Abstract
Neuroimaging as a research method has experienced tremendous growth in recent years. I am not sure this growth has been reflected in the knowledge of psychiatrists of the uses and limitations of neuroimaging methods which are often seen, certainly in the public domain, as offering ‘windows’ into the human mind. This book has been written, at least partially, to address some of these concerns. The editors have aimed the book at clinical novices to imaging techniques, especially clinicians wishing to understand the place of imaging in psychiatric research, as well as researchers embarking on the conduct of imaging studies. The book presents an overview of both imaging techniques and findings in various disorders, a quite substantial task. It is not a ‘how to do’ manual but an overview of (predominantly functional) imaging techniques and the major findings in psychiatric disorders. In general, this is a very well written book that achieves most of its goals, although there are a number of limitations that will hopefully be addressed in a future edition.
The book contains contributions from a variety of highly credentialled imaging researchers, mostly from the UK but also with a number of US authors. There is an introductory chapter covering imaging techniques and methods and then eight chapters covering the applications of imaging studies in areas such as child psychiatry, ageing, schizophrenia, mood disorders, OCD and psychopathy. Most chapters provide an overview of the issues in the discipline as well as a detailed description of the relevant imaging studies and results.
It is in the area of the interpretation and analysis of the studies that there is the most inconsistency between the chapters. For example, some chapters present the study results in a straight descriptive manner whereas, for example, the chapter on schizophrenia essentially reads as an argument for specific theoretical interpretation of the large body of imaging studies in this disorder. The authors argue that the diversity of inconsistent research findings in schizophrenia can be best explained by adopting a model of ‘functional disintegration’ between brain regions. Although this is an attractive and interesting model, the support for it to date is limited and the focus on this model is at the expense of a more comprehensive review of diversity of imaging studies in schizophrenia that would have more value for clinicians and new imaging researchers alike. For example, there is sparse coverage of receptor occupancy studies of antipsychotic medications, an area that directly informs clinical practice and is of considerable clinical and academic interest. There is also almost no coverage of longitudinal imaging studies, such as those demonstrating the evolution of structural changes over time. The excellent chapter on OCD, in contrast, presents an integrative model. However, this is preceded by a more comprehensive overview, placing the model in context.
The other major weakness of what otherwise is an excellent book lies in a lack of breadth in the introductory chapter where there is a substantial focus on functional neuroimaging methods and techniques. Whereas this reflects the growth of these methods, the authors have failed to address a number of other areas that will be of considerable interest to the target reader. These include magnetic resonance spectroscopy, imaging of white matter pathways and a number of non-MR or nuclear medicine techniques, such as near infrared spectroscopy and developments in quantitative electrophysiology. Even within the areas of focus, there is considerable description of the physics of the techniques and data acquisition but no description of methods of data analysis. Data analysis in imaging studies is just as fraught and difficult to comprehend for the non-expert as data acquisition and a readable description of these issues would be of considerable value and add to the usefulness of this book.
Taking these limitations into account, this book fills an important space and would be most valuable for psychiatrists and trainees with a specific interest in imaging techniques and their increasing applications in modern psychiatric research.