Skip to main content
×
×
Home

Neuroimaging distinction between neurological and psychiatric disorders

  • Nicolas A. Crossley (a1), Jessica Scott (a1), Ian Ellison-Wright (a2) and Andrea Mechelli (a3)
Abstract
Background

It is unclear to what extent the traditional distinction between neurological and psychiatric disorders reflects biological differences.

Aims

To examine neuroimaging evidence for the distinction between neurological and psychiatric disorders.

Method

We performed an activation likelihood estimation meta-analysis on voxel-based morphometry studies reporting decreased grey matter in 14 neurological and 10 psychiatric disorders, and compared the regional and network-level alterations for these two classes of disease. In addition, we estimated neuroanatomical heterogeneity within and between the two classes.

Results

Basal ganglia, insula, sensorimotor and temporal cortex showed greater impairment in neurological disorders; whereas cingulate, medial frontal, superior frontal and occipital cortex showed greater impairment in psychiatric disorders. The two classes of disorders affected distinct functional networks. Similarity within classes was higher than between classes; furthermore, similarity within class was higher for neurological than psychiatric disorders.

Conclusions

From a neuroimaging perspective, neurological and psychiatric disorders represent two distinct classes of disorders.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Neuroimaging distinction between neurological and psychiatric disorders
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Neuroimaging distinction between neurological and psychiatric disorders
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Neuroimaging distinction between neurological and psychiatric disorders
      Available formats
      ×
Copyright
This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
Corresponding author
Andrea Mechelli, Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. Email: a.mechelli@kcl.ac.uk
Footnotes
Hide All

See editorial, pp. 373–374, this issue.

A.M. is funded by a research grant from the Medical Research Council (grant ID 99859). N.C. is funded by a Wellcome Trust Clinical Research Training Fellowship (WT093907). The data used in this study were subsequently used in a collaborative project with the BrainMap database (supported by NIH/NIMH R01 MH074457) where they are now available. The sources of funding had no role in study design, data collection, analysis, interpretation, writing the report, or in the decision to submit the article for publication.

Declaration of interest

None.

Footnotes
References
Hide All
1 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
2 Martin, JB. The integration of neurology, psychiatry, and neuroscience in the 21st century. Am J Psychiatry 2002; 159: 695704.
3 Baerlocher, MO, Detsky, AS. Professional monopolies in medicine. JAMA 2009; 301: 858–60.
4 Butler, MA, Corboy, JR, Filley, CM. How the conflict between American psychiatry and neurology delayed the appreciation of cognitive dysfunction in multiple sclerosis. Neuropsychol Rev 2009; 19: 399410.
5 Kanner, AM. When did neurologists and psychiatrists stop talking to each other? Epilepsy Behav 2003; 4: 597601.
6 White, PD, Rickards, H, Zeman, AZ. Time to end the distinction between mental and neurological illnesses. BMJ 2012; 344: e3454.
7 Aarsland, D, Pahlhagen, S, Ballard, CG, Ehrt, U, Svenningsson, P. Depression in Parkinson disease–epidemiology, mechanisms and management. Nat Rev Neurol 2012; 8: 3547.
8 Nadkarni, S, Arnedo, V, Devinsky, O. Psychosis in epilepsy patients. Epilepsia 2007; 48 (suppl 9): 17–9.
9 Fenton, WS. Prevalence of spontaneous dyskinesia in schizophrenia. J Clin Psychiatry 2000; 61 (suppl 4): 10–4.
10 Wright, IC, Rabe-Hesketh, S, Woodruff, PW, David, AS, Murray, RM, Bullmore, ET. Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiatry 2000; 157: 1625.
11 Kempton, MJ, Geddes, JR, Ettinger, U, Williams, SC, Grasby, PM. Meta-analysis, database, and meta-regression of 98 structural imaging studies in bipolar disorder. Arch Gen Psychiatry 2008; 65: 1017–32.
12 Gong, Q, Li, L, Tognin, S, Wu, Q, Pettersson-Yeo, W, Lui, S, et al. Using structural neuroanatomy to identify trauma survivors with and without post-traumatic stress disorder at the individual level. Psychol Med 2014; 44: 195203.
13 Fornito, A, Yucel, M, Pantelis, C. Reconciling neuroimaging and neuropathological findings in schizophrenia and bipolar disorder. Curr Opin Psychiatry 2009; 22: 312–9.
14 A novel gene containing a trinucleotide repeat that is expanded and unstable on Huntington's disease chromosomes. The Huntington's Disease Collaborative Research Group. Cell 1993; 72: 971–83.
15 Malhotra, D, Sebat, J. CNVs: harbingers of a rare variant revolution in psychiatric genetics. Cell 2012; 148: 1223–41.
16 Tsuji, S. The neurogenomics view of neurological diseases. JAMA Neurol 2013; 70: 689–94.
17 Holmes, J. Minding the brain. BMJ 2012; 345: e4581.
18 Bailey, S, Burn, W, Craddock, N, Mynors-Wallis, L, Tyrer, P. Suggested merger of mental and neurological illnesses is premature. BMJ 2012; 345: e4577.
19 Ashburner, J, Friston, KJ. Voxel-based morphometry–the methods. NeuroImage 2000; 11: 805–21.
20 Lancaster, JL, Tordesillas-Gutierrez, D, Martinez, M, Salinas, F, Evans, A, Zilles, K, et al. Bias between MNI and Talairach coordinates analyzed using the ICBM-152 brain template. Hum Brain Mapp 2007; 28: 1194–205.
21 Eickhoff, SB, Laird, AR, Grefkes, C, Wang, LE, Zilles, K, Fox, PT. Coordinate-based activation likelihood estimation meta-analysis of neuroimaging data: a random-effects approach based on empirical estimates of spatial uncertainty. Hum Brain Mapp 2009; 30: 2907–26.
22 Eickhoff, SB, Bzdok, D, Laird, AR, Roski, C, Caspers, S, Zilles, K, et al. Co-activation patterns distinguish cortical modules, their connectivity and functional differentiation. NeuroImage 2011; 57: 938–49.
23 Smith, SM, Fox, PT, Miller, KL, Glahn, DC, Fox, PM, Mackay, CE, et al. Correspondence of the brain's functional architecture during activation and rest. Proc Natl Acad Sci U S A 2009; 106: 13040–5.
24 Crossley, NA, Mechelli, A, Scott, J, Carletti, F, Fox, PT, McGuire, P, et al. The hubs of the human connectome are generally implicated in the anatomy of brain disorders. Brain 2014; 137: 2382–95.
25 Li, L, Wu, M, Liao, Y, Ouyang, L, Du, M, Lei, D, et al. Grey matter reduction associated with posttraumatic stress disorder and traumatic stress. Neurosci Biobehav Rev 2014; 43: 163–72.
26 Javitt, DC. When doors of perception close: bottom-up models of disrupted cognition in schizophrenia. Annu Rev Clin Psychol 2009; 5: 249–75.
27 Orru, G, Pettersson-Yeo, W, Marquand, AF, Sartori, G, Mechelli, A. Using support vector machine to identify imaging biomarkers of neurological and psychiatric disease: a critical review. Neurosci Biobehav Rev 2012; 36: 1140–52.
28 Ioannidis, JP. Excess significance bias in the literature on brain volume abnormalities. Arch Gen Psychiatry 2011; 68: 773–80.
29 Costafreda, SG. Parametric coordinate-based meta-analysis: valid effect size meta-analysis of studies with differing statistical thresholds. J Neurosci Methods 2012; 210: 291300.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Crossley et al. supplementary material
Supplementary Material

 PDF (8.0 MB)
8.0 MB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 44 *
Loading metrics...

Abstract views

Total abstract views: 131 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 26th April 2018. This data will be updated every 24 hours.

Neuroimaging distinction between neurological and psychiatric disorders

  • Nicolas A. Crossley (a1), Jessica Scott (a1), Ian Ellison-Wright (a2) and Andrea Mechelli (a3)
Submit a response

eLetters

Neuroimaging distinction between neurological and psychiatric disorders - was there really one?

Akshay Nair, Leonard Wolfson Clinical Training Fellow, UCL
18 November 2015

Dear Editor of the BJPsych,

I read with great interest the article by Crossley et al (2015) (1) and, whilst commending their work, I was surprised to arrive at the opposite conclusion to that of the authors. In their meta-analysis of structural MRI correlates of ‘psychiatric’ and ‘neurological’ conditions they find that both classifications appear to correlate with some distinct regional brain volume changes. In their discussion of these findings they conclude that their analysis lends weight to the argument that the disorders may be thought of as belonging to two distinct classes. I was surprised at this conclusion and would ask the reader to consider that these results may actually suggest the opposite for the following three reasons.

Firstly, given the established functional organisation of brain anatomy one might, a priori, predict that different clinical symptoms (hallucinations versus motor apraxia for example) are associated with dysfunctional activity in spatially distinct brain regions. With this in mind, the finding that the ‘psychiatric’ and ‘neurological’ classes affected different brain structures is perhaps not surprising. Personally, I found the considerable overlap between the classes the most interesting finding. This finding suggests that disease specific ‘lesions’ have a considerable effect on wider neural network structure. Understanding of the mechanisms of these shared findings requires input from both specialities.

Following on from this it is important to remember the grey matter volume reduction was reliably found in both classes of disorder albeit in some different brain regions. A finding more parsimonious with the authors’ conclusion would have been if there was no evidence of volume loss in one set of disorders versus the other. This would clearly have segregated the conditions. Instead we must now accept that the presence of structural brain changes does not de facto indicate a ‘neurological’ condition as compared to a ‘psychiatric’ one. Undoubtedly, the aetiological mechanisms of volume changes are not the same across disorders, no classically defined ‘psychiatric’ condition is driven by known progressive proteinopathy, for example. However, the finding that both sets of conditions are associated with structural brain changes clearly establishes both as ‘disorders of the central nervous system’.

Finally, from a clinical perspective, the symptoms patients suffer from do not sit neatly on either side of the classical ‘psychiatric’ and ‘neurological’ divide and the findings from this paper may go some way as to explaining why. To segregate these classes based on a few regional differences in grey matter volume may appear somewhat artificial especially in face of the clinical burden of ‘psychiatric’ symptoms in ‘neurological’ patients and visa versa. Furthermore, I do not believe that either group of patients are best served by the call to keep the intellectual framework of these two groups of disorders separate.

Importantly, accepting that there are neurobiological similarities between traditionally ‘neurological’ and ‘psychiatric’ conditions does not equate to saying that either clinical speciality should feel threatened by the other. The considerable differences in clinical approach, decision making and support structures employed by neurologists and psychiatrists are sufficiently distinct that we should not feel threatened to admit that the disorders we are seeing manifest from dysfunction of the same organ. Accepting this stance will, hopefully, facilitate the cross-fertilisation of knowledge and lead to improved care for both sets of patients.

Your Sincerely,

Dr. Akshay Nair MRCPsych

Leonard Wolfson Clinical Training Fellow, Institute of Neurology, UCL

& SpR in General and Older Adult Psychiatry, South London and Maudsley NHS Trust.

... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *