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A Reckoning and Research Agenda for Neuroimaging in Psychiatry.
American Journal of Psychiatry ( IF 15.1 ) Pub Date : 2019-07-01 , DOI: 10.1176/appi.ajp.2019.19050521
Amit Etkin 1
Affiliation  

Human neuroimaging has been a core component of both research in psychiatry and conceptual models of the brain circuit-level mechanisms underlying psychopathology. Despite landmark neuroimaging research over the past 25 years, we still lack the level of precision and insight needed for bringing neuroimaging tools into clinical care contexts. This brief review examines historical research trends in psychiatric neuroimaging, as well as the basic assumptions underlying current efforts, in order to understand factors that have limited the impact of neuroimaging efforts thus far. These factors include the pitfalls of case-control designs, confounders inherent in associational research approaches, and the challenges in embracing fully data-driven analyses. Several critical gaps emerge, the addressing of which could provide the critical new insights that have long been sought from neuroimaging. These include transitioning from group-to individual-level analyses (and through this to intervention studies carried out robustly at the level of individual patients), building "big data" from a longitudinal perspective and not only a cross-sectional one, a greater focus on identifying causal mechanisms, and the development of tools such as electroencephalography in addition to the dominant MRI methods to aid translation to real-world clinical care. Despite the still-unrealized potential of psychiatric neuroimaging, there is now much to be excited about as previous learnings are converted into fundamentally new directions. Indeed, we may now be at an inflection point for neuroimaging if the typical study designs are left in the past and the field systematically and thoughtfully embraces the challenges that the past 25 years of research have now made apparent.

中文翻译:

精神病学中神经影像的计算和研究议程。

人体神经影像学一直是精神病学研究和精神病理学基础的脑回路级机制概念模型的核心组成部分。尽管在过去25年中对神经影像学进行了具有里程碑意义的研究,但我们仍然缺乏将神经影像工具引入临床护理环境所需的精确度和洞察力水平。本文简要回顾了精神神经影像学的历史研究趋势,以及当前研究工作的基本假设,以了解迄今为止限制神经影像学研究影响的因素。这些因素包括案例控制设计的陷阱,关联研究方法固有的混杂因素,以及采用完全数据驱动的分析所面临的挑战。出现了几个关键的差距,其解决方案可以提供长期以来从神经影像学中寻求的关键的新见解。这些包括从小组分析过渡到个人分析(并从此过渡到在单个患者水平上进行的强有力的干预研究),从纵向的角度构建“大数据”,而不仅仅是横断面的分析,而是更加侧重于除了确定主要的MRI方法以外,还可以帮助确定病因机制,并开发脑电图等工具,以帮助翻译为现实世界的临床护理。尽管精神神经影像学的潜力仍未实现,但由于以前的学习已转变为根本上的新方向,因此现在有许多令人兴奋的事情。的确,
更新日期:2019-07-01
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