Stand-alone software running on Windows OS based on voxel-based morphometry using 3D structural whole brain MRI, Voxel-based Specific Regional analysis system for Alzheimer’s disease (VSRAD^®), has been widely used in approximately 3000 institutes in Japan for early and differential diagnosis and for the evaluation of disease progression in neuropsychiatric diseases manifesting dementia as an adjunct to the clinical assessment. Analytic procedures of MRI data using VSRAD^® comprise segmentation into gray matter, white matter, and cerebrospinal fluid partitions, anatomical standardization of all the images to the same stereotactic space using linear affine transformation and further non-linear warping, smoothing, and finally performing a statistical analysis. This statistical analysis provides a Z-score map as a consequence of comparison of a patient’s MRI with a normal database. This software can incorporate target volumes of interest (VOI) for Alzheimer’s disease at bilateral medial temporal areas, dementia with Lewy bodies at a dorsal midbrain area, and major depressive disorders at subgenual anterior cingulate cortex and provide atrophy index in these disease specific VOIs.

Conventionally, the main roll of MR imaging for a psychiatric disorder was excluding any structural abnormalities, and these images were interpreted as “unremarkable” in most cases. MR imaging has made impressive progress in recent years, providing significant morphological and functional information. Many studies using voxel-based morphometry or diffusion MRI have been performed on psychiatric disorders. In this review, we introduce basic points of diffusion tensor imaging (DTI) and the analysis of brain structural connectivity using DTI. We also introduce recent findings about schizophrenia, bipolar disorder, major depressive disorder, and anxiety disorders.

Dopamine transporter (DAT) imaging is a sensitive method to detect presynaptic dopaminergic neuronal dysfunction, which is a hallmark of neurodegenerative disorders. DAT imaging can be useful for differentiating between conditions with and without presynaptic dopaminergic deficits. Drug-induced parkinsonism (DIP) is the second most common type of parkinsonism after Parkinson’s disease, and their distinction has crucial implications in terms of management and prognosis. A normal DAT single photon emission computed tomography (SPECT) finding is helpful in supporting a diagnosis of drug-induced, psychogenic, and vascular parkinsonism by excluding any underlying true nigral dysfunction. Dementia with Lewy bodies (DLB) is diagnosed on the basis of the presence of dementia and other core clinical features: cognitive fluctuations with marked variation of attention and alertness, recurrent well-formed, detailed visual hallucinations, and spontaneous parkinsonism. Differentiating DLB from Alzheimer’s disease (AD) and other dementia symdromes is important for prognosis and management. DAT-SPECT can be an accate method to differentiate between DLB and other dementia syndromes. Here, we review the usefulness of DAT imaging for the diagnosis of these diseases on the basis of our own cases.

The differential diagnosis between depression and the depressed symptoms observed in the early Alzheimer’s disease (AD) is often difficult in clinical practice. This short review discussedthe availability of statistical analysis of brain perfusion single photon emission computed tomography (SPECT) images by 3-dimensional stereotactic surface projection (3D-SSP) for distinguishing between AD and depression. Such a neuroimaging method may help the clinicians to assume the potential AD, pseudo dementia, or transitional condition in the spectrum between AD and depression. Another neuroimaging method, dopamine transporter (DAT) SPECT can evaluate the level of serotonin transporter (SERT) as well as DAT level. Therefore, DAT-SPECT is expected to be available to evaluate the pathophysiology of depression including the SERT activity, although the accumulation of the evidences has not been sufficient yet.

Post-lumbar puncture headaches have a significant impact on the daily life of patients or participants in the study. Although factors such as sex, a young population, low BMI, and presence of chronic headaches a considered to be related to the symptom, the patho-mechanism is still unclear. From our clinical experience, we hypothesized that post-lumbar puncture headaches are associated with a patient’s mental state. The results indicated that the existence of mental disorders in patients may be associated with a low occurrence of post-lumbar headaches. Further studies using larger sample sizes are needed to confirm other factors including medication and patients conditions after lumbar puncture.

Delirium is a common psychiatric complication in patients with cancer. Delirium causes marked distress in the patient and his/her family and causes difficulties in cancer treatment and patient care. Some recent studies demonstrated the effectiveness of systematic multicomponent interventions to prevent delirium. We examined a systematic care program for delirium in inpatients. In our program, the nursing staff assessed the risk and occurrence of delirium, and provided early preventive care for delirium. In this study, we retrospectively investigated the operation of our delirium care program, which was administered to inpatients with cancer. About a quarter of the patients had some risk of delirium, and therefore, early preventive care was provided. After this program began, the medical staff was able to care for patients at risk for delirium in a more proactive and precise manner. On the other hand, we compared the delirium assessments conducted by nurses in this program with the diagnoses made following psychiatric consultations. More than half of the patients who were diagnosed with delirium by a psychiatrist were not diagnosed as having delirium by the nurses. Hypoactive and mixed-type delirium were missed more often than the hyperactive type. We must review the nursing staff education program and improve the accuracy of delirium assessment according to the appropriate frequency of delirium assessment to ensure proper diagnosis of delirium.

We report two cases of depression in patients with cancer. The effect of an antidepressant in conjunction with modified electroconvulsive therapy (mECT) made early intervention for cancer possible. Case 1: A 66-year-old woman had depressive symptoms from year X−3, and consequently started drug therapy at another hospital. In January of year X, she was diagnosed with Stage IIA stomach cancer at the gastroenterological department of our hospital. She began treatment with mECT in April of year X, because depressive symptoms precluded surgical treatment. The mECT sessions improved her depressive symptoms, so she chose to undergo surgery in June of year X. Case 2: In year X−12, a 62-year-old woman developed depressive symptoms and started drug therapy at another hospital. She was diagnosed with breast cancer in year X−3 and underwent surgery. The subsequent exacerbation of depressive symptoms caused her to seek psychiatric treatment for depression in February of year X. Prompt psychiatric treatment, including mECT, was prioritized; however, a recurrence of breast cancer was evident on imaging examination. The mECT sessions improved her depressive symptoms, so she chose to undergo surgery in May of year X. In conclusion, mECT is useful as an early intervention therapy for depressed patients with physical complications..