How does the Synergic Mind approach differ from other psychiatric clinics?

1. We focus on treatment, not outdated diagnostic labels. Traditional psychiatry starts by assigning patients a diagnostic label made up of symptom checklists. These lists are not decided by understanding the causes or successful treatments of mental illness; they are decided by a consensus vote that is then published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 TR). This problem led Thomas R. Insel, the former director of the National Institute of Mental Health (NIMH) to state in 2013 that psychiatric medications "help too few people to get better and very few people to get well", and that psychiatric diagnosis lacked "any objective laboratory measure" (1). Unfortunately, relatively little has changed in the last decade.

At Synergic Mind, we are attempting to help change the landscape of mental health treatment through science and technology. While we still follow well accepted psychiatric principles, such as performing a thorough psychiatric evaluation and do traditional diagnoses our focus is more on understanding your struggles and finding treatments that actually work.

2. Instead of guessing treatment based on subjectively reported symptoms, we look directly at how your brain functions. As psychiatrist and imaging pioneer Daniel Amen, MD said in 1992, psychiatrists, "remain the only specialists that virtually never look at the organ they treat" (2). For most of psychiatry, little has changed since then. At Synergic Mind, we utilize Single Photon Emission Computed Tomography (SPECT) brain imaging alongside other information to give us objective information about your brain function.

SPECT looks at patterns of high and low brain activity or function by examining blood flow (i.e., cerebral perfusion). This is different than MRI or CT imaging, which looks primarily at brain anatomy, and which does not tell us useful information about most mental and many physical illnesses. SPECT is well studied as a measure of brain function and is considered safe for routine clinical use, carrying about the same risk as a CT scan (which are routinely used in ER settings).

There is a growing body of research causing functional imaging to be increasingly recognized as helpful in clinical settings. A recent example of this occurred when the Canadian Association of Nuclear Medicine (CANM) reviewed the SPECT research literature in 2020 and released updated guidelines for SPECT that included mental health indications for conditions such as ADHD, depression, bipolar disorder, PTSD, and sub-typing dementia (3); and there are now studies suggesting it may improve clinical outcomes (4).

There are some clinicians who advocate for PET or fMRI over SPECT. At Synergic Mind, we are not necessarily wed to a particular type of imaging, since they all bring different strengths and weaknesses. However, we typically use quantitative SPECT that is correlated with a normative sample because we feel it has more advantages overall, and yields a broader range of useful clinical information.

While these imaging methods are used frequently in research settings, they have not found widespread use in clinical practice. This is largely due to the fact that most clinicians do not study neuroscience and do not know how to clinically use information about brain function.

3. We utilize the latest findings from neuroscience, connectomics, and molecular medicine to understand and interpret your brain function. There has been an explosion in neuroscience research over the last 20 years that is revolutionizing our understanding of brain function, though most physicians and mental health professionals are unaware of this advancement. For example, whereas the brain was previously treated like a simple computer with different parts that perform different functions, we now know through the science of connectomics that the brain is much more complicated, working both locally and holistically as a series of distinct regions making up semi-fluid networks (5). This new understanding is significantly changing our understanding of how the brain functions and is leading to more clinically relevant information.

Connectomics is a subspecialty of neuroscience that teaches us about the brain 100+ trillion connections and helps us to make sense of brain activity at a more macroscopic or holistic scale (as a series of brain networks) while still allowing for local brain regions to specialize in specific functions. Recent studies in neuroscience and connectomics are now showing that many psychiatric conditions, for instance, are "diseases of connectivity" (i.e., caused by altered connections between brain networks).

When combined with principles of neuroscience and connectomics, molecular medicine also provides powerful information about how the brain functions at a smaller scale. Molecular imaging in particular allows a large scale visualization of these molecular processes helping to better understand how the brain works to create experience and pathology.

At Synergic Mind, we our proprietary method for interpreting brain imaging combines principles of each of these specialties to create an approach that is effective for both understanding your brain and providing information that is useful and specific for treatment decisions. We plan to continually improve and refine this approach with ongoing research in the future.

4. We remain informed about modern neurotechnology, including wearable headsets, so we can give you more options to choose from regarding your brain health. Over the last several years there has been a significant growth in technology that can be used to affect brain function and which can be used to treat mental disorders. Some of these technologies are not new, such as ECT, and others are relatively new but FDA approved and backed by many research studies, such as transcranial magnetic therapy (TMS), a therapy commonly done in office for treatment of depression.

There is now a significant amount of "wearable" neuroscience technology that is intended to affect brain function in various ways. While most of them lack a robust body of research validating their use, these devices can be currently purchased without a doctor's order or recommendation, and there is increasing interest from those who wish to explore non-medication options for improving their brain function. While we do not recommend these devices as a replacement for well established treatments (especially in cases of severe psychopathology or with significant safety concerns), we seem them generally as low risk tools that could be used to maximize your brain function (and we believe they will have a significant potential for treating mental disorders in the future), and we are willing to discuss them in context of your overall treatment plan and mental health.

If we recommend this type of technology, we will typically only focus on technology that has some grounding in several peer-reviewed research studies (e.g., using photobiomodulation light therapy for TBI).

5. We have the ability to use machine learning or artificial intelligence (Al) to enhance our brain imaging and to provide additional research tools that can be utilized to gain more information used for treatment decisions. We use AI as a a tool to augment the organization and gathering of information. We never rely on AI to make clinical decisions (this is done only by a physician) and even when we do consider information obtained in this way, we always verify it and ensure it is considered in the context of all available clinical data. Also, as a matter of clarification, when we say AI we are not referring to popular language models like Chat GPT or Gemini. Our imaging has the option of being enhanced by a graph learning deep neural network model that allows analysis of brain imaging and other relevant medical information. We see this as a way of increasing our abilities to gather useful information in a way that can further personalize your care.

6. We frequently spend time looking through peer reviewed research studies for each patient in order to increase our understanding about how your brain function may affect you and how it can be improved. We always do our best go stay up to date on research and we care enough to look specifically for you. While this does not include hours of research, we make a concerted effort in many cases (especially for treatment resistant conditions) and it is not uncommon for us to contact you later if we learn of brain imaging-based information that could directly benefit your care,

**The benefits of SPECT vs PET and fMRI include the following:

• Lower cost, greater availability, and more flexibility (with regards to performing the scan).

  
  

• It still retains relatively good spatial resolution (due to recent advancements in SPECT cameras the difference in resolution between clinically available and affordable fMRI, PET, and SPECT outside academic centers are generally only around 2-4 mm).

  
  

• Unlike fMRI, SPECT has the ability to quantitatively measure the full range of brain activity and its associated patterns (i.e., absolute flow) without employing statistical methods that cutoff a certain percentage of brain activity. Making treatment decisions based on techniques that require us to remove data, requires the assumption that brain activity within the statistical average has no clinical significance. While there may be situations where it is useful to look only at some data (ignoring holistic information), based on our clinical experience this is frequently not the case; and you can't know ahead of time when it will or will not be important.

  
  

• SPECT offers more flexibility than PET in administering the scan (e.g., you have several hours to do the perform the scan if needed and it can be repeated more than once if necessary). This can be beneficial for psychiatric patients with certain conditions.

  
  

• SPECT measures an average of brain activity over 5 minutes as opposed to much shorter durations in fMRI and PET. Whether this is beneficial or not depends on the clinical question; and we continually remain open to updated information that could change our perspective. There are times when fMRI and PET would appear to be more desirable in clinical settings (e.g., you want to look for brain activity that correlates with a specific action that occurs over a few seconds). But if your question relates to symptoms that do not rapidly shift in seconds to minutes (i.e., most psychiatric disorders are experienced as constant or slowly changing), a more beneficial question may be "what activity patterns predominate on average in this specific person's brain most of the day and which of them could be contributing to their symptoms?". In the later case, SPECT may be the more useful study. Future research will hopefully continue to address this subject to further our understanding.

  
  

• The total time for a SPECT scan is usually less (about 20 minutes compared to 45 min for fMRI and 30-45 min for PET).

REFERENCES

1. Insel TR. Disruptive insights in psychiatry: transforming a clinical discipline. J Clin Invest. 2009 Apr;119(4):700-5. doi: 10.1172/JCI38832. Epub 2009 Apr 1. PMID: 19339761; PMCID: PMC2662575.

2. Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness, Crown, December 22, 1992.

3. CANM guidelines for brain perfusion single photon emission computed tomography (SPECT), The Canadian Association for Nuclear Medicine, 2020. https://www.canm-acmn.ca/guidelines

4. Thornton, F. T., Schneider, H., McLean, M.B., van Lierop, M.J., Tarzwell, R. Improved Outcomes Using Brain SPECT-guided Treatment Versus Treatment-as-usual in Community Psychiatric Patients: A retrospective case-control study. The Journal of Neuropsychiatry and Clinical Neuroscience, Volume 26(1), Jan 1, 2014.

5. Yeo BT, Krienen FM, Sepulcre J, Sabuncu MR, Lashkari D, Hollinshead M, Roffman JL, Smoller JW, Zöllei L, Polimeni JR, Fischl B, Liu H, Buckner RL. The organization of the human cerebral cortex estimated by intrinsic functional connectivity. J Neurophysiol. 2011 Sep;106(3):1125-65. doi: 10.1152/jn.00338.2011. Epub 2011 Jun 8. PMID: 21653723; PMCID: PMC3174820.