title: Preservation and compensation: the functional neuroanatomy of insight and working memory in schizophrenia.
abstract: BACKGROUND
  Poor insight in schizophrenia has been theorised to reflect a cognitive deficit that is secondary to brain abnormalities, localized in the brain regions that are implicated in higher order cognitive functions, including working memory (WM). This study investigated WM-related neural substrates of preserved and poor insight in schizophrenia.
  
  
  METHODS
  Forty stable schizophrenia outpatients, 20 with preserved and 20 with poor insight (usable data obtained from 18 preserved and 14 poor insight patients), and 20 healthy participants underwent functional magnetic resonance imaging (fMRI) during a parametric 'n-back' task. The three groups were preselected to match on age, education and predicted IQ, and the two patient groups to have distinct insight levels. Performance and fMRI data were analysed to determine how groups of patients with preserved and poor insight differed from each other, and from healthy participants.
  
  
  RESULTS
  Poor insight patients showed lower performance accuracy, relative to healthy participants (p=0.01) and preserved insight patients (p=0.08); the two patient groups were comparable on symptoms and medication. Preserved insight patients, relative to poor insight patients, showed greater activity most consistently in the precuneus and cerebellum (both bilateral) during WM; they also showed greater activity than healthy participants in the inferior-superior frontal gyrus and cerebellum (bilateral). Group differences in brain activity did not co-vary significantly with performance accuracy.
  
  
  CONCLUSIONS
  The precuneus and cerebellum function contribute to preserved insight in schizophrenia. Preserved insight as well as normal-range WM capacity in schizophrenia sub-groups may be achieved via compensatory neural activity in the frontal cortex and cerebellum.
authors: Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
authors: Adegboyega
authors: A
authors: Sapara
authors: Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK.
authors: Dominic H
authors: DH
authors: Ffytche
authors: School of Psychology, University of Birmingham, Birmingham, UK.
authors: Max
authors: M
authors: Birchwood
authors: Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
authors: Michael A
authors: MA
authors: Cooke
authors: Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
authors: Dominic
authors: D
authors: Fannon
authors: Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK.
authors: Steven C R
authors: SC
authors: Williams
authors: Department of Psychology, Institute of Psychiatry, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
authors: Elizabeth
authors: E
authors: Kuipers
authors: Department of Psychology, Institute of Psychiatry, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK. Electronic address: veena.kumari@kcl.ac.uk.
authors: Veena
authors: V
authors: Kumari
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000098:blood supply* / Q000473:pathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology*; D008570:Memory, Short-Term / Q000502:physiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D010045:Outpatients; D010100:Oxygen; D011569:Psychiatric Status Rating Scales; D011932:Reading; D012559:Schizophrenia / Q000150:complications* / Q000473:pathology*; D012565:Schizophrenic Psychology; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: Cerebellum; Frontal cortex; Precuneus; Psychosis; Working memory capacity; fMRI