title: Insight in schizophrenia: involvement of self-reflection networks?
abstract: BACKGROUND
  Impaired insight is a common feature in psychosis and an important predictor of variables such as functional outcome, prognosis, and treatment adherence. A cognitive process that may underlie insight in psychosis is self-reflection, or the conscious evaluation of one's traits and characteristics. The current study aims to investigate the neural correlates of self-reflective processing and its relationship with insight in schizophrenia.
  
  
  METHODS
  Forty-seven schizophrenia patients and 21 healthy controls performed a self-reflection task in a functional magnetic resonance imaging (fMRI) scanner. The tasks comprised a self-reflection, close other-reflection, and a semantic (baseline) condition. Insight scores were obtained with the Schedule of Assessment of Insight Expanded. In addition, cognitive insight scores were obtained (Beck Cognitive Insight Scale [BCIS]).
  
  
  RESULTS
  Schizophrenia patients demonstrated less activation in the posterior cingulate cortex in the self- and other-reflection conditions and less activation in the precuneus in the other-reflection condition compared with healthy controls. Better insight was associated with greater response in the inferior frontal gyrus, anterior insula, and inferior parietal lobule during self-reflection. In addition, better cognitive insight was associated with higher activation in ventromedial prefrontal cortex during self-reflection.
  
  
  CONCLUSIONS
  In the current study, evidence for a relationship between self-reflection and insight in patients with schizophrenia was found in brain areas related to self-reflection, self/other distinction and source attribution. The findings support the rationale for a treatment that is currently under evaluation, which attempts to increase insight by enhancing self-reflection.
authors.affiliation: To whom correspondence should be addressed; Psychosecircuit, GGZ Drenthe, Denneweg 9, 9404 LA Assen, The Netherlands; tel: +31 6 31674876, fax: +31 50 3638875, e-mail: Annerieke.de.vos@ggzdrenthe.nl.
authors.forename: Lisette
authors.initials: L
authors.lastname: van der Meer
authors.forename: Annerieke E
authors.initials: AE
authors.lastname: de Vos
authors.forename: Annemarie P M
authors.initials: AP
authors.lastname: Stiekema
authors.forename: Gerdina H M
authors.initials: GH
authors.lastname: Pijnenborg
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: van Tol
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
authors.forename: André
authors.initials: A
authors.lastname: Aleman
mesh_terms: D000328:Adult; D001364:Awareness / Q000502:physiology; D002540:Cerebral Cortex / Q000503:physiopathology*; D005260:Female; D059907:Functional Neuroimaging / Q000295:instrumentation / Q000379:methods*; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000503:physiopathology*; D010296:Parietal Lobe / Q000503:physiopathology; D017397:Prefrontal Cortex / Q000503:physiopathology; D012559:Schizophrenia / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D012647:Self-Assessment
keywords: cognitive insight; fMRI; insight; psychosis; schizophrenia; self-reflection