Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 12 G Bildgebung, Neurophysiologie, Neuropsychologie // Brain Imaging, neurophysiology, neuropsychology
of dementia with more than 70 % accuracy. Automated high-resolution
image processing using deformation based morphometry
together with multivariate analysis predicts of onset of dementia in
at risk stages with more than 80 % accuracy. Functional MRI in the
resting state may evolve as easily accessible marker of cortical functional
connectivity, but requires further study. Detection of subcortical
fiber tract integrity may be a useful adjunct to functional and
structural imaging, but has not yet fully been explored as diagnostic
or outcome marker. Finally, new in vivo tracer of amyloid plaque
load with positron emission tomography may identify amyloid pathology
in asymptomatic subjects as risk marker of AD and may be
useful to detect effects of amyloid lowering treatment strategies in
vivo.
Discussion / Results: Multimodal imaging draws a comprehensive
picture of amyloid pathology, cortical connectivity and neuroanl
degeneration and will be important in the near future to enhance
the power of clinical prevention trials and to better understand the
effect of amyloid pathology on cognitive decline. The broad implementation
of advanced neuroimaging techniques in clinical routine,
however, very likely will depend on the availability of next generation
treatment approaches that aim to modify underlying
disease processes.
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Neuroimaging in neuropsychiatric disorders: differential diagnosis
and prediction of clinical course
Oliver Pogarell (LMU München, Klinik für Psychiatrie)
Introduction: The neurobiological characterisation of psychiatric
disorders provides insight into brain functional alterations and relevant
pathomechanisms, and is a major issue of current research.
Nowadays there is increasing evidence that neurobiological parameters
can be used as diagnostic tools and to warrant or to validate
pharmacological treatment decisions. Clear pathophysiological hypotheses
with respect to neuronal activity or brain neurochemistry
provide a scientific basis for the development of differential treatment
strategies and the evaluation of the course of the disorder under
treatment. Thus the assessment of brain activity at rest or upon
stimulation including underlying neurochemical alterations can
help to facilitate the differential diagnosis and subsequent therapeutic
decisions.
Method: Neurophysiology and neuroimaging are the key tools to
evaluate brain functional disorders and consequently to monitor
neurobiological treatment effects. In particular, a combination of
complementary methods can add to the clinical assessment of psychopathology
with respect to differential diagnoses and treatment
decisions. Furthermore, these methods help to prove pathophysiological
concepts.
Discussion / Results: Both neurophysiological and functional neuroimaging
techniques have been used to discriminate diagnostic
and therapeutic subgroups of neuropsychiatric patients and have
been assessed regarding prognostic and predictive properties. Studies
in patients with depression, obsessive compulsive disorder, attention
deficit or emotional instability provide evidence of different
pathophysiological mechanisms of both categories of psychiatric
disorders and psychopathological dimensions. Therefore the data
might be useful in clinical application – in terms of diagnosis, evaluation
of the course or prediction of subjects‘ responses to treatment.
003
Neuroimaging in major psychosis: neuromarkers for validation
and reformation of psychiatric classification systems
Oliver Gruber (Universitätsklinikum Göttingen, Klinik für Psychiatrie)
Introduction: In psychiatric research, neuroimaging techniques
are usually applied in order to detect morphological and / or functional
(i. e. pathophysiological) brain abnormalities in patient
groups. These group abnormalities may either be common to different
psychiatric disorders, e. g. to different types of major psychoses
(schizophrenia, schizoaffective disorder, bipolar disorder and unipolar
major depression), or they may be specific to one of these
diag nostic categories according to current classifications systems,
which could help to confirm the biological validity of these diagnoses.
On the other hand, the same neuroimaging techniques can
also be used in order to search for neuromarkers that may be common
to subgroups of patients independent of their diagnosis
accord ing to current classification. If this approach of defining intermediate
psychiatric phenotypes according to neuropathophysiological
markers proves to be successful, this could advance the
identification of pathogenetic pathways and could lead to a reformation
of diagnostic systems based on etiology and pathogenesis.
Method: Different methods may contribute to category-independent
search for endophenotypic neuropathophysiological markers
using neuroimaging. Statistical analyses of, for instance, brain activation
abnormalities in single patients may be a first step in the
attempt to identify subgroups of patients with a more homogeneous
underlying pathophysiology. More advanced methods include
pattern classification and related approaches.
Discussion / Results: There is already ample evidence for neurobiological
heterogeneity within the diagnostic categories according
to current psychiatric classification systems. In this talk, examples
for this heterogeneity will be introduced with particular emphasis
on neuroimaging findings. Furthermore, recent examples for the
success of pattern classification methods in detecting common
neuropathophysiological markers in neuroimaging data will be
presented. In order to further evaluate the possible diagnostic value
of neuroimaging markers with regard to future psychiatric diagnosis
based on etiology and pathogenesis it will also be important to
acquire normative data on these neuromarkers.
004
Neuroimaging in depression and schizophrenia: evaluation of therapeutic
approaches
Ute Habel (Universitätsklinik Aachen, Psychiatrie und Psychotherapie)
Introduction: Neuropsychological as well as neuroimaging data
reveal a complex dysfunctional interaction in schizophrenia but
also in depressive patients, where especially subcortical-limbic but
also frontal and cingular regions show aberrant activation patterns
during cognitive as well as emotional functions. Hence, regions of
major importance in cognition but also emotion regulation and
inte gration are affected.
Method: Longitudinal fMRI studies evaluate the possibility to reduce
cognitive and emotional impairments with specific psychological
therapies. In schizophrenia, a cognitive training was evaluated
as well as an emotion recognition training. In depression a standardized
humor training has been evaluated on the dysfunctional correlates
during humorour cartoon processing.
Discussion / Results: A complex pattern of hypo- and hyperactivations
emerged in a subcortical-limbic as well as cortical network in
dependence of task requirements. Results of the longitudinal studies
document the therapeutic effects, normally seen on a behavioral
level, in the underlying neuronal substrates and demonstrate the
specific efficacy of behavioral therapies. However, concerning psy-
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