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The eye's mind: brain mapping and psychiatry

  • Ed Bullmore (a1) and Paul Fletcher (a1)
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Corresponding author
Professor Ed Bullmore, Department of Psychiatry, Brain Mapping Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK. Tel: 01223 336583/2; fax: 01223 336581; e-mail:
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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The eye's mind: brain mapping and psychiatry

  • Ed Bullmore (a1) and Paul Fletcher (a1)
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Psychiatric disorders are characterized by abnormal brain imaging and neurological examination

Sudhir Kumar, Consultant Neurologist, Christian Medical College Hospital
26 May 2003


I read with interest the recent editorial by Ed Bullmore and Paul Fletcher (Ed Bullmore, 2003). They have raised a very pertinent issue of usefulness of brain imaging in various psychiatric disorders. Psychiatry and Neurology have been considered as two separate branches of medicine for many years. However, thinking of it closely, both the specialities deal with disorders of the brain. Traditionally, patients with psychiatric disorders were thought to have no neurological deficits on clinical examination and no abnormal findings on brain imaging. Terms such as “functional” and “organic” were used to represent psychiatric and non-psychiatric disorders respectively. However, as the knowledge about aetiology, pathology and pathogenesis of psychiatric disorders have improved, we have come to know more about the structural areas in the brain affected and also the neurochemical basis of various psychiatric disorders.

Epilepsy and dementia are two well-known groups of disorders that were thought to be “functional” earlier and now, they are very much “organic”. Schizophrenia, as mentioned by the authors, is characterized bybrain changes on imaging. Left frontal lobe, especially its grey matter volume, is specifically reduced in first-episode schizophrenia (SalokangasRK et al). Frontal metabolic and blood flow deficiencies were found in conjunction with cognitive activation tasks in patients with schizophrenia(Davidson LL, 2003). Anatomical MRI findings were recently reviewed in mood and anxiety disorders (Brambilla P et al, 2002). Hippocampus and basal ganglia were abnormal in unipolar disorder, whereas amygdala and cerebellum in bipolar disorders, which suggest that these two mood disorders are biologically distinct. As for anxiety disorders, orbital frontal regions and basal ganglia were anatomically abnormal in obsessive-compulsive disorder, temporal lobe was abnormally reduced in panic disorder, and abnormal hippocampus shrinkage was shown in posttraumatic stress disorder. A functional disorder in contralateral striatothalamocortical circuits controlling sensorimotor function and voluntary motor behaviour was found by SPECT studies in patients with unilateral hysterical sensorimotor loss (Vuilleumier P et al, 2001).Neurological examination also reveals many abnormalities in psychiatric disorders. Patients with schizophrenia have abnormalities in three main neurological domains: integrative sensory function, motor coordination, and motor sequencing (Dazzan P et al, 2002). Exaggerated deep tendon reflexes are common in anxiety disorders. Minor neurological signs have also been described in mood disorders and obsessive-compulsive disorders.

On the other hand, some patients initially labeled as conversion disorder, on follow up, were found to have other “organic” neurological diseases that were missed initially (Mace CJ et al, 1996). Psychiatric symptoms can be the presenting feature of many neurological disorders such as Alzheimer’s disease (which may start with depression), stroke and collagen vascular diseases. Several “organic” conditions may present with psychiatric symptoms such as frontal lobe tumours and strokeswith depression, vitamin B 12 deficiency with psychosis and depression, etc.In summary, psychiatric disorders are characterized by abnormalities in brain imaging and neurological examination. They should be considered as brain disorders with an “organic” basis. The time has come to view Psychiatry and Neurology as two sides of the same coin.


Brambilla P, Barale F, Caverzasi E, et al (2002). Anatomical MRI findings in mood and anxiety disorders. Epidemiol Psichiatr Soc. 11(2): 88-99.

Davidson LL, Heinrichs RW (2003). Quantification of frontal and temporal lobe brain-imaging findings in schizophrenia: a meta-analysis. Psychiatry Res. 15; 122(2): 69-87.

Dazzan P, Murray RM (2002). Neurological soft signs in first-episode psychosis: a systematic review. Br J Psychiatry 181(43): s50-s57

Ed Bullmore, Paul Fletcher (2003) The eye’s mind: brain mapping and psychiatry. Br J Psychiatry 182: 381-384

Mace CJ, Trimble MR (1996) Ten-year prognosis of conversion disorder.Br J Psychiatry; 169(3): 282-8

Salokangas RK, Cannon T, Van Erp T et al (2002) Structural magnetic resonance imaging in patients with first-episode schizophrenia, psychotic and severe non-psychotic depression and healthy controls. Results of the schizophrenia and affective psychoses (SAP) project. Br J Psychiatry Suppl.; 43:s58-65.

Vuilleumier P, Chicherio C, Assal F, et al (2001). Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain; 124(Pt 6): 1077-90
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