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K. Ranga Rama Krishnan - Brain imaging in clinical psychiatry

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This single-source reference provides a solid understanding of neuroimaging technology in detecting regional changes and abnormalities in brain anatomy and chemistry-emphasizing flexible and sensitive techniques with potential utility as adjuncts for effective differential diagnosis, subclassification, and management of psychiatric disorders.

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title Brain Imaging in Clinical Psychiatry author Krishnan K - photo 1

title:Brain Imaging in Clinical Psychiatry
author:Krishnan, K. Ranga Rama
publisher:CRC Press
isbn10 | asin:0824798597
print isbn13:9780824798598
ebook isbn13:9780585158099
language:English
subjectMental illness--Pathophysiology, Brain--Imaging, Brain Diseases--pathology, Mental Disorders--pathology, Diagnostic Imaging--methods.
publication date:1997
lcc:RC473.B7B735 1997eb
ddc:616.89/071
subject:Mental illness--Pathophysiology, Brain--Imaging, Brain Diseases--pathology, Mental Disorders--pathology, Diagnostic Imaging--methods.
Page i
Brain Imaging in Clinical Psychiatry
edited by
K. Ranga Rama Krishnan and P. Murali Doraiswamy
Duke University Medical Center
Durham, North Carolina
MARCEL DEKKER, INC.
NEW YORK BASEL HONG KONG
Page ii
ISBN: 0-8247-9859-7
The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the address below.
This book is printed on acid-free paper.
Copyright 1997 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.
Marcel Dekker, Inc.
270 Madison Avenue, New York, New York 10016
Current printing (last digit):
10 9 8 7 6 5 4 3 2 1
PRINTED IN THE UNITED STATES OF AMERICA
Page iii
This book is dedicated to our families.
Page v
Preface
The search for brain pathology as an underlying cause of psychiatric disorders continues to be the driving force behind biological psychiatry. Until about a decade ago, the only way to evaluate abnormalities in brain structure was by postmortem neuropathological studies. These studies were limited by several confounding factors, such as postmortem changes in the brain, problems with fixation, heterogeneous samples, agonal factors, and comorbid medical conditions including cardiovascular and cerebrovascular disease. Thus the results of the early postmortem studies were often contradictory and difficult to interpret. Early imaging techniques such as skull x-rays and ventriculograms were insensitive and provided limited information.
The advent of computed tomography (CT) enabled observation of living brain tissue for the first time. In the years since CT began providing in vivo evidence of cerebral atrophy, for example, enlarged ventricles and sulcal dilation in schizophrenia, there have been numerous reports of CT showing gross morphological changes in patients with psychotic disorders.
Magnetic resonance imaging (MRI)with its greater tissue differentiation, three-dimensional acquisition capability, and increased flexibility in acquiring and reslicing the brain in orientations that facilitate rendering, visualizing, and quantifying specific structures in the brainhas led to a veritable explosion of studies documenting regional changes in the brain in psychiatric disorders. Patients with psychiatric disorders generally manifest subtle brain abnormalities that are best characterized by quantitative measures.
Page vi
Magnetic resonance spectroscopy (MRS) is a unique, noninvasive tool that is useful for probing metabolic function in the living brain without using any radioactive compounds. MRS has been successfully applied in investigating neuropsychiatric disorders including schizophrenia, Alzheimer's disease, and depression. Some MRS measured neurochemicals may also have clinical utility as adjuncts in following progression of a disease.
Positron emission tomography (PET) and single photon emission computed tomography (SPECT) now afford unprecedented opportunities for studying in vivo neurochemistry, cerebral blood flow, and receptor binding. A number of studies using these technologies have begun to elucidate the pathophysiology of neuropsychiatric disorders and have led to increased clinical use of these methods in neuropsychiatry (e.g., for Alzheimer's disease and temporal lobe epilepsy). Functional MRI has begun to complement and extend both the time and spatial resolution of neuronal and activation studies and has the potential to revolutionize our understanding of human brain function in neuropsychiatric disorders.
This book provides clinicians and researchers with a background and comprehensive introduction for imaging neuropsychiatric disorders. It addresses relevant questions regarding the current state of imaging in different neuropsychiatric disorders and indicates the potential clinical value of the various neuroimaging techniques.
The general format is organized by specific disorder categories and by imaging modalities. The contributors are primarily clinical scientists who utilize neuroimaging in their research. Chapters 1A, 1B, and 2 are designed to provide a basic understanding of the general principles of MRI, MRS, SPECT and PET. For a more detailed discussion on instrumentation and technical aspects of these modalities, readers are referred to the references in these chapters. Chapter 4, on normal functional neuroanatomy, is restricted to a discussion of the limbic system and planum temporale. We selected this region given its obvious relevance to neuropsychiatry and its significance in contemporary neuropsychiatric imaging studies. The normal functional anatomy of other cortical and subcortical areas, as well as more theoretical discussions of brain circuitry, are not elaborated separately in order to limit the length of this book. Chapter 5 summarizes imaging studies of normal brain development and is restricted to issues relevant to interpreting imaging studies of child and adolescent psychiatric disorders. It does not address other aspects of brain maturation, such as changes during birth and infancy, that were felt to be more relevant to a neuroradiologist or pediatric neurologist.
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