Overdiagnosis in the era of neuropsychiatric imaging

New guidelines proposed by the National Institute of Mental Health are intended to transform the management of patients with psychiatric disorders. It is anticipated that neuroimaging and other biomarkers will play a more prominent role in diagnosis and prognosis, especially in the prodromal phase of illness. Earlier treatment of psychiatric disorders has the potential to improve outcomes significantly. However, diagnosis in the absence of symptoms can lead to overdiagnosis. Overdiagnosis is a problem in many fields of medicine but could pose additional problems in psychiatry because of the stigmatization that often accompanies a diagnosis of mental illness. This review discusses the magnetic resonance imaging methods that hold the most promise for evaluating neuropsychiatric disorders, the likelihood that they could lead to overdiagnosis, and opportunities to minimize the impact of overdiagnosis in psychiatric disorders.