109. Forensic And Clinical Applications

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109. Forensic And Clinical Applications

109. Forensic And Clinical Applications

 

 

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Syllabus

Foreword ………………………………………………………………………………………………………… v
Preface …………………………………………………………………………………………………………. vii
Acknowledgments ……………………………………………………………………………………….. viii
List of Figures……………………………………………………………………………………………….xix
List of Tables…………………………………………………………………………………………….. xxiii
List of Contributors ………………………………………………………………………………………xxv
Chapter 1: Electroencephalography, Topographic Mapping,
and Event-Related Potentials in Substance Abuse Research ………1
Elena M. Kouri, PhD and Scott E. Lukas, PhD
History of the Electroencephalogram ………………………………………………….. 1
Recording the Electroencephalogram …………………………………………………. 2
EEG Amplifiers …………………………………………………………………………. 4
EEG Filters………………………………………………………………………………… 5
EEG Montages …………………………………………………………………………… 5
Analysis of the EEG ………………………………………………………………………….. 7
Topographic Mapping ……………………………………………………………………… 10
Artifact Avoidance…………………………………………………………………………… 10
Utility of Electroencephalographic Techniques in Substance Abuse
Research ……………………………………………………………………………………… 11
Measures of Acute Drug Effects ………………………………………………… 11
Measures of Tolerance and Dependence …………………………………….. 15
Correlates of Vulnerabilities to Drug Abuse ……………………………….. 16
Event-Related Potentials ………………………………………………………………….. 16
Utility of Event-Related Potentials in Substance Abuse Research ……….. 19
Measures of Acute Drug Effects ………………………………………………… 19
Measures of Tolerance and Dependence …………………………………….. 20
Correlates of Vulnerabilities to Drug Abuse ……………………………….. 20
Caveats in Interpreting Electrophysiologic Data
in Substance Abuse Research………………………………………………………… 21
Future Directions …………………………………………………………………………….. 22
Acknowledgments …………………………………………………………………………… 22
References………………………………………………………………………………………. 22

Chapter 2: Positron Emission Tomography and Single-Photon
Emission Computed Tomography: Methods and Applications
in Substance Abuse Research ……………………………………………. 29
Robert T. Malison, MD
Introduction …………………………………………………………………………………….. 29
Principles Underlying Positron Emission Tomography
and Single-Photon Emission Computed Tomography ……………………… 30
Positron and Single-Photon Generation………………………………………. 30
PET and SPECT Cameras …………………………………………………………. 31
Computed Tomography …………………………………………………………….. 33
Basic Limitations of Positron Emission Tomography
and Single-Photon Emission Computed Tomography ……………………… 33
Radioactive Decay ……………………………………………………………………. 33
Photon Attenuation …………………………………………………………………… 34
Photon Scatter ………………………………………………………………………….. 34
Limited Spatial Resolution ………………………………………………………… 36
Tracer Modeling ………………………………………………………………………. 36
Applications in Substance Abuse Research………………………………………… 39
In Vivo Pharmacology ………………………………………………………………. 39
Neuronal Activity/Metabolism…………………………………………………… 40
Brain Chemistry ……………………………………………………………………….. 41
Neurotransmitter Synthesis ……………………………………………………. 41
Receptors and Transporters……………………………………………………. 41
Neurotransmitter Release ………………………………………………………. 42
Conclusions…………………………………………………………………………………….. 42
References ………………………………………………………………………………………. 43
Chapter 3: Fundamentals of Magnetic Resonance ………………… 47
Perry F. Renshaw, MD, PhD, Blaise deB. Frederick, PhD,
and Luis C. Maas III, MD, PhD
Introduction …………………………………………………………………………………….. 47
General Principles……………………………………………………………………………. 48
Magnetic Resonance Spectroscopy ……………………………………………………. 50
Evolution of Methods ……………………………………………………………….. 50
Current Status of Research ………………………………………………………… 54
Magnetic Resonance Imaging …………………………………………………………… 59
Methods…………………………………………………………………………………… 59
Image Contrast …………………………………………………………………………. 60
Contrast Agents………………………………………………………………………… 61
Contraindications……………………………………………………………………… 61
Claustrophobia …………………………………………………………………………. 62

Functional Magnetic Resonance Imaging ………………………………………….. 62
BOLD fMRI …………………………………………………………………………….. 63
Principles……………………………………………………………………………… 63
Data Processing Methods ………………………………………………………. 65
Advantages and Limitations…………………………………………………… 65
Dynamic Susceptibility Contrast MRI………………………………………… 66
Principles……………………………………………………………………………… 66
Limitations …………………………………………………………………………… 68
Other Magnetic Resonance Methods …………………………………………………. 68
Diffusion Weighted Imaging ……………………………………………………… 68
Magnetic Resonance Angiography …………………………………………….. 69
Relaxometry …………………………………………………………………………….. 69
Magnetization Transfer …………………………………………………………….. 69
Summary ………………………………………………………………………………………… 70
Acknowledgments …………………………………………………………………………… 70
References………………………………………………………………………………………. 70
Chapter 4: Electroencephalographic Studies
of Substance Use and Abuse………………………………………………. 77
Lance O. Bauer, PhD
Introduction …………………………………………………………………………………….. 77
Electroencephalographic Studies of Acute Effects of Psychoactive
Drugs ………………………………………………………………………………………….. 77
Spontaneous EEG Activity………………………………………………………… 77
Alcohol ………………………………………………………………………………… 78
Benzodiazepines …………………………………………………………………… 80
Marijuana/THC …………………………………………………………………….. 81
Opioids ………………………………………………………………………………… 82
Cocaine ………………………………………………………………………………… 82
Evoked Potentials (EP) and Event-Related Potentials (ERP)………… 83
Alcohol ………………………………………………………………………………… 84
Benzodiazepines …………………………………………………………………… 85
Marijuana/THC …………………………………………………………………….. 86
Opioids ………………………………………………………………………………… 87
Cocaine ………………………………………………………………………………… 87
Electroencephalographic Studies of Chronic Substance Abusers …………. 88
Alcohol ……………………………………………………………………………………. 89
Benzodiazepines ………………………………………………………………………. 90
Marijuana/THC ………………………………………………………………………… 91
Opioids ……………………………………………………………………………………. 91
Cocaine ……………………………………………………………………………………. 94

Discussion ………………………………………………………………………………………. 97
Neuroimaging Research in Context ……………………………………………. 97
Future Directions ……………………………………………………………………. 100
Acknowledgments …………………………………………………………………………. 100
References …………………………………………………………………………………….. 101
Chapter 5: Emission Tomographic Studies
in Substance Abuse …………………………………………………………..113
Jonathan M. Levin, MD, MPH
Introduction …………………………………………………………………………………… 113
Alcohol and Alcoholism …………………………………………………………………. 114
Acute Alcohol Administration …………………………………………………. 114
Cerebral Blood Flow …………………………………………………………… 114
Cerebral Metabolism …………………………………………………………… 115
Chronic Alcohol Effects and Alcoholism………………………………….. 115
Cerebral Blood Flow …………………………………………………………… 115
Cerebral Metabolism …………………………………………………………… 116
Receptor Studies …………………………………………………………………. 117
Effects of Withdrawal and Abstinence ………………………………….. 117
Neurological Disorders Associated with Alcoholism …………………. 118
Wernicke-Korsakoff Syndrome ……………………………………………. 118
Marchiafava-Bignami Syndrome ………………………………………….. 119
Cerebellar Degeneration ………………………………………………………. 119
Hepatic Encephalopathy ………………………………………………………. 119
Drug Challenge and Receptor Level Studies……………………………… 120
Effects of Treatment for Alcohol Abuse ……………………………….. 120
Benzodiazepine Studies……………………………………………………….. 120
Dopamine Studies ……………………………………………………………….. 120
Serotonin Studies ………………………………………………………………… 121
Summary ……………………………………………………………………………….. 121
Marijuana ……………………………………………………………………………………… 121
Acute Intoxication ………………………………………………………………….. 121
Chronic Use and Abuse …………………………………………………………… 122
Hallucinogens ……………………………………………………………………………….. 122
Ketamine ……………………………………………………………………………….. 122
MDMA (“Ecstasy”) ………………………………………………………………… 122
Psilocybin and Mescaline ………………………………………………………… 123
Summary ……………………………………………………………………………….. 123
Benzodiazepines ……………………………………………………………………………. 123
Effects of Acute Administration ………………………………………………. 123
Cerebral Blood Flow …………………………………………………………… 123
Cerebral Metabolism …………………………………………………………… 124
Effects of Chronic Administration ……………………………………………. 124

Heroin and Opiates ………………………………………………………………………… 124
Acute Administration ……………………………………………………………… 124
Cerebral Blood Flow and Receptor Studies …………………………… 124
Cerebral Metabolism …………………………………………………………… 125
Chronic Administration …………………………………………………………… 125
Withdrawal and Abstinence …………………………………………………….. 126
Cocaine …………………………………………………………………………………………. 128
Acute Cocaine Administration …………………………………………………. 128
Cerebral Blood Flow …………………………………………………………… 128
Cerebral Metabolism …………………………………………………………… 129
Cocaine Binding and Receptor Studies …………………………………. 130
Chronic Cocaine Abuse and Dependence ………………………………….. 131
Cerebral Blood Flow …………………………………………………………… 131
Cerebral Metabolism …………………………………………………………… 132
Withdrawal …………………………………………………………………………. 133
Cocaine Craving …………………………………………………………………. 133
Abstinence ………………………………………………………………………….. 135
Receptor/Transporter Effects ……………………………………………….. 135
Treatment for Cocaine Abuse and Dependence ……………………… 136
Summary ……………………………………………………………………………….. 137
Amphetamine and Methamphetamine ……………………………………………… 137
Amphetamine …………………………………………………………………………. 137
Cerebral Blood Flow …………………………………………………………… 137
Cerebral Metabolism …………………………………………………………… 138
Receptor Studies …………………………………………………………………. 138
Chronic Effects ………………………………………………………………………. 138
Methamphetamine ………………………………………………………………….. 139
Methylphenidate ……………………………………………………………………………. 139
Cerebral Blood Flow and Metabolism ………………………………………. 139
Receptor Studies …………………………………………………………………….. 139
Solvents (“Thinners”) and Toluene …………………………………………………. 140
Conclusions…………………………………………………………………………………… 141
Acknowledgment …………………………………………………………………………… 142
References…………………………………………………………………………………….. 142
Chapter 6: Magnetic Resonance Findings
in Substance Abuse …………………………………………………………. 155
Marc J. Kaufman, PhD and Jonathan M. Levin, MD, MPH
Introduction …………………………………………………………………………………… 155
Alcohol and Alcoholism…………………………………………………………………. 156
Acute Effects………………………………………………………………………….. 156
MR Imaging ……………………………………………………………………….. 156
MR Spectroscopy ………………………………………………………………… 156
Functional MRI…………………………………………………………………… 158

Chronic Effects ………………………………………………………………………. 159
MR Imaging ……………………………………………………………………….. 159
Tissue Relaxation Abnormalities ………………………………………. 159
Ventricular Enlargement ………………………………………………….. 160
Cortical Atrophy ……………………………………………………………… 161
Corpus Callosum Atrophy ………………………………………………… 161
Cerebellar Degeneration …………………………………………………… 161
White Matter Lesions ………………………………………………………. 164
Effects of Aging ………………………………………………………………. 164
Abstinence and Relapse ……………………………………………………….. 165
MR Imaging ……………………………………………………………………. 165
MR Spectroscopy …………………………………………………………….. 165
Special Syndromes Associated with Alcohol Abuse ………………….. 166
Hepatic Cirrhosis and Encephalopathy ………………………………….. 166
MR Imaging ……………………………………………………………………. 166
MR Spectroscopy …………………………………………………………….. 166
Wernicke and Korsakoff’s Syndromes ………………………………….. 167
Central Pontine Myelinolysis ……………………………………………….. 168
Marchiafava-Bignami Disease ……………………………………………… 169
Fetal Alcohol Exposure ……………………………………………………….. 169
Methanol ……………………………………………………………………………. 170
Marijuana and Hallucinogens………………………………………………………….. 170
Benzodiazepines ……………………………………………………………………………. 171
Heroin and Opiates ………………………………………………………………………… 171
Acute Effects………………………………………………………………………….. 171
Cerebrovascular Effects…………………………………………………………… 172
Leukoencephalopathy ………………………………………………………….. 172
Chronic Effects ………………………………………………………………………. 174
Cocaine …………………………………………………………………………………………. 174
Acute Effects………………………………………………………………………….. 174
Research Studies …………………………………………………………………….. 175
MR Spectroscopy ………………………………………………………………… 175
Functional MRI …………………………………………………………………… 176
Cocaine Craving …………………………………………………………………. 178
MR Angiography ………………………………………………………………… 179
Chronic Effects ………………………………………………………………………. 179
Prenatal Effects ………………………………………………………………………. 181
Amphetamine and Other Stimulants ………………………………………………… 181
Amphetamine …………………………………………………………………………. 181
Methamphetamine ………………………………………………………………….. 182
Methylphenidate …………………………………………………………………….. 182
Solvent Abuse and Occupational Exposure ………………………………………. 183
Acute Effects………………………………………………………………………….. 183
Chronic Effects ………………………………………………………………………. 183

Polydrug Abuse……………………………………………………………………………… 184
MR Imaging …………………………………………………………………………… 184
MR Spectroscopy ……………………………………………………………………. 184
Concluding Remarks ……………………………………………………………………… 185
Acknowledgments …………………………………………………………………………. 185
References…………………………………………………………………………………….. 186
Chapter 7: Neuropsychological Correlates of Drug Abuse…… 199
Staci A. Gruber, EdM and Deborah A. Yurgelun-Todd, PhD
Introduction …………………………………………………………………………………… 199
Alcohol …………………………………………………………………………………………. 201
Acute Effects………………………………………………………………………….. 201
Chronic Effects ………………………………………………………………………. 203
Marijuana ……………………………………………………………………………………… 205
Acute Effects………………………………………………………………………….. 205
Chronic Effects ………………………………………………………………………. 205
Summary ……………………………………………………………………………….. 207
Hallucinogens ……………………………………………………………………………….. 208
Acute Effects………………………………………………………………………….. 208
Chronic Effects ………………………………………………………………………. 209
Phencyclidine …………………………………………………………………………. 210
Acute Effects………………………………………………………………………. 210
Chronic Effects …………………………………………………………………… 211
Benzodiazepines ……………………………………………………………………………. 211
Acute Effects………………………………………………………………………….. 211
Chronic Effects ………………………………………………………………………. 212
Opiates………………………………………………………………………………………….. 212
Acute Effects………………………………………………………………………….. 213
Chronic Effects ………………………………………………………………………. 213
Cocaine …………………………………………………………………………………………. 214
Acute Effects………………………………………………………………………….. 215
Chronic Effects ………………………………………………………………………. 215
Summary ……………………………………………………………………………….. 217
Amphetamine and Other Stimulants ………………………………………………… 217
Acute Effects………………………………………………………………………….. 217
Chronic Effects ………………………………………………………………………. 218
Solvents ………………………………………………………………………………………… 218
Acute Effects………………………………………………………………………….. 219
Chronic Effects ………………………………………………………………………. 219
Conclusion ……………………………………………………………………………………. 220
Acknowledgments …………………………………………………………………………. 221
References…………………………………………………………………………………….. 221

Chapter 8: Neuroimages as Legal Evidence ………………………. 231
Jennifer J. Kulynych, JD, PhD and Douglas W. Jones, PhD
Introduction …………………………………………………………………………………… 231
Science and the Law ………………………………………………………………………. 232
The Meaning of “Evidence” …………………………………………………….. 232
From the Laboratory to the Courtroom……………………………………… 233
Neuroimages as Psychiatric Evidence ……………………………………………… 237
Evidentiary Tests for the Admissibility of Expert Scientific
Testimony…………………………………………………………………………… 238
Scientific Uncertainty and the Interpretation
of Neuroimaging Data …………………………………………………………. 240
Substance Abuse, Neuroimaging, and Crime ……………………………………. 241
Substance Abuse as a Defense to Crime ……………………………………. 243
Legal Applications of Substance Abuse Imaging Data……………….. 244
Conclusion ……………………………………………………………………………………. 245
References …………………………………………………………………………………….. 245
Glossary ………………………………………………………………………… 249
Bibliography of Research Studies in Substance Abuse …………. 261
Marc J. Kaufman, PhD
Introduction to the Bibliography ……………………………………………………… 261
Bibliography Table of Contents ………………………………………………………. 263
EEG and Evoked Potentials ……………………………………………………………. 269
Emission Tomography ……………………………………………………………………. 306
Magnetic Resonance ………………………………………………………………………. 335
Neuropsychology …………………………………………………………………………… 360
Index ………………………………………………………………………………………………… 399

……………………………………………………………………………………………………………………………………………………………………………………………………………………

 

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