Editorial introduction: The implications of translational neuroscience for clinical practice and its evaluation.

Abstract

While basic neuroscience is primarily focussed on understanding how neurological activity gives rise to thoughts, emotions, and behaviour, clinical medicine is concerned with the development of tools aimed at therapeutic innovation and clinical decision making. Translational neuroscience has been defined as a meta-theoretical approach to bridge the mind-brain explanatory gap in a series of important publications.1-8 Its value is therefore in its representation of the point of intersection between basic neuroscience and clinical applications and is an approach to investigation and action that retains the potential to bridge this gap, with wide ranging implications for direct patient care. The impressive advances in neuroscience that have occurred over the last three decades began with the publication of the first studies of functional neuroimaging. The results of these studies generated considerable excitement, signalling ways in which a revolution in our understanding of the biological basis of the human psyche could take place, leading to the development of new clinical models for investigation and treatment.9, 10 However, while much progress has been made in terms of the former,11 progress in achieving the latter has remained less than commensurate, and the speed of translation from basic science to clinical application can be described as anything but rapid.12 There remains an urgent need, therefore, to translate our current knowledge in neuroscience, neuropathogenesis, and neuroengineering, into the pragmatic domain of clinical practice to develop new clinical methods that, through implementation into “hands on” clinical practice, are able to generate measurable benefits and quantifiable clinical outcomes in those individual patients at risk of, or suffering from, neurodegenerative, neuropsychiatric, and neurodevelopmental diseases. All such diseases, and the illness states they generate, represent a major economic burden to Society and are the cause of substantial suffering by patients and those who care for them. In this current issue of the JECP, the Journal presents a substantial Special Section focused on an intensive exploration of the implications of ongoing translational neuroscience research for modern medical practice. The Special Section, consisting of 16 papers, is the result of a specific commission by the Editor-in-Chief of the JECP to Professor Dr Drozdstoy Stoyanov, Professor of Psychiatry, and Head of the Neuropsychiatry and Brain Imaging Group at the Medical University of Plovdiv, Bulgaria, an assignment that was accepted in late 2017. How do we translate the findings of modern neuroscience into clinical medicine and its evaluation? Is there a means of achieving an “objectivization” of subjective experience on an individual level? What are the proper ways to incorporate neuroscience from the perspective of epistemology and the philosophy of the mind? To consider such questions, we need look no further than to the contributions of Ivana Marková13 and Diogo Telles Correia.14 These two conceptual papers set the background for a much better understanding of the theoretical diversity and controversies in this particular field of debate and orientate the reader to the substance of the papers that follow. Can we revalidate clinical assessment tools (such as, for example, the Paced Auditory Serial Addition Test or the International Affective Picture System) and psychotherapy methodology by means of in vivo neuroscience? And would this produce sounder evidence in support of the relevant diagnostic standards? For sure, cognitive and affective psychological tests are regarded to have been located for a long period in a separate domain from the neurosciences, with presumably independent validation procedures and standard validity operations established regardless of the evidence generated by neuroscience research. For instance, new clinical psychological tests have been validated against other, previously existing assessment tools, composed of cognitive, affective, or verbal items (in the case of inventories). In that sense, a crucial methodological issue concerning the choice of clinical assessment tests has been addressed by Isaeva et al.15 Neuroscience operates validation procedures on an essentially similar basis, in search for post hoc correlations with the associated psychological scores and several papers in this Special Section exemplify an attempt to methodologically integrate the data from neuroscience with those from clinical psychological and neuropsychiatric evaluation. Here, the works by Kandilarova and colleagues,16 Haralanov, Terziivanova, and associates,17, 18 Iancheva and co-workers,19 and Gaberova, Yordanova, and colleagues20, 21 are noteworthy and should be read alongside the contribution by Matanova et al22 who discuss the importance of brain-based therapeutic strategies, although the identification of various inconsistencies calls for further investigations within the frameworks outlined. The applications of functional neuroimaging in the fields of learning and education have been explored by fostering our knowledge of the mechanisms underlying cognition and their effects at the psychological level using task-related functional magnetic resonance imaging. In conventional medical evaluation, subjective clinical observations and patients' reports are assumed to be “reified” with methods from the biological sciences within a robust technocratic framework. But which is the agent of “reification” in cognitive neuroscience? Is it the method of clinical evaluation or the in vivo neuroimaging technique? The paper contributed by Popova and colleagues23 on adult brain activation during visual learning and memory tasks describes an experimental approach to translational neuroscience in the context of such questions and provides many clues for the direction of ongoing research. Beyond the individual clinical evaluation, how do we translate evidence from neuroscience to and from the level of the population? Is it possible to establish a direct link for translation from neuroscience to public health outcomes (such as, for example, quality of life), and what are the appropriate study designs to achieve this? A remarkable contribution to the Special Section from Nunes and Maes24 addresses such a question directly, connecting quality of life in psychiatric patients with immediate clinical and neurobiological markers of disease and producing diagnostic categories by machine learning experiments that target specific constellations of clinico-biological markers, known also as “biological signatures” of disease.25 Research of this type surely opens an avenue for debate on the possibility of integrating all those levels and sources of enquiry and yet avoids the trap of ontological reductionism. Psychosomatic relationships, with their public health and health services projections and personality dispositions, are another highlight of the Special Section, representing another approach to translate data across various disciplinary matrices, as Hüsing26 and Fietz and associates27 discuss. When thinking beyond the clinical assessment, there are implications that transcend into legal and moral responsibility. Indeed, how can we use and/or justify the incorporation of neuroscience methods and evidence into legal procedures? How do we perform the imperative of the normative responsibility (and Law is normative by definition) when providing statements grounded on entirely subjective evaluation (interviews and/or self-assessments)? In answer to these questions, Hardcastle and Lamb's contribution to the Special Section provides many valuable insights.28 Finally, the last Century has witnessed the adoption of an outdated dichotomy, as defined in the neo-Kantian tradition, and attributed to the German philosopher Wilhelm Windelband.29 This dichotomy separates human knowledge into nomothetic (explanatory) and ideographic (understanding). While the former is based on natural sciences and quantitative exploration of mechanisms, the latter represents subjective, empathetic, qualitative knowledge of the individual and his or her multidimensional needs in the given context. The ultimate destination of all scientific endeavour in medicine is the person of the patient.30-34 With reference to such a truism, it is possible, at the time of writing, to observe a process of delivery of more robust nomothetic components into the traditional ideographic sciences (such as psychology and phenomenology) and the induction of a more ideographic, person-centred component into the nomothetic sciences (as neurology and neuroscience). It is translational neuroscience that appears to be at the intersection of those trends, as the constituent papers of the Special Section amply demonstrate. In conclusion, the Journal extends its gratitude to Professor Dr Drozdstoy Stoyanov for accepting its commission to create the current Special Section and congratulates him on securing the contributions of so many distinguished colleagues as part of this exercise. The result is impressive and serves as a most important contribution to the field going forward. The author declares no conflicts of interest.