Neuroimaging in psychiatry

Meet two patients — the scan that mattered and the scan that did not

Patient one. A 63-year-old woman, no psychiatric history, is referred with three weeks of "depression". On examination she is apathetic, mildly dysarthric, and her left arm drifts. She gets an MRI within hours, and it changes everything.[15][16]

Patient two. A 27-year-old man with a textbook second episode of psychosis — insidious onset, normal neurology, normal bloods, no seizures, no fever. His family want a scan "to be certain". The MRI is normal, and it changes nothing, except that it delays his treatment by a fortnight and convinces his father the illness is "not physical after all".[15][16]

Both patients teach the same lesson from opposite ends. Imaging in psychiatry is driven by the phenotype, not the diagnosis — and the harm of the unnecessary scan is not the cost, it is the false reassurance and the false dualism it leaves behind.[15][16]

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