Scientifically Unfounded Claims in Diagnosing and Treating Patients

American Journal of Psychiatry (Impact Factor: 12.3). 05/2010; 167(5):598. DOI: 10.1176/appi.ajp.2010.10020157
Source: PubMed
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    • "The practice has drawn heated criticism from mainstream psychiatry. Although papers on the use of SPECT scans in psychiatry [27-32] have been published and providers claim that the work is “based on hundreds of texts and scientific articles” [33], critics contend that the publications do not support the use of SPECT imaging in psychiatric practice [34]. In support of this contention, critics cite the 2006 Practice Guidelines issued by the American Psychiatric Association [35] which state that: "
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    ABSTRACT: Functional neuroimaging is being used in clinical psychiatry today despite the vigorous objections of many in the research community over issues of readiness. To date, a systematic examination of the perspectives of key stakeholders involved in this debate has not yet been attempted. To this fill this gap, we interviewed investigators who conduct functional neuroimaging studies involving adults with mood disorders, schizophrenia, obsessive compulsive disorder, and/or attention deficit hyperactivity disorder, providers who offer clinical neuroimaging services in the open marketplace, and consumers of these services, in order to understand perspectives underlying different views and practices. Semi-structured interviews were conducted over the telephone. Verbal consent was obtained and all interviews were audio recorded. Interviews of investigators and service providers followed the same interview guide. A separate set of questions was developed for consumers. All interviews were transcribed and made software ready. We applied the qualitative methodology of constant comparison to analyze the data, whereby two researchers independently analyzed the results into textual themes. Coding discrepancies were discussed until consensus was achieved. Investigators, service providers, and consumers held many common perspectives about the potential or actual risks and benefits of functional neuroimaging for mental illness. However, we also found striking divergences. Service providers focused on the challenges posed by the persistence of symptoms based diagnostic categories, whereas the limitations of the science in this area was the challenge noted most frequently by investigators. The majority of consumers stated that their expectations were met. Our findings point toward a fundamental tension between academic investigators on the one hand, and commercial service providers and their customers on the other. This scenario poses dangers to the communities directly involved, and to public trust in science and medicine more generally. We conclude with recommendations for work that needs to be done to minimize tensions and maximize the potential of neurotechnology through concerted efforts to respect its limitations while leveraging the strengths, investments, and hopes of each stakeholder group.
    BMC Psychiatry 08/2013; 13(1):208. DOI:10.1186/1471-244X-13-208 · 2.21 Impact Factor
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    • "support for routine clinical use of neuroimaging by the broader psychiatric community (American Psychiatric Association, 2005; Adinoff and Devous, 2010a,b). Despite the breadth of neuroimaging research on mental health disorders, missing from discussions about the anticipated integration of neuroimaging in routine mental health care are the voices of stakeholders. "
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    ABSTRACT: Images of brain function, popularly called "neuroimages," have become a mainstay of contemporary communication about neuroscience and mental health. Paralleling media coverage of neuroimaging research and the high visibility of clinics selling scans is pressure from sponsors to move basic research about brain function along the translational pathway. Indeed, neuroimaging may offer benefits to mental health care: early or tailored intervention, opportunities for education and planning, and access to resources afforded by objectification of disorder. However, risks of premature technology transfer, such as misinterpretation, misrepresentation, and increased stigmatization, could compromise patient care. The insights of stakeholder groups about neuroimaging for mental health care are a largely untapped resource of information and guidance for translational efforts. We argue that the insights of key stakeholders-including researchers, healthcare providers, patients, and families-have an essential role to play upstream in professional, critical, and ethical discourse surrounding neuroimaging in mental health. Here we integrate previously orthogonal lines of inquiry involving stakeholder research to describe the translational landscape as well as challenges on its horizon.
    Frontiers in Human Neuroscience 10/2012; 6:293. DOI:10.3389/fnhum.2012.00293 · 3.63 Impact Factor
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    • "Imaging Council of the Society of Nuclear Medicine proposed a test of Amen's methods by asking him to interpret 310 a set of blinded SPECT scans, but the offer was declined (Adinoff and Devous 2010). Amen (2010) has countered that the society did not " formally " approach him with this proposal. "
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    ABSTRACT: Brain imaging provides ever more sensitive measures of structure and function relevant to human psychology and has revealed correlates for virtually every psychiatric disorder. Yet it plays no accepted role in psychiatric diagnosis beyond ruling out medical factors such as tumors or traumatic brain injuries. Why is brain imaging not used in the diagnosis of primary psychiatric disorders, such as depression, bipolar disease, schizophrenia, and ADHD? The present article addresses this question. It reviews the state of the art in psychiatric imaging, including diagnostic and other applications, and explains the nonutility of diagnostic imaging in terms of aspects of both the current state of imaging and the current nature of psychiatric nosology. The likely future path by which imaging-based diagnoses will be incorporated into psychiatry is also discussed. By reviewing one well-known attempt to use SPECT-scanning in psychiatric diagnosis, the article examines a real-world practice that illustrates several related points: the appeal of the idea of image-assisted diagnosis for physicians, patients and families, despite a lack of proven effectiveness, and the mismatch between the categories and dimensions of current nosology and those suggested by imaging.
    AJOB Neuroscience 10/2012; 3(4):31-41. DOI:10.1080/21507740.2012.713072
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