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|Title:||IS FUNCTIONAL NEUROIMAGING THE NEXT TOOL OF PREDICTIVE MEDICINE IN PSYCHIATRY?
A FRAMEWORK OF NEUROETHICAL RESPONSIBILITIES IN FMRI RESEARCH.
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|Authors/Affiliations:||1 Emily Bell*; 1 Eric Racine; |
1 Institut de recherches cliniques de Montreal, QC, Canada
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|Content:||Background: Over the last 15 years, functional magnetic resonance imaging (fMRI) has become a popular method of imaging brain function. However, the representation of brain activity by fMRI reflects indirect effects of neural activity on local blood flow under constrained experimental conditions. Heavy statistical processing is used to reconstruct the data into colorful brain activation maps. Unfortunately, functional neuroimaging is technologically complicated, practiced largely without standardization, and is vulnerable to over-interpretation and misuse. Increasingly, fMRI has been extended to explore brain function in pathological conditions, including psychiatric illnesses. If functional neuroimaging is used to diagnose or inform treatment strategies for psychiatric disease this has the potential to change the current landscape in mental health. Difficulties in the interpretation and use of fMRI create ethical challenges in patients where studies may lead to the development of new but premature and potentially harmful clinical practices. |
Methods: Based on a review of the literature we have identified key assumptions underlying the view of fMRI as a predictive tool in psychiatry with a focus on depression and we have created a model framework of neuroethical responsibilities which highlight the scientific and interpretation challenges in the use of fMRI in depression and mood disorders.
Results and conclusions: Currently, fMRI is not able to substantially predict or differentiate psychiatric disorders based on neurocircuitry, although a variety of functional changes have been reported across psychiatric conditions in the literature. However, the suggestion that fMRI might play a role in diagnosis raises ethical concerns about stigma and discrimination and raises questions about resource allocation and private sector commercialization of in demand medical imaging technologies. Conversely, functional neuroimaging is already aiding in the development of novel treatment strategies in psychiatry by elucidating new treatment targets for neurostimulation. We suggest, however, that despite considerable enthusiasm, many challenges exist in the use of fMRI as a predictive tool in psychiatry. In particular, there is a need to 1) standardize techniques and sustain scientific rigor and integrity in study design, 2) promote public responsibility in disseminating neuroimaging research about the biological underpinnings of mental illness and 3) make critical assessments of emerging uses of functional imaging as they relate to the diagnosis or treatment of psychiatric disorders.
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