Scientific, Forensic, and Clinical Consultation
Mental Health Evaluations: Schizophrenia, Bipolar Disorder, and other Psychiatric Conditions
Advancing the understanding of schizophrenia through neuroscience investigation was the original research focus of The Mind Research Network (MRN), a 501(c)(3) organization founded in 1998. While research at MRN has expanded into over a dozen areas related to mental health and disease (including traumatic brain injury, autism, neurodevelopment, forensic research, and addiction) schizophrenia and conditions on the Mood Disorder spectrum remain a research focus of the scientists at MRN. Using MRN’s advanced neuroimaging technology and data analysis methods, great progress is being made in our understanding of several serious mental illnesses —including schizophrenia, bipolar disorder, and major depression—not only at basic neuroscience level by learning how these conditions manifest in brain structure and function across all domains of cognition and affective (emotional) processing but also by studying how individuals with these conditions respond to different types of treatment (e.g. trans cranial direct current stimulation [TDCS], electroconvulsive therapy [ECT]).
Current psychosis research at the Mind Research Network
An example of their progress in the neuroimaging and mood disorder area, MRN researchers have moved one step closer towards the development of a new diagnostic tool to accurately classify patients with schizophrenia and bipolar disorder, which is a historically difficult disorder to diagnose. Using fMRI scans (which essentially give a picture of changes in blood flow over time) in a large scale research project, MRN Executive Science Officers and MINDSET consulting experts Dr. Vince Calhoun and Dr. Kent Kiehl and their teams have been able to differentiate between the two disorders with better than 90% accuracy. Networks in the brain can be identified using fMRI, thus allowing researchers to see locations and patterns of brain activation while participants are doing a task as opposed to when they are at rest. Dr. Calhoun explains, “When looking at schizophrenia and bipolar disorder, we found two regions that showed profound differences in schizophrenia. Once we identified these networks, we were able to look at whether the changes in these areas could help us better differentiate schizophrenia from bipolar disorder, and also from healthy individuals.” This discovery may eventually provide clinicians with more objective methods to accurately differentiate and diagnose these disorders earlier in the disease progression, which could result in the application of more effective treatments and better long-term prognoses.
In 2013, Dr. Vince Calhoun received a $15 million Center of Biomedical Research Excellence (COBRE) Center grant from the National Institues of Health, specifically the National Institute of General Medical Science (NIGMS). Under the COBRE Center grant, scientists are working on five research projects designed to study the underlying brain structure, function, chemistry, and genetics in individuals suffering from different types of psychosis and mood disorders. The scientist are also evaluating the effectiveness of specific treament interventions for patients suffering from Auditory Verbal Hallucinations and patients suffering from Major Depressive Disorder. MRN has a long history of using cutting edge tools (e.g. magnetic resonance spectroscopy [MRS] and magnetoencephalography [MEG]), and developing state-of-the-art analysis methods (e.g. group independent component analysis [ICA]), and is one of the first in the country to apply these and other tools to study schizophrenia, bipolar disorder, and depression in an integrated and comprehensive way. The hope is that the results of the COBRE Center research will eventually be used to facilitate the early diagnosis of schizophrenia and the reliable prediction of treatment outcomes.
Legal Relevance of psychosis and other Mood Disorders
The presence or absence of a mental illness such as schizophrenia or Bipolar Disorder can be relevant to a number of legal proceedings. While competency to stand trial (or competence to waive one’s rights) and insanity are legal constructs and not established or negated by the presence or absence of mental illness, it is highly relevant to these inquiries. Mental health experts hired to do court evaluations frequently disagree as to whether a defendant suffers from mental illness leaving the lawyers and courts with conflicting expert opinions. This is largely due to the fact that the tests for bipolar or schizophrenia are not yet as accurate as a test for diabetes for example. An objective assessment of brain structure and function and whether that data is more consistent with that of individuals suffering from a mental health condition or that of healthy individuals can provide an additional piece of information in conjunction with traditional psychiatric and psychological evaluations. Such objective information can be useful evidence for a court to have to help make more informed competency and insanity determinations.
Psychosis evaluations for competency and mitigation
MINDSET has an extensive network of forensic clinical experts that can perform evaluations of all psychiatric and psycholgical conditions. In competency and insanity evaluations it is not sufficient to demonstrate the presence or absence of a serious mental disorder, it is also required that the individual lack the ability to understand and appreciate the court proceedings and be able to assist in their defense (in the case of competency evaluations) or that they failed to appreciate that their actions where wrong, or lacked mens rea (in the case of insanity evaluations). For mitigation efforts, a client's mental health history needs to be thoroughly investigated. We have forensic psychologists and psychiatrists experienced with the breadth and depth of mental health mitigation preparation. Here is a list of services we provide:
- Competency to stand trial (fitness assessment)
- Other criminal competencies (e.g. to waive rights, confess, execution etc.)
- Mental state at the time of the offense
- Not guilty by reason of Insanity
- Diminished capacity/mental state
- General Cognitive Functions
- Mental Health and Personality Disorder (e.g. Psychopathy) Diagnosis
- Treatment Recommendations
Our experts have developed mechanisms for identifying linked changes in large-scale genetic and functional brain imaging data sets. Using these tools, the relationship between multiple genetic markers and brain activation patterns in schizophrenia were identified. Ongoing research indicates this relationship is different for schizophrenia patients than for healthy controls, which suggests a fundamental difference in the brain organization between these two groups. Simply put – the brain structure of individuals that suffer from major mental illnesses like schizophrenia and bipolar disorder are different from the brain structure of individuals that do not suffer from those conditions. These differences may be detected using neuroimaging methods, specifically non-invasive, safe, magnetic resonance imaging (MRI).
MINDSET offers neuroimaging evaluations as well as educates you and your legal team on the applicable body of peer-reviewed scientific literature and how the neuroscience may be relevant to the particular client and case. In capital cases imaging evaluations are often performed to rule out the presence of any tumors or lesions. We have a mobile MRI that we can bring directly to your client (i.e. detention facility) for data collection using the most advanced research sequences and data analysis methods currently available. In addition to collecting structural MRI data (including diffusion tensor imaging (DTI) data) to help rule out the presence of tumors, detect head injury related pathology, and identify structural abnormalities consistent with developmental pathology, the mobile has functional imaging capabilities (fMRI) that allow us to conduct different behavioral and cognitive testing while the client is in the scanner. Our experts are nationally renowned in the fields of neuroimaging and psychosis. We have a database of brain imaging and genetic data of more than 1200 individuals with psychosis and mood disorders and over 3,000 healthy controls. A number of extremely sophisticated algorithms compare the data of your client to the data of others in the database. Depending on the condition of interest, the brain data may also be able to help inform the differential diagnosis of psychiatric illness.
The team of experts at MINDSET work together using their unique areas of expertise to provide a well rounded and scientifically informed mental health evaluation.
For more information about our mental health evaluation services email or call (505) 249-7058.
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