Imaging Psychoses: Diagnosis and Prediction of Violence

The main purpose of this chapter is to address the issue of whether neuroimaging techniques can or should have a role in the diagnosis or classification of mental diseases such as schizophrenia for forensic purposes. We will first review the concept of schizophrenia by describing several aspects of the illness that are increasingly well established. We will then shift our focus to what has been discovered about schizophrenia using neuroimaging methodologies to examine patients' brain structure, the connectivity of their neurons, as well as functioning under a number of different circumstances. Because of its forensic relevance, we also address schizophrenia's comorbidity with violence and substance use. Lastly, we review the potential for using neuroimaging as a diagnostic tool to classify individuals both before and after illness onset. One key observation within this chapter is that classification algorithms may benefit further from several modes of brain imaging techniques (e.g. combinations of structural, functional and connectivity markers); these algorithms may be further aided by behavioral measures, such as those assessed by neuropsychological tasks. While there are still several pending issues that need to be addressed, findings reported in this chapter suggest that there is potential for neuroimaging to become a standard component of the approach to confirming a diagnosis of schizophrenia. Perhaps in time it will be useful for distinguishing schizophrenia patients from patients with related disorders, and/or guiding treatment recommendations.