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Neuroimaging methods are also being used to monitor and tiffany key rings the effects of treatment. For example, cognitive enhancement therapy was recently compared against enriched supportive therapy in patients with schizophrenia. The main outcome measure was MRI-determined changes in grey matter over the course of 2 years.17 The potential and pitfalls of using MRI-based methods as outcome measures in clinical trials has been reviewed,18 as this approach is now routinely used in clinical trials of neurologic disorders.If neuroimaging methods are ever to be used in routine psychiatric practice, there will need to be careful investigation of the feasibility and barriers of incorporating these modalities into routine clinical practice. From a practical clinical perspective, MRI investigations of the brain are noninvasive and safe; MRI methods such as resting state and structural imaging are not time-consuming or demanding on the patient. The optimal time for scanning patients will need to be determined because it might be early in the course of treatment when the use of early treatment changes in brain function could compliment baseline predictors of outcome. Early treatment changes in brain function may provide crucial return to tiffany about whether the brain has the capacity to recover with treatment. In addition to routine clinical use, the use of imaging methods in clinical trials could reduce sample sizes in treatment studies by eliminating patients who are unlikely to respond to a specific treatment modality.

If neuroimaging studies eventually provide compelling evidence that imaging modalities have an ability to impact clinical care, there will still remain many policy issues, perhaps barriers, that will determine whether there is clinical uptake of neuroimaging techniques. A policy framework supporting the dissemination of basic science information into clinical environments can facilitate the transfer of necessary information between disciplines. Indeed, Insel1 noted that NIMH would have a focus on dissemination science in order to strengthen the public health impact of NIMHsupported frank gehry.Adequate policies about the management of large amounts of personal data are generally recognized to be a necessary condition for the uptake of personalized approaches to treatment. 19 Although such information management is often associated with genomic data, imaging data also has the potential to be viewed as containing highly sensitive information, particularly if functional or structural markers of disease states are established. Of course, information about the economic costs and benefits of using such technologies for patients with psychiatric illnesses will be needed; this kind of work would be facilitated by policies that enable interdisciplinary work. The fact that some psychiatric illnesses are common may actually be a deterrent to policy makers supporting the integration of imaging data into clinical practice because the demands for such investigations could be significant. Psychiatric disorders are also extremely costly, however, and it may therefore be possible to overcome barriers to access if there is a convincing case that such investigations can lower the direct or indirect costs of these illnesses. The cost-effectiveness of having patients undergo neuroimaging will need to be established if there is any likelihood of integrating imaging into routine use.

Beyond the scientific, clinical and policy changes that may be necessary if neuroimaging and other elements of personalized medicine are to be incorporated into clinical practice, a cultural shift may also be necessary. Psychiatry may be both optimally and poorly placed to be receptive to the integration of elements of personalized medicine into clinical practice. As psychiatrists, we still teach and advocate for holistic and comprehensive tiffany keys of our patients. We work to balance the information provided by randomized clinical trials with specific patient features as we select treatments. This occurs in part because we have so few comparative effectiveness trials that we often have no other way to select among the many first- and second-line treatments other than by trying to match patients' symptoms with the effect and side-effect profiles of treatments. Clinicians are already cognizant that individual tailoring of treatments to patients is optimal. Notably, early uses of the term "personalized medicine" referred to personalized behavioural plans for patients or to acknowledge the psychologic and sociologic elements of illness - notions that are extremely familiar to psychiatrists.