Magazine article Clinical Psychiatry News

Neuroimaging Studies: Disease Response or Cause? (Chicken-or-Egg Question about Results)

Magazine article Clinical Psychiatry News

Neuroimaging Studies: Disease Response or Cause? (Chicken-or-Egg Question about Results)

Article excerpt

HONOLULU -- Most neuroimaging studies that compare normal brains with those of people with neuropsychiatric disorders conclude that the differences seen identify the causes of the psychopathology.

If subsequent studies show that medication relieves symptoms and makes brains with psychopathology look normal again, most researchers conclude mat the drug has treated the cause of the disorder.

It's not that simple, Elizabeth E. Gerard said in a poster presentation at the annual meeting of the American Academy of Child and Adolescent Psychiatry. What you see may not be the only cause of the disorder, or may not be the cause at all. It could be a response to the disorder. In that case, you would expect medication to correct the differences seen between brains, since eliminating the symptoms also would eliminate the response, said Ms. Gerard, a Doris Duke Fellow in child psychiatry at Columbia University, New York.

If it is true that some neuroimaging studies demonstrate neurologic responses to a syndrome, their findings could help identify ways that people recover or might recover from the illness, she said.

Ms. Gerard and her mentor, Dr. Bradley S. Peterson, based their conclusions on a review of the literature, which included findings from two studies of patients with Tourette's syndrome led by Dr. Peterson. They chose Tourette's syndrome as a useful model to illustrate their point because 90% of children with the disorder either recover completely or have only mild symptoms as adults. "Something is going on in those patients that helps them recover, and we presume that there's a neural basis for" the remision of their symptoms, she said.

In the first functional MRI study of Tourettes syndrome, images taken of 22 subjects with the disorder while they were attempting to suppress tics were compared with those of the same subjects while they were allowed to express their tics (Arch. …

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