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Tracing the history of neuroimaging as a tool for psychiatry research.
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As a result of the growing opportunity to utilize neuroimaging as a tool for psychiatric research, the Psychiatric Neuroimaging Research Group was founded in 1994 and evolved into a departmental program in 2003. The program was led by Dr. Scott Rauch until he assumed the role of President of McLean Hospital in 2006. The program is now led by Dr. Randy Buckner, an investigator with the Howard Hughes Medical Institute. Dr. Buckner develops novel neuroimaging approaches and explores their application to clinical research.
Under Dr. Rauch’s leadership, the program successfully melded three existing strengths of MGH – the clinical research programs within the Department of Psychiatry, the biomedical imaging advances being made within the Department of Radiology, and the anatomical techniques being innovated by the Center for Morphometric Analysis (CMA) within the Department of Neurology. This interdisciplinary experiment resulted in several major breakthroughs that have led the field of psychiatric neuroimaging research.
The first wave of discovery yielded probes to tap into affective and cognitive systems disrupted in psychiatric illness. Particularly influential examples include the development of functional MRI paradigms that employ emotionally-laden stimuli, such as fearful faces, to provoke responses in fear circuits, and cocaine administration procedures to evaluate neural responses to craving and the receipt of addictive drugs. Paradigm development continues to be a strength of the program. Another example of paradigm development includes recent work on probes that target safe provocation of anxiety through respiratory distress, that tax selective components of executive function, and that explore the basis of social interaction.
The second wave of discovery applied these novel techniques to understand differences in psychiatric disorders. Arising from close collaborations between the clinical research programs and the imaging group, major papers have reported differences in specific brain systems including for posttraumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, major depression, bipolar disorder, and schizophrenia.
In a particularly elegant series of studies using a longitudinal cohort, temperament was measured in infants who were followed through adolescence. Supporting very early determinants of behavior, infants with inhibited temperament were at high risk for anxiety disorders and grew up to be adults with abnormally elevated activity in fear circuitry. These studies collectively provide neuroscience targets for further exploration of psychiatric illness and, in doing so, help to underscore that such illnesses arise from treatable biological origins.
Significant progress has been achieved in several domains of translational research. The first domain concerns the use of neuroimaging measures in clinical trials. As novel treatments for psychiatric illness emerge, a potential area of high impact for neuroimaging research is its contribution to the design of clinical trials and use as a biomarker endpoint. Recent work has especially focused on the neural bases of the placebo effect with direct practical applications to trial design. A second domain concerns understanding the neural bases of commonly practiced complementary medical approaches including meditation and acupuncture. In a recent study employing sensitive methods to examine cortical architecture, long-term meditators were shown to have increased cortical thickness in brain areas important to attention and introception.
One of the most promising translational opportunities arises from the use of neuroimaging to guide and evaluate neurotherapeutics. Device and surgical treatments are becoming a more common option for severe, intractable psychiatric illness. These interventions include transcranial magnetic stimulation (TMS), cortical stimulation (CS), and deep brain stimulation (DBS).
Neuroimaging, in addition to providing targets for these interventions, also provides methods for presurgical planning and post-operative evaluation. The Division of Neurotherapeutics, directed by Dr. Darin Dougherty, was established in 2003 to foster research on neurotheraputic treatment of psychiatric illness.
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