The quest for developing new treatments from imaging techniques: promises, problems and future potential

Drug discovery and development in psychiatry is beset by many challenges, both those which are associated with the development process in general (and affecting all of medicine) and others, which are unique to psychiatry. Due to these factors, marginal progress has been achieved in the past as many features of serious mental illness remain untouched by existing treatments. Arguably, the most important of these drug targets is cognitive dysfunction, which strongly predicts clinical outcome in a number of major neuropsychiatric conditions. Therefore, a critical need exists for progress in the characterization of this and other targets for drug discovery and development. A key area, which is already showing promise, is the use of non-invasive functional neuroimaging to investigate both cognitive dysfunction and its remediation with novel agents. In this article, the authors describe the paradigmatic case of cognitive dysfunction in schizophrenia, and the prospects for using functional magnetic resonance imaging (fMRI) to investigate the effects of agents targeting cognition. The authors observe a number of advantages of this approach over other methodologies, as well as some significant issues to be resolved in the application of this technology. The authors propose that pharmaco-fMRI is emerging as a major tool to enhance the drug development process in order to bring truly novel treatments to patients with a range of neuropsychiatric disorders.