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

400 Pages·2003·58.34 MB·English

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

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ISBN: 0·8247·0884·9

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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).
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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 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

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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-
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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

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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-
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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

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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
.

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