Diagnosing a mental illness isn’t always easy. In fact, it can be a subjective process that allows one clinician to see one disease, while another sees a different disease and a third sees nothing at all, even when all three medical practitioners are looking at the same patient. This kind of uncertainty can be annoying, but it can also lead to very serious problems, as some might not get the right diagnosis or the right treatment for a very real mental health issue.
In a perfect world, a person with symptoms of a mental illness could get a simple test that would definitively diagnose the problem or prove that no problem really exists. Some believe that neuroimaging scans provide this opportunity, but others aren’t so sure that the scans can ever take the place of the tried-and-true methods that are currently in use.
Families might not be asked to provide input on this issue at all, but understanding the nature of the tests experts might propose can allow families to make good choices about the care a loved one might receive.
Older Methods
When a person has behaviors that seem unusual to outsiders, they may land in the offices of mental health professionals. Here, experts may ask a series of questions regarding:
- The length of time in which the behavior has taken place
- The thoughts the person might have
- The impulses the person might struggle to control
- The person’s overall health
Blood tests and other physical examinations might play a role, but experts typically focus on the answers to interview questions in order to make a firm diagnosis of mental illness. By comparing the person’s responses to guidelines published by medical experts, doctors can make a reasonable guess about what’s happening inside the head of the person who needs help.
Unfortunately, this process can be a little imprecise. Some people don’t describe their symptoms in ways that mesh with the textbooks experts use, while others may not be willing to provide the open and honest answers that could result in a proper diagnosis. In addition, some mental illnesses have symptoms that overlap, even though the treatments for those illnesses can be quite different.
People who have mental illnesses may know this all too well, as they may struggle for years in order to get a proper treatment. Those who have bipolar disorder, for example, may wait 13 years to get the right diagnosis, according to The Guardian, and 71 percent of these people report that their symptoms worsened due to the delay. This isn’t a minor problem, and it’s hoped that brain scans can help.
Potential Neuroimaging Scans Benefits
Brain scanning technology is incredibly sophisticated, and at the moment, there are scans that can detect:
- Brain structure
- Energy use within cells in the brain
- Blood flow to cells in the brain
- Types of tissues appearing inside the head
Scientists are also developing sophisticated computer programs that might possibly be used to read brain scans. In an article published in PLOS One, for example, researchers describe a computer program that can work in tandem with an MRI. Programmers have developed software that can compare an MRI with other MRIs completed by people who have known mental illnesses, and matches could lead to a diagnosis. This kind of system could make human diagnosis almost obsolete, as the computer program might become more and more accurate with each scan read.
Some tests are designed to help experts differentiate between normal behavioral quirks and those driven by pathology. For example, some people with attention deficit hyperactivity disorder (ADHD) tend to fidget and find it hard to pay attention to almost anything. Some small children behave in this way, even though they don’t have a disorder at all. In 2013, the U.S. Food and Drug Administration allowed a company to market a device that could be used to diagnose ADHD in those ages 6 to 17. Brain wave frequencies are analyzed in this test, and the developers suggest that unusual waves could definitively point to the disorder.
Most experts suggest that these tests shouldn’t be used in place of traditional interview techniques. Just talking to people and getting a feel for the way they think and the way they react remains the most reasonable way to spot a mental illness that’s in play, and get a reasonable treatment program in the works. However, brain scans can be helpful in augmenting the interview process.
Sometimes, brain scans bring back definitive information about alterations that can help to support a diagnosis that a clinician already has in mind. In these situations, brain scans work to confirm the work that the therapist has already completed.
There are times, too, when scans pick up hidden physical problems that could lead to symptoms of mental illness.
Tumors, for example, can press on delicate tissues and cause people to behave in erratic ways. Some types of scans could pick this up and allow people to get the physical help they need.
Possible Drawbacks
Despite the possible benefits, most experts advise caution. At the moment, for example, the National Institute of Mental Health suggests that brain scans can’t be the only method used to diagnose:
- Autism
- Anxiety
- Depression
- Schizophrenia
- Bipolar disorder
This kind of caution is merited, as the brain is a complex organ that scientists don’t yet understand. For example, human bodies tend to have a significant amount of variability, particularly in the brain. Some people have heavier brains, for example, while some people have lighter loads to carry in their skulls. Scans of someone with a congenitally light brain might seem to signal disease, even though that light brain might be normal for that person. Comparative scans that track a person through time might provide better answers, but few people would submit to a scan of healthy tissue, as these exams can be costly and the results can be hard to interpret.
Similarly, much of the research done on neuroimaging scans has compared a set of healthy brain tissues with a set of diseased tissues. Only one diagnosis is in play in these studies. Often, however, people who have mental illnesses have many different conditions impacting them at once. They might have anxiety disorders and depression, for example, or they might have schizophrenia and addiction. The scans of brains like this might show changes, but it might be difficult to determine what is causing the damage and what problem might need to be addressed.
In addition, the scans might not be effective in diagnosing diseases at the early stages. Dramatic changes might fly right out of a scan, but subtle changes that could impact behavior might be easily overlooked or explained away. Those who might benefit from a scan might be in the advanced stages of the disorder, and by that point, they may already have a valid diagnosis and treatment plan.
Good Choices
Although neuroimaging scans may not provide all the answers when it comes to appropriately diagnosing a mental illness, it’s reasonable for some families to include the technology in their treatment plans, as they may get answers from a scan that could elude them with other forms of care. For example, people who have brain injuries may not know of their physical ailments unless they get a scan, and that could be vital for their healing. In a study of the issue, published in the Journal of Psychoactive Drugs, researchers found that 52.3 percent of patients saw their treatment plans modified after a scan, and 22.9 percent had those changes because brain trauma that had been previously undetected was found in the scan.
Results like this seem to suggest that scans should have a place in the diagnosing process for almost anyone, even if they’re only used in order to rule out some kind of underlying injury or physical illness. These problems can really take their toll on the way someone behaves and feels, and they often can’t be amended with talk therapy alone. A scan could make the issues come to light, and that could make proper therapy all the easier to provide.
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Scans for mental illness might also be beneficial for some people, as long as they’re provided in tandem with traditional interview techniques. Scans can help resistant people see that their illnesses are real and in need of treatment, and they may help the treatment team to see the extent of damage that the person is dealing with. Scans might also help treatment teams to measure recovery, as some problems attributed to mental illness can be measured by brain size, blood flow and energy use in the brain. A secondary scan could show that kind of progress.
Scans aren’t without risk, however, as they do tend to emit radiation. They are also typically performed with very loud machines that people must crawl into. Some people just aren’t well enough to deal with a dose of radiation, and others find the confining nature of the tests too hard to deal with. People who have these issues might try to avoid the scans altogether.
In general, it’s best to talk with the treatment team about the risks and benefits of scanning, and then ensure that the scans will be just one part of the care the person is destined to receive. Customized care is always best, when a mental health issue is in play, and talking with a therapist is often the best way to make that happen.
Find Out More
Dealing with a mental health issue in a beloved family member isn’t easy, especially when that person might also be using and abusing drugs. If you’re searching for the right kind of help for someone you love, please call us. We can direct you to a Dual Diagnosis facility that provides care for both addiction and mental health issues, and we can help you to find a facility that uses scans, if that’s something that you think might be helpful. Just call and we’ll get started.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton