Electronic Health Reporter

By Dr. Antonio Rotondo, licensed clinical psychologist, specializing in neuropsychology.

Neurotechnologies that help diagnose and treat brain disorders are, in essence, a form of “information technology” in the behavioral healthcare world. They’re also relatively new in the history of psychiatry, and their advent is allowing us to more accurately diagnose and treat those who suffer from addiction and mental illness.

Subjective pursuit or objective science? Psychiatry vs. other branches of medicine

With most medical diagnoses, doctors have been able to rely on objective tests to diagnose and treat patients’ ailments:

• If a primary care doctor suspects a diagnosis of diabetes, they can order an oral glucose tolerance test and measure blood sugar levels.
• In the case of a broken bone, a simple X-ray should reveal it.
• Even with diagnoses that are far more diabolical, such as cancer, physicians can perform a whole battery of medical procedures (lab tests, ultrasounds, scans, biopsies, etc.) which can provide an objective diagnosis.

On the other hand, in the absence of similarly objective, diagnostic tools, diagnosing and treating mental disorders has long been a more subjective exercise— and probably one big reason that psychiatry has historically been subject to marginalization next to other “more scientific” branches of medicine.

Much also remains to be understood about the neurobiology of mental disorders and their treatment. It’s a fact that the psychotherapist Gary Greenberg, writing in the April 2019 issue of The Atlantic, has rightfully noted is “unsurprising, given that the brain turns out to be one of the most complex objects in the universe.”

Advances in brain imaging technologies and what they can reveal

But in recent years we’ve begun learning more and more about the brain and the neurobiology of its dysfunction, thanks to various brain imaging technologies that allow us to map this incredibly complex organ, trace its activity and locate abnormalities in health and function:

• MRI scans use a strong magnetic field and radio waves to create detailed, 3-D images of the brain and its tissues, allowing doctors to diagnose brain tumors, aneurysms, epilepsy, brain hemorrhages and other issues.
• CT scans use X-rays to produce horizontal, or axial, images (often called slices) of the brain. These allow physicians to detect brain clots, lesions, injuries, intracranial bleeding, infections, structural anomalies, and other conditions. CT scans can also be used to evaluate the effectiveness of treatments for brain tumors.
• SPECT scans—or “single-photon emission computerized tomography”—are a type of nuclear imaging test that takes 3-D pictures using a radioactive substance. SPECT scans can help diagnose dementia, clogged blood vessels, seizures, epilepsy, and head injuries.
• qEEG scans measure the brain’s electrical activity via brainwaves and their patterns, which in turn offer insight into how brain cells are communicating. The “q” in “qEEG” stands for “quantitative”: it means that unlike a typical EEG scan, a qEEG will be able to analyze and compare electrical signals and brainwave patterns against a database of healthy-functioning brains’ electrical signals and brainwave patterns.

Diagnosing and treating mental disorders – in pursuit of a more exact science

Thanks to these developments, we now know with reasonable clinical certainty that specific brain networks and regions are associated with various types of cognitive and psychiatric dysfunction, involving substance addiction, mood disturbances (depression, anxiety, mania, etc.), or neuropsychological deficiencies (attention problems, impulse control issues, learning disabilities, etc.).

As a neuropsychologist, I assess and diagnose mental health conditions in patients with substance use disorders and co-occurring conditions, like anxiety, depression and post-traumatic stress disorder (PTSD). The goal of each assessment is to provide as accurate a diagnosis as possible. (After all, the more accurate the diagnosis, the better we can treat a patient’s symptoms and underlying condition.) The qEEG has proven particularly helpful in this work.

One Example of How the qEEG Is Helping Us Better Diagnose and Treat Mental Disorders

Take, for example, bipolar disorder— a mental disorder that is notorious for being wrongly diagnosed. (Research has suggested that the misdiagnosis rate could in fact be as high as 69 percent.) In the past, clinicians like myself relied on their own subjective observations and a patient’s self-reporting of symptoms (via a psychiatric questionnaire) to venture a diagnosis.

Today, before assessing the patient’s subjective complaints, I can use a qEEG to assess and map a patient’s brain’s brainwave patterns. The resulting brain map can help to rule out certain conditions while zeroing in on a smaller cluster of potential diagnoses.

For example, an excess of active or overactive brain waves, known as beta and high beta respectively, may indicate the presence of mania or hypomania, which are hallmark symptoms of bipolar disorder.

Because excess beta or high beta waves can also be indications of a few other disorders associated with hyperarousal, such as an anxiety disorder or PTSD, a thorough assessment would also include a neuropsychological exam comprising a personality questionnaire and other exercises that allow me to observe the patient. In other words, the qEEG looks at what a patient’s brain is doing, while the neuropsychological testing looks at how a patient is interacting with the tasks I put in front of them.

With a patient whose qEEG suggests they could be manic or hypomanic, their answers on a detailed personality inventory can provide further information about potential mania or hypomania. I also can administer certain tests, like the Trailmaking Part B and the Stroop task, which help to evaluate a patient’s cognitive flexibility, verbal inhibitory control and impulse control— all of which can be compromised in people with bipolar disorder.

When used in combination with these tests, then, the qEEG can be vital to getting an accurate diagnosis—and, in turn, an effective treatment plan—for bipolar disorder as well as a whole host of other disorders. In addition to helping us narrow down our search for where and what the mental disorder is, the objective data that the qEEG provides can reveal symptoms that a patient is not reporting. (For various reasons, patient self-reporting can be inaccurate.)

The next frontier in behavioral health technology – brain stimulation therapies

And, being able to pinpoint specific areas of dysfunction allows us to be more comprehensive in our treatment of bipolar disorder and other conditions, employing not just medications (which can often prove hard to tolerate) but also brain stimulation therapy that therapeutically targets the specific areas of dysfunction. In fact, brain imaging technologies like the qEEG are what make brain stimulation therapy, and the next frontier of behavioral healthcare, even possible. In this sense, we’ve only begun to tap into technology’s potential for helping us understand mental illnesses and their origins in the brain— but the future looks bright.