cortical and subcortical brain regions and in re
lated neuroanatomic circuits possibly involved in mood regulation. This impor
tant new area ofinvestigationin neuropsychiatry has beengrowingrapidly over
the past few years.
The application of newly available methods from brain imaging to the
study of affective disorders holds substantial promise to elucidate the brain
mechanisms implicated in these illnesses. The latest advances in this important
new area of research have not yet been reviewed in a comprehensive book
providingcompleteandeasilyaccessibleinformationonthelatestdevelopments.
This new volume includes chapters from leading authoritiesinthe field andfills
an important gap in the neuropsychiatric literature. It will be an invaluable re
sourcefor practitioners in the fields ofpsychiatry, neurology, primarycaremed
icine, andrelatedmentalhealthprofessions, as wellas researchers, graduateand
postgraduate trainees, and students. The book is a source of the latest infor
mation on new developments in brain imaging applied to the study of brain
mechanisms involved in causation ofaffective disorders and the mechanismsof
action ofavailable treatments.
lair C. Soares
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Contents
Series Introduction WilliamA. Frosch iii
Foreword J. John Mann v
Preface vii
Contributors xiii
PART I. GENERAL
1. Brain Imaging Methods in Neuropsychiatry 1
Roberto B. Sassi andlair C. Soares
2. Investigation ofMood Disorders by Transcranial Magnetic
Stimulation 19
Fumiko Maeda, Marie-Charlotte Dubeau, Lisa Koski, and
Sarah H. Lisanby .
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