4.7 Article

Insight and Psychosis: Functional and Anatomical Brain Connectivity and Self-Reflection in Schizophrenia

期刊

HUMAN BRAIN MAPPING
卷 36, 期 12, 页码 4859-4868

出版社

WILEY
DOI: 10.1002/hbm.22955

关键词

schizophrenia; insight into psychosis; functional connectivity; anatomical connectivity; brain connectivity; self-reflection; dynamic causal modelling (DCM); diffusion tensor imaging (DTI); tract-based spatial statistics (TBSS)

资金

  1. EURYI Award from the European Science Foundation [044035001]
  2. National Institute for Health Research [NF-SI-0510-10129] Funding Source: researchfish

向作者/读者索取更多资源

Impaired insight into illness, associated with worse treatment outcome, is common in schizophrenia. Insight has been related to the self-reflective processing, centred on the medial frontal cortex. We hypothesized that anatomical and functional routes to and from the ventromedial prefrontal cortex (vmPFC) would differ in patients according to their degree of impaired insight. Forty-five schizophrenia patients and 19 healthy subjects performed a self-reflection task during fMRI, and underwent diffusion tensor imaging. Using dynamic causal modelling we observed increased effective connectivity from the posterior cingulate cortex (PCC), inferior parietal lobule (IPL), and dorsal mPFC (dmPFC) towards the vmPFC with poorer insight and decrease from vmPFC to the IPL. Stronger connectivity from the PCC to vmPFC during judgment of traits related to self was associated with poorer insight. We found small-scale significant changes in white matter integrity associated with clinical insight. Self-reflection may be influenced by synaptic changes that lead to the observed alterations in functional connectivity accompanied by the small-scale but measurable alterations in anatomical connections. Our findings may point to a neural compensatory response to an impairment of connectivity between self-processing regions. Similarly, the observed hyper-connectivity might be a primary deficit linked to inefficiency in the component cognitive processes that lead to impaired insight. We suggest that the stronger cognitive demands placed on patients with poor insight is reflected in increased effective connectivity during the task in this study. (C) 2015 Wiley Periodicals, Inc.

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