Bridging the Gap: Strategies to Make Psychiatric Neuroimaging Clinically Relevant.

Psychiatric neuroimaging has had limited impact on the clinical care of psychiatric disorders. Despite decades of discoveries of abnormalities in brain circuits, neuroimaging findings have not translated into clinical application. Some have proposed the solution to this problem is larger samples and increasing amounts of imaging data per individual. We believe that these proposals are unlikely to close the translational gap between the bench and the bedside because they continue to rely on purely observational correlations between biology and phenotype. Because these studies never test the causality of these correlations, these approaches are unlikely to lead to a clinically-actionable result. We propose that observed imaging findings should be probed directly to determine if they are linked to clinical phenotypes and therefore targets for therapeutic engagement. In this Disruptive Innovation, we provide an example of how perturbing circuit-phenotype relationships can identify and validate circuit targets for both clinical intervention as well as generating models of pathophysiology. This approach can be readily implemented, as these technologies are mature and widely available, and there exist empirically-derived targets that can be tested. All that is needed is to change our mindset to test the validity of identified brain signals rather than generating ever more of them.