Current goals of neuroimaging for mental disorders: a report by the WPA Section on Neuroimaging in Psychiatry
Authors: Giulia Maria Giordano, Stefan Borgwardt
Journal: World Psychiatry (2019)

The WPA Section on Neuroimaging in Psychiatry was established in 1996 in Madrid, during the 10th World Congress of Psychiatry. The main goals of the Section include the dissemination of innovative methodological approaches as well as research findings from different applications of neuroimaging techniques in psychiatry; the sound integration of clinical and neuroimaging research; and the promotion of collaborations with other WPA Scientific Sections and among researchers interested in the field across the world. In line with these goals, the Section organized, throughout the years, symposia in World Congresses of Psychiatry and International WPA Meetings, and promoted joint initiatives with other WPA Scientific Sections (e.g., with the WPA Schizophrenia Section during the WPA International Congress in Prague in 2012, and with the WPA Psychophysiology Section during the World Congress of Psychiatry in Madrid in 2014). In 2015, the Section officers (S. Galderisi, L. DeLisi and S. Borgwardt) discussed the opportunity to review decades of research on neuroimaging in schizophrenia and primary psychotic disorders, in the light of many findings suggesting that abnormalities of brain structure and function are associated with psychiatric disor-ders but do not reflect boundaries of cur-rent diagnostic categories. They envisaged the need to acknowledge that neuroimaging research, up to now, failed to meet the expectations of scientists and clinicians looking for the discovery of biomarkers of current diagnostic categories, but opened important perspectives for future routine applications in the field of early identification of mental disorders and response to treatment. These considerations gave rise to the plan of producing a book on neuroimaging in psychiatry. In the light of the huge bulk of research in the field, the officers decided to start from psychoses, and elaborated the outline of what we hope is just the first of a series of books, i.e., Neuroimaging of Schizophrenia and Other Primary Psychotic Disorders1. Several outstanding scientists agreed to collaborate to the project, and the book is now available in both paper and electronic versions. The volume reviews structural, functional, neurochemical and multimodal neuroimaging studies, within a transnosographic perspective of primary psychotic disorders, and provides an in-depth coverage of current achievements and limitations of neuroimaging research in these disorders. Throughout the book, the authors emphasize that no specific neuroimaging abnormality can be considered as a biomarker for any diagnostic category so far; nevertheless, several documented abnormalities are relevant to important clinical features, such as the severity of the clinical picture, the progression and persistence of symptoms over time, and the response to treatment. The book highlights current goals of neuroimaging research in psychoses: translating neuroimaging findings into clinical practice, in order to add value to the existing clinical assessment; moving from differences at the group level to the individual level; and identifying quantitative indices supporting clinical decisions. Promising results in this field come from machine learning, i.e., the implementation of algorithms able to learn from the experience and attribute specific characteristics to various samples, by integrating different variables, such as clinical, neurocognitive, neuroimaging and genetic data. In the near future, this progress may contribute to improve the predictive accuracy of diagnosis and prognosis2. The application of machine learning methods in neuroimaging research has increased, especially with the aim to predict the onset of a full-blown psychotic disorder in individuals with at-risk mental states, or to predict poor outcome, independently from the conversion to psychosis. Effective prediction would allow the early identification of the specific subgroup of at-risk individuals that will benefit from preventive interventions3-6. Further important topics addressed in the book include the impact of antipsychotic medications on brain structure and function, links between genetic and neuroimaging research, as well as recent progress in the field of “imaging genetics” . All authors shared the view that the potential of neuroimaging research for translation into psychiatric clinical practice should now be tested. Further investigations with multicenter and multimodal imaging design, integrating clinical measures and imaging data, and applying new multivariate approaches, such as different combined machine learning algorithms, are needed to consolidate promising findings and finally add methods of precision psychiatry to current clinical practice. All those who contributed to this book, including the authors of the present report, are grateful to the WPA for providing Section members with the opportunity to meet and exchange knowledge and experiences7, and contribute to the progress of the many facets of psychiatry.