title: Correlating anterior insula gray matter volume changes in young people with clinical and neurocognitive outcomes: an MRI study.
abstract: BACKGROUND
  The anterior insula cortex is considered to be both the structural and functional link between experience, affect, and behaviour. Magnetic resonance imaging (MRI) studies have shown changes in anterior insula gray matter volume (GMV) in psychosis, bipolar, depression and anxiety disorders in older patients, but few studies have investigated insula GMV changes in young people. This study examined the relationship between anterior insula GMV, clinical symptom severity and neuropsychological performance in a heterogeneous cohort of young people presenting for mental health care.
  
  
  METHODS
  Participants with a primary diagnosis of depression (n = 43), bipolar disorder (n = 38), psychosis (n = 32), anxiety disorder (n = 12) or healthy controls (n = 39) underwent structural MRI scanning, and volumetric segmentation of the bilateral anterior insula cortex was performed using the FreeSurfer application. Statistical analysis examined the linear and quadratic correlations between anterior insula GMV and participants' performance in a battery of clinical and neuropsychological assessments.
  
  
  RESULTS
  Compared to healthy participants, patients had significantly reduced GMV in the left anterior insula (t = 2.05, p = .042) which correlated with reduced performance on a neuropsychological task of attentional set-shifting (ρ = .32, p = .016). Changes in right anterior insula GMV was correlated with increased symptom severity (r = .29, p = .006) and more positive symptoms (r = .32, p = .002).
  
  
  CONCLUSIONS
  By using the novel approach of examining a heterogeneous cohort of young depression, anxiety, bipolar and psychosis patients together, this study has demonstrated that insula GMV changes are associated with neurocognitive deficits and clinical symptoms in such young patients.
authors.affiliation: Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, NSW, Australia. sean.hatton@sydney.edu.au
authors.forename: Sean N
authors.initials: SN
authors.lastname: Hatton
authors.forename: Jim
authors.initials: J
authors.lastname: Lagopoulos
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hermens
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Naismith
authors.forename: Maxwell R
authors.initials: MR
authors.lastname: Bennett
authors.forename: Ian B
authors.initials: IB
authors.lastname: Hickie
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000473:pathology*; D001714:Bipolar Disorder / Q000473:pathology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000473:pathology*; D003866:Depressive Disorder / Q000473:pathology*; D056344:Executive Function; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D036421:Nerve Fibers, Unmyelinated / Q000473:pathology*; D009483:Neuropsychological Tests; D011618:Psychotic Disorders / Q000473:pathology*