In the mind's eye: provider and patient attitudes on functional brain imaging.

Success in functional neuroimaging has brought the promise of quantitative data in the form of brain images to the diagnosis of disorders of the central nervous system for which only qualitative clinical criteria have previously existed. Even though the translation of research to clinical neuroimaging for conditions such as major depression may not be available yet, rapid innovation along this trajectory of discovery to implementation compels exploration of how such information will eventually affect providers and patients. Clinical neuroethics is devoted to elucidating ethical challenges prior to and during the transfer of new research capabilities to the bedside. Through a model of proactive ethics, clinical neuroethics promotes the development of responsible social and public policies in response to new diagnostic and prognostic capabilities for the benefit of patients and their families, and for providers within the health care systems in which they practice. To examine views about the potential interaction of clinical neuroimaging and depression, we surveyed both mental health providers and outpatients and inpatients diagnosed with major depressive disorder. From responses of 52 providers and 72 patients, we found high receptivity to brain scans for treatment tailoring and choice, for improving understanding of and coping with disease, and for mitigating the effects of stigma and self-blame. Our results suggest that, once ready, roll out of the fully validated technology has significant potential to reduce social burden associated with highly stigmatized illnesses like depression.

[1]  Judy Illes,et al.  Commercializing cognitive neurotechnology—the ethical terrain , 2007, Nature Biotechnology.

[2]  G. Bush,et al.  Functional Neuroimaging of Attention-Deficit/Hyperactivity Disorder: A Review and Suggested Future Directions , 2005, Biological Psychiatry.

[3]  Amy J. Ross,et al.  Functional Magnetic Resonance Imaging Studies in Bipolar Disorder , 2006, CNS Spectrums.

[4]  E. Beckham,et al.  Handbook of depression , 1995 .

[5]  W. Drevets Neuroimaging studies of mood disorders , 2000, Biological Psychiatry.

[6]  Ulrich Ettinger,et al.  Applications of functional magnetic resonance imaging in psychiatry , 2006, Journal of magnetic resonance imaging : JMRI.

[7]  R. Hari,et al.  Future of functional brain imaging , 1996, European Journal of Nuclear Medicine.

[8]  Vikram Patel,et al.  Depression, chronic diseases, and decrements in health: results from the World Health Surveys , 2007, The Lancet.

[9]  M. Abou-Saleh,et al.  Neuroimaging in psychiatry: An update. , 2006, Journal of psychosomatic research.

[10]  K. Moras The Value of Neuroscience Strategies to Accelerate Progress in Psychological Treatment Research , 2006, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[11]  P Videbech,et al.  The Danish PET/depression project: PET findings in patients with major depression , 2001, Psychological Medicine.

[12]  S. Nolen-Hoeksema Responses to depression and their effects on the duration of depressive episodes. , 1991, Journal of abnormal psychology.

[13]  R. Kikinis,et al.  A review of diffusion tensor imaging studies in schizophrenia. , 2007, Journal of psychiatric research.

[14]  J. Desmond,et al.  An fMRI study of personality influences on brain reactivity to emotional stimuli. , 2001, Behavioral neuroscience.

[15]  A. Gray Stigma in psychiatry. , 2002, Journal of the Royal Society of Medicine.

[16]  Judy Illes,et al.  NEUROETHICS: DEFINING THE ISSUES IN THEORY, PRACTICE, AND POLICY , 2006 .

[17]  Changing the face of mental health care through needs-based planning. , 2007, Australian health review : a publication of the Australian Hospital Association.

[18]  M. Thase,et al.  Can’t shake that feeling: event-related fMRI assessment of sustained amygdala activity in response to emotional information in depressed individuals , 2002, Biological Psychiatry.

[19]  E. Beckham,et al.  The diagnostic classification of depression. , 1995 .

[20]  N. Sartorius,et al.  Reducing the Stigma of Mental Illness: A Report from a Global Association , 2005 .

[21]  M. Mintun,et al.  Increased amygdala response to masked emotional faces in depressed subjects resolves with antidepressant treatment: an fMRI study , 2001, Biological Psychiatry.

[22]  E. Kandel,et al.  Toward a neurobiology of psychotherapy: basic science and clinical applications. , 2005, The Journal of neuropsychiatry and clinical neurosciences.

[23]  Daniel R Weinberger,et al.  Imaging genomics. , 2003, British medical bulletin.

[24]  Ian H. Gotlib,et al.  Ruminative Response Style and Vulnerability to Episodes of Dysphoria: Gender, Neuroticism, and Episode Duration , 1998, Cognitive Therapy and Research.

[25]  I. Gotlib,et al.  Handbook of depression, 2nd ed. , 2009 .

[26]  A. Burns,et al.  Regional cerebral volume measurements in late‐life depression: relationship to clinical correlates, neuropsychological impairment and response to treatment , 2001, International journal of geriatric psychiatry.

[27]  M. Härter,et al.  Depressed patients’ perceptions of depression treatment decision‐making , 2007, Health expectations : an international journal of public participation in health care and health policy.

[28]  M. Angermeyer,et al.  Public attitudes to people with depression: have there been any changes over the last decade? , 2004, Journal of affective disorders.

[29]  Daniel R Weinberger,et al.  Neuroimaging-genetic paradigms: a new approach to investigate the pathophysiology and treatment of cognitive deficits in schizophrenia. , 2006, Harvard review of psychiatry.

[30]  T. Canli When genes and brains unite: ethical implications of genomic neuroimaging , 2004 .

[31]  Klaus P. Ebmeier,et al.  Cognitive impairment and fMRI in major depression , 2006, Neurotoxicity Research.

[32]  L. Baker,et al.  Internet use and stigmatized illness. , 2005, Social science & medicine.

[33]  R A Haslam,et al.  Anxiety and depression in the workplace: effects on the individual and organisation (a focus group investigation). , 2005, Journal of affective disorders.

[34]  B. J. Casey,et al.  Amygdala response to fearful faces in anxious and depressed children. , 2001, Archives of general psychiatry.

[35]  Norman Sartorius,et al.  Stigma and mental health , 2007, The Lancet.

[36]  Judy Illes,et al.  Imaging or Imagining? A Neuroethics Challenge Informed by Genetics , 2005, The American journal of bioethics : AJOB.

[37]  M. Thase,et al.  Use of FMRI to predict recovery from unipolar depression with cognitive behavior therapy. , 2006, The American journal of psychiatry.

[38]  A. Benbow Mental illness, stigma, and the media. , 2007, The Journal of clinical psychiatry.

[39]  R G Priest,et al.  Lay people's attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch , 1996, BMJ.

[40]  R. Davidson,et al.  Depression: perspectives from affective neuroscience. , 2002, Annual review of psychology.

[41]  D. Kupfer,et al.  MRI study of thalamic volumes in bipolar and unipolar patients and healthy individuals , 2001, Psychiatry Research: Neuroimaging.