22 - Neuroimaging of anxiety disorders: commentary

Summary

Introduction

In this section, nine chapters summarize brain imaging findings with regard to the structure, function and chemistry of post-traumatic stress disorder (PTSD) and other anxiety disorders, as well as obsessive–compulsive disorder (OCD). The authors of these reviews have done a marvelous job of capturing the tremendous progress that has been made in this field over the last two decades, by succinctly distilling the material into salient points. In many respects, this entire volume is a testament to the progress in psychiatric neuroscience attributable to the translational tools of neuroimaging. Still, here I wish to underscore the translational potential of neuroimaging, as exemplified by advances in neuroimaging and the neurocircuitry of anxiety disorders. In so doing, I will highlight several themes, spanning the potential contributions of neuroimaging to: diagnosis, pathophysiology, etiology, and clinical utility, as well as trends in the evolution of psychiatric neuroimaging as a field.

Diagnosis

Neuroimaging is yet to deliver on the promise of diagnostic value in psychiatry, with very few exceptions, such as ruling out general medical causes (e.g. tumor, or stroke) of disturbed mental status. Especially with DSM-V looming, there is an amplified yearning in the field for biomarkers of diagnostic specificity and sensitivity sufficient to transform our syndrome-based nosology to one of true pathophysiology-based diseases.