Conventional and Quantitative Electroencephalography in Psychiatry
John R. Hughes, M.D., Ph.D. & E. Roy John, Ph.D.
J Neuropsychiatry Clin Neurosci 1999 11: 190-208
A Monthly Summary of News and Events
Vol. 2 No. 8 - September 1999
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QEEG in Psychiatry
by David Kaiser
Conventional and Quantitative Electroencephalography in Psychiatry
John R. Hughes, M.D., Ph.D. & E. Roy John, Ph.D.
J Neuropsychiatry Clin Neurosci 1999 11: 190-208
In 1989 the American Psychiatric Association established a task force to study Quantitative Electrophysiological assessment and determine whether it might soon play an important role in psychiatry. The task force was asked to identify the present state of scientific knowledge about Quantitative Electroencephalogram (QEEG), the current role it plays in clinical psychiatric practice, the training necessary for its proper use, and its possible future in the study of mental disorders. They concluded that QEEG was particularly useful for detecting slow wave abnormalities and this would prove useful in assessing delirium, dementia, intoxication, and other syndromes involving gross CNS dysfunction. But using QEEG for diagnosis of other disorders, such as schizophrenia or depression, was not yet established. What was needed were clinical replications and sharing of normative and patient data bases in order to advance the field.
That was 10 years ago and, as they advocated, beaucoup research is now in.
More than 500 EEG and QEEG papers have been published in the last decade. These papers -- of well-designed studies that confirm EEG and QEEG abnormalities in a high proportion of psychiatric patients -- make a convincing case for assisting psychiatry with this technology. A recent review by Hughes and John present a very coherent argument for its use and evaluates the evidence for each mental health disorder. (For an incoherent argument, anything newer?)
Eventually, of course, we'll all be fitted with powerful electromagnets, a million sensors floating in tiny pools of frozen nitrogen, all packaged to fit under our scalp, enabling Big Brother and other mental health professionals to read our thoughts and feelings before we act upon them. (Think of the savings in personal liability alone!). But in the current climate, both political and economical, portable magno-neuroimaging remains but a fantasy. (Each sensor will have its own IP address and broadcast uncensored thoughts out to 615 nations -- the increase in political entities being a direct consequence of the technology).
What we do have now is a practical, sensitive, and inexpensive method of imaging cortical activity -- called QEEG. Visual inspection of the EEG in search of abnormalities (called coventional EEG by some, voodoo EEG by others) has been regarded as too nonspecific and subjective for diagnostic applications. True, it can be used to identify paroxysmal activity and gross amounts of slow wave activity, as well to stage sleep for those researchs who like staying up all night; but the disordered EEG associated with mental illness is usually too subtle for the human eye and mind to detect. The disorder often spans both time and topography.
Hughes and John argue that QEEG can do the following very well:
In dementia, for instance, QEEG may "enable early detection and prognosis of future cognitive impairment" -- well in time to undergo neurofeedback training to prevent or at least delay mental disintegration.
The authors adopt the general procedures, quality of evidence, and strength of recommendation ratings used in the Report to the American Academy of Neurology. The general procedures require eight major categories to be considered in evaluating a procedure:
Here are the the Quality of Evidence Ratings used:
Class I: Evidence provided by one or more well-designed, prospective,blinded, controlled clinical studies.
Class II: Evidence provided by one or more well-designed clinical studies,such as case control or cohort studies.
Class III: Evidence provided by expert opinion, nonrandomized historicalcontrols, or case reports of one or more.
And finally, the Strength of Recommendation Ratings
Type A: Strong positive recommendation, based on Class I evidence oroverwhelming Class II evidence.
Type B: Positive recommendation, based on Class II evidence.
Type C: Positive recommendation, based on strong consensus of Class III evidence.
Type D: Negative recommendation, based on inconclusive or conflicting Class II evidence.
Type E: Negative recommendation, based on evidence of ineffectivenessor lack of efficacy.
Cerebrovascular Disease: Type B recommendation (many concordant Class II studies)
Dementia: Type A recommendation (multiple Class I; many concordant Class II studies)
Learning and Attention Disorders: Type B recommendation (multiple Class II studies; abundant Class II evidence)
Mood Disorders: Type B recommendation (multiple Class II studies)
Postconcussion Syndrome: Type C recommendation (several Class II studies; multiple concordant Class III studies)
Schizophrenia: Type D recommendation (conflicting Class II & III evidence)
Substance Abuse: Type D recommendation (conflicting Class II & III evidence)
The clinical implications are obvious. Now available -- an inexpensive and sensitive tool to explore the psychological health of individuals; one which circumvents the great seat of self-deception and distortion in mental health (i.e., consciousness).
Hughes, JR. & John, ER (1999). Conventional and Quantitative Electroencephalography in Psychiatry
J Neuropsychiatry Clin Neurosci, 11, 190-208
http://neuro.psychiatryonline.org/cgi/content/full/11/2/190 - FULL TEXT
Hoffman DA, Lubar JF, Thatcher RW, Sterman MB, Rosenfeld PJ, Striefel S, Trudeau D, Stockdale S (1999). Limitations of the American Academy of Neurology and American Clinical Neurophysiology Society paper on QEEG.
J Neuropsychiatry Clin Neurosci, 11, 401-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10440020&form=6&db=m&Dopt=b
QEEG: a report on the present state of computerized EEG techniques.
Am J Psychiatry 1991 Jul;148(7):961-4
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&uid=2053652&Dopt=r
ADHD With Comorbid Disorders: Clinical Assessment and Management
by Steven R. Pliszka, Caryn L. Carlson, Jim M. Swanson
The Developing Mind: Toward a Neurobiology of Interpersonal Experience
by Daniel J. Siegel
Once a Month : Understanding and Treating PMS
by Katharina Dalton, Wendy Holton
ADHD in the Schools : Assessment and Intervention Strategies
by George J. Dupaul
Secondary Traumatic Stress : Self-Care Issues for Clinicians, Researchers, and Educators
by B. Hudnall Stamm
Anxiety & Depression
by Rich Wemhoff
Biological Psychology : An Introduction to Behavioral, Cognitive, and Clinical Neuroscience
by Mark R. Rosenzweig, Arnold L. Leiman, S. Marc Breedlove
From Thoughts to Obsessions : Obsessive Compulsive Disorder in Children and Adolescents
by Per Hove Thomsen
EEG and psychometric differences between boys with and without ADHD
--Is ADHD is a learned behavioral or brain dysfunction? Psychometric and the EEG measures clearly differentiated two samples of 4 boys (with or without ADHD) with no overlap in scores, were reliable over 3 months (r = .87), and were significantly correlated with one another (r = .85). These robust and reliable findings suggest that both the psychometric and the psychophysiological EEG measures deserve further exploration.
Psychological changes accompanying stress-management training for essential hypertension.
--Treatment yielded significant psychological changes that included an increase of problem-solving abilities. No significant correlations were found between psychological changes and self-measured systolic or diastolic blood pressure reductions.
Thalamic metabolic rate predicts EEG alpha power, but not in depressed patients.
--PET, EEG, and structural MRI were obtained to assess the relation between thalamic metabolic activity and alpha power in depressed patients and healthy controls. Robust inverse correlations between mental (metabolic) activity and alpha power were observed in the healthy adults, but not for depressed patients. This may indicate a possible abnormality in thalamocortical circuitry associated with depression.
Neuroimaging findings in substance-related disorders.
--Clinicians need prognostic indicators which can allow patients at higher risk for relapse to be identified and provided with more intensive treatment. Likewise, methods sensitive to diagnostic heterogeneity could be used to guide the development of tailored treatment regimens for patient subgroups. Neuroimaging is a promising approach to obtain such an approach. For instance, intoxication with alcohol results in depressed global glucose metabolism that continues into the stages of withdrawal and abstinence. Long-term alcoholism is associated with atrophy of several brain regions, the frontal lobes and limbic structures in particular.
Symptoms in children with ADHD with and without comorbid tic disorder.
--Boys with ADHD and chronic multiple tic disorder received scored higher on the Anxious/Depressed, Thought Problems, and Attention Problem scales of the Child Behavior Checklist and the Delinquent Behavior, Thought Problems, and Somatic Complaints scales of the TRF than did boys without chronic tic disorder. Children with mild tic disorder were more similar to boys without chronic tic disorder than they were to children with more severe tic disorder.
Characteristics of insomnia in the United States
--One-third of Americans report some type of sleep problem. 1 in 4 reported occasional insomnia while 9% reported that their sleep difficulty occurred on a regular nightly basis. Insomniacs rarely visited a physician to discuss their sleep problem and 2/3rds did not have an understanding of available treatments for insomnia.
The first panic attack: a neurobiological theory.
--An important difference between the initial panic attack and specific phobia is the developmental timing of critical emotional experience: Those occurring early in development lead to panic; those occurring later in development lead to specific phobia.
Identification of AD/HD subtypes using laboratory-based measures
-- Measures of inattention, impulsivity, and activity level identified four subgroups of children with ADHD: Hyperactive-inattentive, Impulsive-inattentive, Inattentive only, and Hyperactive only. The Hyperactive-inattentive group was impaired on intellectual functioning and academic achievement. The impulsive-inattentive group was more aggressive.
Epileptic seizures induced by animated cartoon, "Pocket Monster".
-- Last year a large number of children in Japan had fits while watching the animated cartoon television program "Pocket Monster." A survey of 75 hospitals where many of the children were treated determined the following: Most seizures occurred at a scene in which red and blue frames alternated at 12 Hz. Most had no prior history of epilepsy. Almost all seizures induced by the TV program "Pocket Monster" were epileptic, and partial seizures were induced more frequently than generalized seizures. The "Pocket Monster"-induced seizures in nearly 1 in 5,000 children watching the show.
A new way of building a database of EEG findings.
--A proposed method of storing interpretations and categorizations of EEG in order to improve accessibility of EEG data for clinical, normative, educational and scientific use. One positive aspect of the proposed system is the generation of a database without additional demands upon the EEG interpreter.
Psychopathology and achievement in children at high risk for developing alcoholism.
--Children who are at high risk for developing alcoholism are also more likely to develop psychopathology -- particularly, depression, affective disorder, ADHD, and/or conduct disorder. Deficits in academic performance (reading and math scores) may offer an early indication of a developing disorder.
Autism: not an extremely rare disorder.
--Has been an increase in its prevalence in recent years? The prevalence of autism were reviewed in English language papers. Prevalence rates for studies including some children born before 1970 was under 0.5 in 1000 children, whereas a mean rate of about 1 in 1000 was found for latter studies. The US studies, however, reported atypically low rates.
Treatment of chronic pain with antiepileptic drugs: a new era.
--Shortcomings of traditional pain relief agents have led physicians to investigate alternatives such as antiepileptic drugs. Antiepileptic drugs have been widely studied and prescribed for the relief of acute and chronic pain. Similarities in the neurophysiology of pain and epilepsy suggest that antiepileptic drugs may be a suitable adjunct in the management of chronic pain.
Dependence, parental bonding, and personality disorders in alcoholics
--Alcoholics and non-alcoholics were similar in the parental perceptions and locus of control. However personality disorders were prevalent in nearly one-third of all alcoholics, commonly due to schizoid or dependent personality disorders.
Advanced Training Courses | ||
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BETA/SMR Advanced Practicum
with Sue Othmer Topics Covered
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Alpha-Theta Advanced Practicum
Topics Covered
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| 1999 Schedule | ||
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| Encino, California | BETA/SMR Advanced Practicum | 9/22/99 Wed |
| Encino, California | Alpha-Theta Advanced Practicum | 9/28/99 Tue |
| New York, New York | BETA/SMR Advanced Practicum | 10/12/99 Tue |
| Austin, Texas | Alpha-Theta Advanced Practicum | 11/23/99 Tue |
| Beta-SMR Advanced Practicum Limit = 20 | Alpha-Theta Advanced Practicum Limit = 15 | ||
Conferences for Neurofeedback Clinicians & Researchers | ||
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| CONFERENCE | LOCATION | DATES |
| SNR 1999 | Myrtle Beach, SC | Sep 30-Oct 3, 1999
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| Brain Function, Mod. & Training | Palm Springs [again! :(] | Feb 4-8th, 2000 |
B.J. Wheeler, Ph.D. Licensed Psychologist 3900 Prescott Ave. Lincoln NE 68506 Phone and Fax: (402)488-6112 BJW3900@navix.net Earlene Strayhorn, MD 1022 S. Oak Park Ave Oak Park, IL 60304 (708) 750-4360 stanwest@msc.com Gary J. Schummer, M.Div., Ph.D. 1750 E Ocean Blvd Unit 608 Long Beach CA 90802 562 378-0547 x1 Margaret Wright, M.S., MFT 1417 Manhattan Beach Blvd #A Manhattan Beach CA 90266 310-545-6610 Carol Hindman, BCIAC Center for Wellness 420 Brookside Avenue Redlands CA 92373-4610 909 792-2216 cbhindman@compuserve.com Patricia Wenz, M.A. Neurofeedback of Florida, Inc. 690 Friday Rd Cocoa FL 32926-3317 (407) 639-6051 wenz@patwenz.com Alexander Adam Eschbach, PhD Advanced Biofeedback Center 1800 McDonough Rd Ste 203 Hoffman Estates IL 60192 847-488-0888 DocEsch@aol.com Ross Halpern, Ph.D. Eve Avrin 1405 Geneva Rd Ann Arbor, MI 48103 (734) 712-2552 rosshalpern@navix.net | Daniel Kuhn, M.D. The Kuhn Center 30 West 63rd St. #26-0 New York NY 10023-7103 212-315-1755 dankuhn@mindspring.com East Doncaster Jacques Duff (Director) Behavioural Neuotherapy Clinic 82 Blackburn Road East Doncaster 3109 Victoria Australia 613 98420 370 info@adhd.com.au Lisa Tataryn #1 Lagrave St Winnepeg Manitoba R3V 1J1 Canada 204 269-3931 Naomi Palmor, Ph.D., C.C.C. OR Sharga 17/2 Ramot Dalet Jerusalem Israel 011-972-2-587-3242 eegbio@actcom.co.il (new address) Nick Fenger, Ph.D. 34 Meadowbrook Country Club E Ballwin MO 63011-1693 US (314) 481-9121 TNFenger@sprintmail.com (new address/phone/email) Beverley Steffert 14 Peer Road St.Neot's Cambridgeshire PE193JR UK 01144 1480 350 823 DrSTEFFERT@aol.com (new email) |
No rants this month