Multi-site six month outcome study of complex psychiatric patients evaluated with addition of brain SPECT imaging

Psychiatric diagnoses are made primarily through clinical histories, with psychiatrists searching for DSM (Diagnostic and Statistical Manual of Mental Disorders)-driven symptom clusters, and outcomes for patients have not substantially improved in decades for many disorders.

In this study, the research team examined the outcome impact of the addition of single photon emission computed tomography (SPECT) to the assessment of complex patients.

The research team designed a multisite, prospective, 6-mo outcome study. The study was completed after final outcome measures were obtained on 500 participants.

The study occurred in four psychiatric clinics, the Amen Clinics in Newport Beach and San Francisco, CA; Bellevue, WA; and Reston, VA.

Participants were new outpatients at the four clinics who were entered into the study between January 2011 and August 2012.

Evaluations included (1) histories, (2) mental-status examinations, (3) a Structured Clinical Interview for DSM-IV (SCID-IV), (4) the Beck Depression Inventory-II (BDI-II), (5) the Brief Symptom Inventory (BSI), (6) the Quality of Life Inventory (QOLI), and (7) brain SPECT scans during rest and concentration. At 6 mo, standardized outcome measurements were readministered (BDI-II, BSI, QOLI), and the research team asked questions about improvement and compliance.

Seventy-five percent of participants reported significant clinical improvement; 55% reported being "very compliant," 41% "somewhat compliant," and 4% "noncompliant." Significant improvements were observed across all three assessments: (1) BDI, 360 out of 500 (72%) participants decreased, mean difference=-6.92; (2) BSI, 367 out of 461 (80%) participants decreased, mean difference=-0.39.; (3) QOLI, 427 (85%) of participants improved) at 6 mo (Hotelling T2=460; P<.0001), mean difference=+1.65. Net improvement was measured at 81% (n=405).

To the research team's knowledge, this study is the first outcome study of complex psychiatric patients using SPECT as an additional diagnostic tool and demonstrating significant improvement. Further studies comparing the addition of brain SPECT to "treatment as usual" groups are warranted.