Chapter

Psychiatrische Diagnostik und Psychopathologie bei HMPAO-SPECT

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Mittels bildgebender Verfahren wie die Single-Photon-Ernission-Computed-Tomography (SPECT) und die Positron-Emission-Tomography (PET) konnten bei psychiatrischen Erkrankungen Perfusionsstörungen verschiedener Hirnareale nachgewiesen werden. Bei Schizophrenien hatte man in den früheren Studien Veränderungen im Frontallappen (Buchsbaum et al. 1982) gefunden. Diese Befunde konnten in den neueren Arbeiten nicht repliziert werden, hingegen scheint der Temporallappen besonders betroffen zu sein (Buchsbaum et al. 1990, deLisi et al. 1989) Bei affektiven Störungen sind Veränderungen im prefrontalen Cortex (Baxter et al. 1989, Cohen et al. 1989) und im Temporallappen (Post et al. 1987, Amsterdam et al. 1992) festgestellt worden. Bei den meisten der obengenannten Untersuchungen — besonders den PET-Studien — wurde meistens die Psychopathologie zum Zeitpunkt der Untersuchung vernachlässigt. Daher haben wir uns im Rahmen des jetzigen Projektes zum Ziel gesetzt, zu untersuchen, inwiefern eine spezifische bzw. globale Psychopathologie im Zusammenhang mit Durchblutungsverhältnissen (gemessen mit der HMPAO-SPECT-Technik) steht.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

Chapter
Die biologischen Ursachen und Folgen der Heroinabhängigkeit wurden im Rahmen der klinischen Forschung noch nicht eingehend untersucht. In der Studie von Cascella et al. (1991) fand man keine Korrelation zwischen dem Verhältnis Ventrikel zu Gesamtgehirn und der Dauer des Heroin-Konsums, allerdings wurde keine Aussage getroffen, ob dieses Verhältnis im Vergleich zu Kontrollpatienten pathologisch ist. Wiesbeck und Täschner (1991) haben keinen Unterschied zwischen der Ventrikelgröße bei Patienten mit einer drogeninduzierten Psychose und Patienten mit einer paranoid-halluzinatorischen Psychose ohne Drogenanamnese gefunden. Da bei Psychosen aus dem schizophrenen Formenkreis die Ventrikel erweitert sind, hat die obengenannte Arbeit jedoch nur einen begrenzten Wert im Hinblick auf heroinbedingte pathologische CT-Befunde. In der Arbeit von London et. al. (1990) wurde mittels der PET-Technik festgestellt, daß eine einmalige Gabe von Heroin eine signifikante Reduktion der Durchblutung im Temporallappen und im postcentralen Gyrus hervorruft, wobei die Reduktion im rechten Temporallappen stärker ausgeprägt war. Systematische Computer tomographische Untersuchungen (CT) und Durchblutungsmessungen (SPECT) bei heroinabhängigen Patienten sind bis jetzt nicht durchgeführt worden. Wir haben im Rahmen eines größer angelegten Projekts verschiedene bildgebende Verfahren (CT, SPECT, EEG-Mapping) bei heroinabhängigen Patienten, die zur Entgiftung in unserer Klinik stationär behandelt wurden, angewandt.
Article
• Local cerebral uptake of deoxyglucose labeled with fluorine 18 was measured by positron-emission tomography in eight patients with schizophrenia who were not receiving medication and in six age-matched normal volunteers. Subjects sat in an acoustically treated, darkened room with eyes closed after injection of 3 to 5 mCi of deoxyglucose 18F. After uptake, seven to eight horizontal brain scans parallel to the canthomeatal line were done. Scans were treated digitally, with a 2.3-cm strip peeled off each slice and ratios to whole-slice activity computed. Patients with schizophrenia showed lower ratios in the frontal cortex, indicating relatively lower glucose use than normal control subjects; this was consistent with previously reported studies of regional cerebral blood flow. Patients also showed diminished ratios for a 2.3-cm square that was positioned over central gray-matter areas on the left but not on the right side. These findings are preliminary; issues of control of mental activity, brain structure identification, and biologic and anatomic heterogeneity of schizophrenia remain to be explored.
Article
Single photon emission computed tomography (SPECT) brain imaging with 123I labeled iofetamine (IMP) has been used to study several neuropsychiatric disorders. However, little attention has been given to patients with major depression. In the present study IMP SPECT images were obtained on 19 depressed patients and 12 medical comparison subjects who had no focal abnormalities on MRI or CT scans. 5 mCi of 123I IMP was administered intravenously and SPECT images were obtained using a GE Starcamm 2000 SPECT system. After standard reconstruction of the images, an automated region of interest (ROI) computer program was applied to each tomographic brain image. Coronal images were then used to analyze lateralized differences in IMP activity. Measurements were made of the mean IMP activity per pixel, the maximum activity per pixel, and the ratio of the mean activity per pixel in the ROI to that of the cerebellum. On visual inspection, 12 out of 19 depressed patients (63%) and only of 12 medical comparison patients (8%) appeared to have substantially increased IMP activity in the right temporal lobe (P less than 0.005). But semi-quantitative analysis showed that while IMP activity was greater in the right than the left temporal lobe of depressed patients (P less than 0.0001), it was also present in medical comparison patients (P less than 0.01). Although there was no difference in the frequency of asymmetry between groups, it was more pronounced in depressed patients. These data suggest that asymmetric temporal lobe activity on IMP SPECT images may be of potential diagnostic utility in some patients with affective disorders.
Article
Positron emission tomography studies with fluorodeoxyglucose in patients with schizophrenia are reviewed and findings in the frontal lobes, basal ganglia, and temporal lobes summarized from more than 20 published studies. Despite methodological and clinical population differences between studies, most reports indicate that patients with schizophrenia are more likely to be low in these areas than in the occipital lobe, cerebellum, or in white matter. This is consistent with blood flow and some neuroanatomical findings. Cluster analysis on our own sample suggests that patients may be low in all three areas rather than a pattern of three distinct clusters. Further study of individual symptom differences, medication effects, and of psychophysical tasks salient for these brain areas is indicated.
Article
Using positron emission tomography, we studied cerebral glucose metabolism in drug-free, age- and sex-matched, right-handed patients with unipolar depression (n = 10), bipolar depression (n = 10), obsessive-compulsive disorder (OCD) with secondary depression (n = 10), OCD without major depression (n = 14), and normal controls (n = 12). Depressed patients were matched for depression on the Hamilton Depression Rating Scale, and subjects with OCD without depression and OCD with depression had similar levels of OCD without depression and OCD with depression had similar levels of OCD pathology. We also studied six non-sex-matched patients with mania. Mean (+/- SD) glucose metabolic rates for the left dorsal anterolateral prefrontal cortex, divided by the rate for the ipsilateral hemisphere as a whole (ALPFC/hem), were similar in the primary depressions (unipolar depression = 1.05 +/- 0.05; bipolar depression = 1.04 +/- 0.05), and were significantly lower than those in normal controls (1.12 +/- 0.06) or OCD without depression (1.15 +/- 0.05). Results for the right hemisphere were similar. Values in subjects with OCD with depression (1.10 +/- 0.05) were also significantly lower than in subjects with OCD without depression, and values in subjects with bipolar depression were lower than those in manic subjects (1.12 +/- 0.03) on this measure in the left hemisphere, although results were not significant in the right hemisphere. There was a significant correlation between the HAM-D score and the left ALPFC/hem. With medication for depression (n = 12), the left ALPFC/hem increased significantly and the percentage change in the Hamilton scale score correlated with the percentage change in the left ALPFC/hem.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Temporal lobe glucose metabolic rate was assessed in 21 off-medication patients with schizophrenia and 19 normal controls by positron emission tomography with 18F-deoxyglucose. Patients with schizophrenia had significantly greater metabolic activity in the left than the right anterior temporal lobe, and the extent of this lateralization was in proportion to the severity of psychopathology.
Article
As temporal lobe dysfunction has been postulated in the affective disorders, the authors investigated glucose utilization in the temporal lobes of 13 affectively ill patients in comparison with 18 normal volunteer controls and 17 previously reported schizophrenic patients, following injections of fluorine 18-2-deoxy-D-glucose (FDG) during somatosensory stimulation to the right forearm. Using a boundary-finding algorithm to outline each temporal lobe, maximum glucose use relative to maximums elsewhere in the same positron emission tomography (PET) slice were calculated. In a small group of moderately to severely depressed patients, this relative measure was significantly reduced in the right (with a similar trend in the left) temporal lobe compared to normal volunteers and the other comparison groups. The lack of a significant increase in glucose utilization, measured either as a maximum or in relation to other areas in the PET scan slice, suggests that a temporal lobe activation or a seizure-like process is not generally occurring during active depressive phases of the illness.
HMPAO-SPECT bei Migraine Accompagnée
  • F Grünwald
  • H Durwen
  • J Ruhlmann
  • H Penin
  • Hj Biersack