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Brain Imaging in Affective Disorders - J. Soares (Marcel Dekker, 2003) WW PDF

400 Pages·2003·58.34 MB·English
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Preview Brain Imaging in Affective Disorders - J. Soares (Marcel Dekker, 2003) WW

Brain Imaging in Affective Disorders edited by lair C. Soares University ofTexas Health Science Center at San Antonio San Antonio, Texas, U.S.A. MARCEL 11 DEKKER MARCEL DEKKER, INC. Copyrighted Material NEW YORK· BASEL Library of Congress Cataloging.in·Publication Data A catalog record for this book is available from the Library of Congress. ISBN: 0·8247·0884·9 This book is printed on acid-free paper. Headquarters Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016 tel: 212-696-9000; fax: 212-685-4540 Eastern Hemisphere Distribution Marcel Dekker AG Hutgasse 4, Postfach 812, CH-4001 Basel, Switzerland tel: 41-61-260-6300; fax: 41-61-260-6333 World Wide Web http://www.dekker.com The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special SaleslProfessional Marketing at the headquarters address above. Copyright © 2003 by Marcel Dekker, Inc. All Rights Reserved. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Current printing (last digit): 10 9 8 7 6 5 4 3 2 PRINTED IN THE UNITED STATES OF AMERICA Copyrighted Material iii 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 proper shape and placement of glass and ground and polished the lenses himself. In autumn Galileo focused his instrument on the face of the Moon. The follow- ing spring he discovered "four planets never seen from the beginning of the world right up to our day," in orbit around the planet Jupiter. By March, a copy of the 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 of lenses he had ground, turned them on the hitherto invisible world of bacteria, protozoa, and red cells, and made a detailed observation of capillary circulation. Word quickly spread to London, where he was elected a Fellow of The Royal Society. Through Pasteur, Koch, and many others, we now have an understanding of the interplay of organisms 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, see Dava Sobel's Galileo's Daughter (Walker & Co., 1999). Copyrighted Material 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 what goes on inside our bony crania, the brain and its accompany- ing mind have remained inside a previously unpenetrable "black box." The last two decades of advances in neuroimaging have provided an expanding capacity to explore the anatomic, chemical, and functional aspects of the brain. New techniques have been applied to both normal patients and patients with a variety of neuropsychiatric problems. Dr. Soares has brought together a stellar group of investigators to help us understand the latest findings in patients with affective and/or anxiety disorders. All clinicians need to master this material-it is the future of our field. William A. Frosch Copyrighted Material v Foreword Affective disorders represent a major cause of disability worldwide. By the year 2020, it is estimated that unipolar affective disorders will be the second leading cause of death worldwide. Therefore, improving our understanding of the cause of affective disorders, enhancing diagnostic methodology, and developing ways of selecting and monitoring treatment are central priorities in medical practice. At the present time we stand on the verge of seeing the implementation of brain imaging techniques to study both the structure and function of the brain in psychiatry and neurology. This book brings together both the range of the 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 of new 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 playa crucial role in treatment development. This book provides clinicians and researchers with a rich source of information on what brain imaging techniques are available and what they have yielded. Structural studies using magnetic resonance imaging 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- Copyrighted Material vi Foreword mitter dysfunctions in the brain of patients with affective disorders. Early in- fonnation on differences in brain function between bipolar and unipolar affective 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, are the subject of individ- ual chapters. Spectroscopy has proven to be a valuable tool, not just in the study of the GABAergic system, but also in the study of energy pathways and a variety of lipid 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. This book is an extremely valuable volume for the reader and an important reference for the clinician who wants to know the state of the art, as well as the researcher. J. John Mann, M.D. Professor of Psychiatry and Radiology Columbia University Chief, Division of Neuroscience New York State Psychiatric Institute New York, New York Copyrighted Material vii Preface Over the past two decades, the methods for in vivo brain imaging investigations have advanced substantially. Newer and more sophisticated tools for anatomical, chemical, and functional in vivo studies of the human brain have become avail- able and have increasingly been applied to the study of brain mechanisms in- volved in major neuropsychiatric disorders. Affective disorders are a major group of psychiatric illnesses that are very common in clinical practice and pose a considerable burden to patients, their families, and society in general. Despite the enormous importance of these major 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 involved in these disorders and the mechanisms of action of available treatments. As the causation of these major psychiatric disorders remains largely unknown, there is considerable hope that this newer generation of studies will substantially 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 emission tomog- Copyrighted Material 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 allowed unprecedented in vivo neurochemical investigations of the human brain. 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 of investigation in neuropsychiatry has been growing rapidly 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 providing complete and easily accessible information on the latest developments. This new volume includes chapters from leading authorities in the field and fills an important gap in the neuropsychiatric literature. It will be an invaluable re- source for practitioners in the fields of psychiatry, neurology, primary care med- icine, and related mental health professions, as well as researchers, graduate and 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 of affective disorders and the mechanisms of action of available treatments. lair C. Soares Copyrighted Material Contents Series Introduction William A. Frosch iii Foreword J. John Mann v Preface vii Contributors xiii PART I. GENERAL 1. Brain Imaging Methods in Neuropsychiatry Roberto B. Sassi and lair C. Soares 2. Investigation of Mood Disorders by Transcranial Magnetic Stimulation Fumiko Maeda, Marie-Charlotte Dubeau, Lisa Koski, and Sarah H. Lisanby . Copyrighted Material 1 19 ix

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