title: Self-reflection and the psychosis-prone brain: an fMRI study.
abstract: OBJECTIVE
  The Cortical Midline Structures (CMS) play a critical role in self-reflection, together with the insula. Abnormalities in self-referential processing and its neural underpinnings have been reported in schizophrenia and at-risk populations, suggesting they might be markers of psychotic vulnerability. Psychometric measures of schizotypal traits may be used to index psychosis proneness (PP) in nonclinical samples. It remains an unresolved question whether differences in self-reflective processing are associated with PP.
  
  
  METHODS
  Six hundred students completed the Community Assessment of Psychic Experiences Questionnaire, positive subscale. Two groups were formed from the extremes of the distribution (total N = 36). fMRI was used to examine CMS/insula function during a self-reflection task. Participants judged personality trait sentences about self and about an acquaintance.
  
  
  RESULTS
  High PP subjects attributed less positive traits to others (i.e., acquaintances) than subjects with low PP. Across groups, the contrasts self > semantic and self > other induced activation in CMS and insula, whereas other > semantic did not produce insula activation. Other > self induced posterior cingulate cortex activation in low PP but not in high PP. In addition, high PP subjects showed stronger activation than low PP in left insula during self > semantic. Examining valence effects revealed that high PP individuals showed increased activation in left insula, right dMPFC, and left vMPFC for positive self-related traits, and in bilateral insula, ACC, and right dMPFC for negative self-related traits.
  
  
  CONCLUSIONS
  The findings suggest that aspects of self-referential processing and underlying brain mechanisms are similar in clinical and subclinical (high PP) forms of psychosis, suggesting that these may be associated with vulnerability to psychosis.
authors: Institute of Psychiatry, Department of Psychosis Studies, King's College London, London, United Kingdom. gemma.modinos@kcl.ac.uk
authors: Gemma
authors: G
authors: Modinos
authors: Remco
authors: R
authors: Renken
authors: Johan
authors: J
authors: Ormel
authors: André
authors: A
authors: Aleman
mesh_terms: D000293:Adolescent; D001921:Brain / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007600:Judgment; D008279:Magnetic Resonance Imaging; D008297:Male; D011618:Psychotic Disorders / Q000503:physiopathology* / Q000523:psychology*; D011930:Reaction Time; D012649:Self Concept; D012660:Semantics; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires; D014705:Verbal Behavior; D055815:Young Adult