Neurofunctional view of psychiatry: clinical brain imaging revisited

Abstract

Despite an exponential increase in the use of brain imaging in neuroscience, it has as yet hardly been integrated into clinical psychiatry. Our aim is to examine the potentials and perspectives of functional brain imaging in the diagnosis and treatment of mental disorders. This review focuses on functional MRI in probing neural activation and on diffusion tensor imaging in delineating functionally related fibre-track organization. As a case study, it examines the state-of-the-art in applying these methods in schizophrenia by referring to several hurdles in the common clinical practice of psychiatry. First, we evaluate the ability of functional brain imaging to target various neuropathological mechanisms such as neurodegeneration, disrupted development and dysconnection. Then we discuss the use of brain-imaging genomics in identifying disease-specific genetic-based neuroendophenotypes. Lastly, we describe the current effort in using brain imaging to designate the most effective and least adverse treatment for patients with schizophrenia. By examining the use of advanced MRI techniques in schizophrenia, we show both the remarkable variety of functional inferences, as well as their possible implications in clinical psychiatry. We advocate the need for extending the view on neuropathology from region-based to network-based, for integrating neurogenomic features as biological markers for illness definition and for relying on neural parameters to guide effective individual treatment.