title: Insight and psychosis: Functional and anatomical brain connectivity and self-reflection in Schizophrenia.
abstract: Impaired insight into illness, associated with worse treatment outcome, is common in schizophrenia. Insight has been related to the self-reflective processing, centred on the medial frontal cortex. We hypothesized that anatomical and functional routes to and from the ventromedial prefrontal cortex (vmPFC) would differ in patients according to their degree of impaired insight. Forty-five schizophrenia patients and 19 healthy subjects performed a self-reflection task during fMRI, and underwent diffusion tensor imaging. Using dynamic causal modelling we observed increased effective connectivity from the posterior cingulate cortex (PCC), inferior parietal lobule (IPL), and dorsal mPFC (dmPFC) towards the vmPFC with poorer insight and decrease from vmPFC to the IPL. Stronger connectivity from the PCC to vmPFC during judgment of traits related to self was associated with poorer insight. We found small-scale significant changes in white matter integrity associated with clinical insight. Self-reflection may be influenced by synaptic changes that lead to the observed alterations in functional connectivity accompanied by the small-scale but measurable alterations in anatomical connections. Our findings may point to a neural compensatory response to an impairment of connectivity between self-processing regions. Similarly, the observed hyper-connectivity might be a primary deficit linked to inefficiency in the component cognitive processes that lead to impaired insight. We suggest that the stronger cognitive demands placed on patients with poor insight is reflected in increased effective connectivity during the task in this study.
authors.affiliation: Department of Neuroscience, University of Groningen, BCN Neuroimaging Center (NIC), University Medical Center, Groningen, The Netherlands.
authors.forename: Branislava
authors.initials: B
authors.lastname: Ćurčić-Blake
authors.affiliation: Department of Neuroscience, University of Groningen, BCN Neuroimaging Center (NIC), University Medical Center, Groningen, The Netherlands.|Department of Rehabilitation, Lentis, Zuidlaren, The Netherlands.
authors.forename: Lisette
authors.initials: L
authors.lastname: van der Meer
authors.affiliation: Department of Clinical Psychosis and Experimental Psychopathalogy, University of Groningen, Grote Kruisstraat, The Netherlands.|Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands.
authors.forename: Gerdina H M
authors.initials: GH
authors.lastname: Pijnenborg
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King's College London, Denmark, Hill, United Kingdom.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
authors.affiliation: Department of Neuroscience, University of Groningen, BCN Neuroimaging Center (NIC), University Medical Center, Groningen, The Netherlands.
authors.forename: André
authors.initials: A
authors.lastname: Aleman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D009415:Nerve Net / Q000502:physiology*; D009434:Neural Pathways / Q000473:pathology / Q000502:physiology*; D010100:Oxygen / Q000097:blood; D017397:Prefrontal Cortex / Q000098:blood supply / Q000473:pathology*; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000473:pathology*; D012565:Schizophrenic Psychology; D066127:White Matter / Q000098:blood supply / Q000473:pathology*; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: anatomical connectivity; brain connectivity; diffusion tensor imaging (DTI); dynamic causal modelling (DCM); functional connectivity; insight into psychosis; schizophrenia; self-reflection; tract-based spatial statistics (TBSS)