The benefit of foresight? An ethical evaluation of predictive testing for psychosis in clinical practice
Open accessAbstract
Risk prediction for psychosis has advanced to the stage at which it could feasibly become a clinical reality. Neuroimaging biomarkers play a central role in many risk prediction models. Using such models to predict the likelihood of transition to psychosis in individuals known to be at high risk has the potential to meaningfully improve outcomes, principally through facilitating early intervention. However, this compelling benefit must be evaluated in light of the broader ethical ramifications of this prospective development in clinical practice. This paper advances ethical discussion in the field in two ways: firstly, through in-depth consideration of the distinctive implications of the clinical application of predictive tools; and, secondly, by evaluating the manner in which newer predictive models incorporating neuroimaging alter the ethical landscape. We outline the current state of the science of predictive testing for psychosis, with a particular focus on emerging neuroimaging biomarkers. We then proceed to ethical analysis employing the four principles of biomedical ethics as a conceptual framework. We conclude with a call for scientific advancement to proceed in tandem with ethical consideration, informed by empirical study of the views of high risk individuals and their families. This collaborative approach will help ensure that predictive testing progresses in an ethically acceptable manner that minimizes potential adverse effects and maximizes meaningful benefits for those at high risk of psychosis.
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Sharing an at-risk designation may be helpful (beneficence) and honour the ethical principle that young people have the right to receive information relevant to their health (autonomy).
“Thus, sharing an at-risk designation may not only be helpful (beneficence), but honour the ethical principle that young people have the right to receive information relevant to their health (autonomy) 268”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [268]
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Lin, Y.-S., Fusar‐Poli, P., & Borgwardt, S. (2019) · Springer eBooks · doi:10.1007/978-3-319-97307-4_6 · Cited by 2 · see citing works
Flagged first, then by citations
1 of the 93 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Tognin S. van Hell H.H. Merritt K. Towards precision medicine in psychosis: benefits and challenges of multimodal multicenter studies—psyscan: translating neuroimaging findings from research into clinical practice Schizophr. Bull. 2019 Published Online First https://academic.oup.com/schizophreniabulletin/advance-article-abstract/doi/10.1093/schbul/sbz067/5551326 PMC7043057 31424555 · DOI
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Preventive psychiatry: a blueprint for improving the mental health of young people
Fusar‐Poli, P., Correll, C. U., Arango, C., Berk, M., Patel, V., & Ioannidis, J. P. A. (2021) · World Psychiatry · doi:10.1002/wps.20869 · Cited by 497 · see citing works
Artificial intelligence-assisted psychosis risk screening in adolescents: Practices and challenges
Cao, X., & Liu, X. (2022) · World Journal of Psychiatry · doi:10.5498/wjp.v12.i10.1287 · Cited by 65 · see citing works
Towards personalised predictive psychiatry in clinical practice: an ethical perspective
Lane, N. M., & Broome, M. R. (2022) · The British Journal of Psychiatry · doi:10.1192/bjp.2022.37 · Cited by 15 · see citing works
Self-citationNeiders, I., Mežinska, S., & van Haren, N. E. M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06949-3 · Cited by 9 · see citing works
Towards a More Globally Inclusive and Relevant Neuroethics
Palk, A. C. (2022) · African Sun Media eBooks · doi:10.52779/9781991201959/09 · Cited by 1 · see citing works
Ethical trade-offs in AI for mental health
Holm, S. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1407562 · Cited by 1 · see citing works
Predicting Childhood Neurologic Impairments: Preparing for or Prejudicing the Future?
Mann, P. C. (2021) · The International Library of Bioethics · doi:10.1007/978-3-030-86182-7_21 · Cited by 1 · see citing works
Preliminary investigation of public perspectives towards psychiatric genetics in Japan
Ishizuka, K. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.102519
Ethical considerations and current research practices in adolescent psychosis
Plessen, K. J., Jox, R. J., & Armando, M. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-89832-4.00010-x
Sung, J., Midorikawa‐Inomata, A., Fujio, K., & Inomata, T. (2026) · Survey of Ophthalmology · doi:10.1016/j.survophthal.2026.02.003 · Cited by 1 · see citing works
Neiders, I., Kalēja, J., Mileiko, I., Poļaka, I., & Mežinska, S. (2026) · Global Bioethics · doi:10.1080/11287462.2026.2648374
- Authors
- Lane, N. M., Hunter, S. A., & Lawrie, S. M.
- Affiliations
- NHS Lanarkshire (GB)
- NHS Lothian (GB)
- Royal Edinburgh Hospital (GB)
- Corresponding author
- Lane, Natalie M
- Venue
- NeuroImage: Clinical
- Publisher
- Elsevier BV
- Published
- 2020
- Volume
- 26
- Pages
- 102228
- ISSN
- 2213-1582 (ISSN-L)
- PMC
- PMC7229349
- OpenAlex
- W3008325654
- Cited by
- 11
- References
- 93
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 1
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- NeuroImage Clinical (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- psychosis prediction, neuroimaging biomarkers, early intervention, ethical evaluation, biomedical ethics, high-risk individuals, family perspectives, transition to psychosis
- MeSH terms
- Adult, Ethics, Medical, Humans, Professional-Patient Relations, Prognosis, Psychotic Disorders, Schizophrenia, Biomarkers, Risk Assessment, Neuroimaging, Early Medical Intervention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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