Imaging Mental Disorders in the 21st Century
Abstract
Computer-based brain-imaging technologies were introduced into medicine beginning in the 1970s, with the introduction of computed axial tomography (CAT or CT) and, subsequently, magnetic resonance imaging (MRI), magnetic resonance spectroscopy, functional MRI, positron emission tomography (PET), and single photon emission computed tomography (SPECT). These technologies have revolutionized the practice of neurology but, to date, have had less impact on the practice of psychiatry. Nevertheless, brain imaging has become an increasingly important area of psychiatric research over the past 30 years and is beginning to influence how we understand psychiatric illness and how it should be treated. Brain imaging arrived on psychiatry's doorstep when explanatory models for psychiatric illness were in transition. The introduction of the first generation of psychotropic medications challenged the field to address biological determinants of mental illness, as did the emergence of new research establishing that many major mental illnesses have a high degree of heritability. CT and MRI captured the imagination of the field by their ability to visually present the 3-dimensional structure of the brain-as if this might settle once and for all whether illnesses such as schizophrenia are really brain diseases. The search for the structural basis of schizophrenia offers a useful example of how brain imaging informs our understanding of the illnesses we psychiatrists treat. That CT scanning…
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