1. To become familiar with the interdisciplinary aspects of psychoradiology.
2. To learn about the methodological principles of structural, functional and molecular imaging of the brain.
3. To understand the pathophysiological concepts underlying psychiatric disorders.
Psychoradiology is a field of radiology that investigates the brain and mind both in health and disease. It usually applies various methods including structural and volumetric magnetic resonance (MR) imaging, functional MR imaging, MR spectroscopy and diffusion tensor imaging (DTI). A combination of methods increases the soundness of the results. Psychoradiology can help to both unravel the physiological processes of the mind and to understand pathological alterations that lead to disease. In recent years brain stimulation techniques have been gaining increasing attention for the treatment of various psychiatric disorders. Psychoradiology may become an important tool to guide the target of the intervention and to understand the changes in the brain´s networks associated with this treatment.
1. To understand the important role of imaging in the diagnostic evaluation of psychiatric patients.
2. To become familiar with important imaging patterns that may be encountered in patients with psychiatric disorders.
3. To understand future trends in neuroimaging of patients with psychiatric disorders.
During the last three decades, psychiatrists have developed a comprehensive view on brain functions, which underly symptoms and syndroms of psychiatric disorders. Different avenues from genetic and molecular research, neurophysiology, and multimodal neuroimaging have contributed to this development. More recently, parallel to the introduction of the Diagnostic Manual DSM-5, the National Institute of Mental Health (NIMH) has challenged the diagnostic categories by introducing Research Domain Criteria (RDoC) as a new matrix for cognitive and behavioral domains forming human experience and behavior. These domains can be addressed from cellular to system Levels. Neuroimaging represents a key technology for the investigation of these domains and will play a pivotal role in psychiatric research. This lecture will outline these issues and give examples of the diagnostic value of neuroimaging, research on pathophysiology and mechanisms of therapeutic action (example: brain stimulation), and finally prediction of individual outcome as well as monitoring progress of disease.
1. To become familiar with the principles and practice of using structural and volumetric methods in patients with neuropsychiatric disorders.
2. To understand methods and applications of task-based and resting-state functional MR imaging techniques in neuropsychiatric patients.
3. To learn about the role of spectroscopy and molecular imaging in patients with neuropsychiatric disorders.
Structural MR imaging in neuropsychiatric disorders includes volumetric techniques, such as whole-brain voxel-based morphometry and automated segmentation of brain structures, as well as assessment of tissue characteristics such as myelin content. With the advent of advanced data mining and machine learning techniques, the results of these approaches can be combined to detect disease-specific patterns, as singular volumetric measures might lack specificity. For example, hippocampal volume is not only reduced in Alzheimer’s disease, but also in depression and schizophrenia. Ultrahigh field MRI will further facilitate the detection of disease-specific changes, e.g. in the hippocampal subfields in schizophrenia. Functional MRI in neuropsychiatric disorders largely relies on resting-state paradigms, as they are easily implementable and less dependent on patient cooperation and command of language than task-based paradigms. Many fMRI studies have investigated differences between patient and control groups and have provided valuable insight into alterations of functional brain connections and networks in neuropsychiatric diseases. However, applications in the individual patient are still sparse. Technical advances such as individualized functional networks, reliability correction, and also optimized scan length and the collection of large healthy reference populations are currently paving the way towards applications of fMRI as an individualized imaging marker for neuropsychiatric disorders. Molecular imaging techniques such as PET/SPECT and MR spectroscopy have provided insight into alterations in neurotransmission and metabolism in neuropsychiatric disorders. Recently, molecular imaging of neuroinflammatory markers such as microglia activation has increasingly attracted interest, due to increasing evidence suggesting a role for inflammation in the pathogenesis of neuropsychiatric disorders.
1. To become familiar with the principles of imaging-based prediction methods.
2. To understand the role of neuroimaging in predicting neuropsychiatric diagnoses.
3. To learn about imaging-based methods to predict treatment response in psychiatry.
1. To understand the principles of neuromodulation.
2. To become familiar with methods of imaging-based neuromodulation.
3. To become familiar with future prospects of neuroimaging and neuromodulation.
Non-invasive transcranial brain stimulation (NIBS) methods (e.g. transcranial direct current stimulation - tDCS, repetitive transcranial magnetic stimulation - rTMS and others) provide a unique in vivo intervention for probing the functional role of regions and hubs in human neural systems that play a role in the pathophysiology of psychiatric disorders. Recent research has shown that the individual human brain functional MRI connectivity (fcMRI) shows distinct patterns of within- and between-subject variability. Anatomically targeted analyses of NIBS in neuropsychiatric patients and healthy subjects have generated promising results. Even combining several neuroimaging methods (resting state fcMRI, task-based fMRI, magnetic resonance spectroscopy (MRS)) may be useful to detect classifiers that can reliably predict NIBS effects. These neuroimaging methods allow individual brain properties as well as the evaluation of state dependency. By combining neuroimaging and NIBS (term: imaging stimulation), new functional models are expected to be developed and compared in different states of health and pathology, e.g. during the course of psychiatric disorders from preclinical stages to relapsing-remitting or chronic disorders.