The Puzzle of Neuroimaging and Psychiatric Diagnosis: Technology and Nosology in an Evolving Discipline.
The Puzzle of Neuroimaging and Psychiatric Diagnosis: Technology and Nosology in an Evolving Discipline.
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DOI：
10.1080/21507740.2012.713072
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发表时间：
2012-10-01
影响因子：
--
通讯作者：
Gillihan SJ
中科院分区：
文献类型：
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作者：
Farah MJ;Gillihan SJ
大脑成像提供了与人类心理相关的结构和功能的更敏感的测量，并揭示了几乎每一种精神疾病的相关性。然而，除了排除肿瘤或创伤性脑损伤等医学因素外，它在精神诊断中没有起到公认的作用。为什么脑成像不能用于诊断抑郁症、躁郁症、精神分裂症和多动症等原发精神疾病？本文讨论了这一问题。它回顾了精神成像的最新技术，包括诊断和其他应用，并从成像的当前状态和精神病理学的当前性质两个方面解释了诊断成像的无用之处。还讨论了基于成像的诊断将被纳入精神病学的可能的未来路径。通过回顾在精神病学诊断中使用SPECT扫描的一次著名尝试，本文检查了一个现实世界的实践，它说明了几个相关的点：尽管缺乏被证明的有效性，但图像辅助诊断的想法对医生、患者和家庭具有吸引力，以及当前病因学的类别和维度与成像所建议的类别和维度之间的不匹配。
Brain imaging provides ever more sensitive measures of structure and function relevant to human psychology and has revealed correlates for virtually every psychiatric disorder. Yet it plays no accepted role in psychiatric diagnosis beyond ruling out medical factors such as tumors or traumatic brain injuries. Why is brain imaging not used in the diagnosis of primary psychiatric disorders, such as depression, bipolar disease, schizophrenia, and ADHD? The present article addresses this question. It reviews the state of the art in psychiatric imaging, including diagnostic and other applications, and explains the nonutility of diagnostic imaging in terms of aspects of both the current state of imaging and the current nature of psychiatric nosology. The likely future path by which imaging-based diagnoses will be incorporated into psychiatry is also discussed. By reviewing one well-known attempt to use SPECT-scanning in psychiatric diagnosis, the article examines a real-world practice that illustrates several related points: the appeal of the idea of image-assisted diagnosis for physicians, patients and families, despite a lack of proven effectiveness, and the mismatch between the categories and dimensions of current nosology and those suggested by imaging.