Neurological basis of poor insight in psychosis: a voxel-based MRI study.
BACKGROUND
As a reflection of poor insight, people with schizophrenia often disagree with carers and clinicians about whether (a) their experiences are abnormal, (b) they are mentally ill, and (c) they need treatment.


METHODS
This study used voxel-based morphometry to identify the associations between total and regional grey matter volumes and self-reported and observer-rated insight in 52 patients with schizophrenia or schizoaffective disorder. Thirty healthy participants were also studied.


RESULTS
There were positive associations in patients between (i) the ability to recognise experiences as abnormal and the total and right superior temporal gyrus grey matter volumes, (ii), awareness of problems ('something wrong') and the left precuneus grey matter volume and (iii) awareness of symptoms and attributing them to illness and grey matter volumes in the left superior-middle temporal gyrus and the right inferior temporal and lateral parietal gyri. The 'recognition of the need for medication' dimension did not correlate with total or any regional grey matter volumes. Relative to controls, patients had less total and regional grey matter volumes in the thalamus and middle occipital and superior temporal gyri.


CONCLUSIONS
Lower grey matter volumes in the temporal and parietal regions that have been implicated in self-monitoring, working memory and access to internal mental states are associated with poor insight on certain dimensions in psychosis.
Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
Michael A
MA
Cooke
Dominic
D
Fannon
Elizabeth
E
Kuipers
Emmanuelle
E
Peters
Steven C
SC
Williams
Veena
V
Kumari
D000328:Adult; D001364:Awareness / Q000502:physiology*; D001931:Brain Mapping; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe / Q000473:pathology*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D012803:Sick Role; D013702:Temporal Lobe / Q000473:pathology*