An observational study of CT scanning in psychiatric patients

Abstract

Progress in Neurology and Psychiatry 24www.progressnp.com C Certain disorders of the brain may present initially or solely with psychiatric signs and symptoms. 1 The possibility that some of these may be reversible has led to the use of brain imaging in psychiatric practice. A number of published studies have addressed the issue of proper use of brain computerised tomography (CT) imaging in psychiatry. [2][3][4][5][6][7][8][9] The recommendations of these studies varied, from advocating imaging scans as a screening procedure for all patients, risking low yield, to restricting the recommendation to scan only those patients with clear focal neurological abnormalities on examination, accepting the risk of missing a rare diagnosis. Hence, there is a wide divergence of opinion about the proper utilisation of brain scans in psychiatric conditions. Moreover, CT scans are now available in most UK hospitals. They are a relatively cheap, quick, sensitive imaging test for the majority of brain lesions, are easily accessible, and are increasingly being requested for psychiatric patients. CT is a diagnostic procedure that if used unselectively may result in the discovery of incidental findings that may have important implications.In contrast, new more sensitive brain imaging techniques have become available such as: magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT), which although being more sensitive for a variety of conditions are costly, less easy to perform and are not available widely.Our study was carried out to determine the current practice of CT usage among psychiatric patients in a district hospital in the UK. We wanted to study the indications for usage, the results of CT scans repor ted and factors that may influence positive results. We assessed whether the scan results influenced the diagnosis and management of these patients. MethodWe included consecutive patients referred for CT brain scanning for primar y psychiatric diagnosis between Januar y and December 2003 in the Depar tment of Radiology at West Wales Hospital, Carmarthen. The indications for referral for CT brain were based upon the clinical judgement of the psychiatrist. CT scans were performed using the most recently available scanner equipment in the Depar tment. The scan repor ts were read by a radiologist to decide whether the scan was within normal limits, or whether it was abnormal, and the type of abnormality was recorded.We analysed the medical records of all patients and collected data for specific parameters including age, sex, primar y psychiatric diagnosis, duration of symptoms, significant past medical histor y, presence or absence of confusion, abnormal neurological signs and previous history of head injury or An observational study of CT scanning in psychiatric patientsOpinion is divided on the proper use of brain scans in psychiatry. In this study, the authors reviewed CT scanning in common psychiatric conditions in a district hospital. In their study about 64 pe...