title: Longitudinal trajectory of clinical insight and covariation with cortical thickness in first-episode psychosis.
abstract: Among people with a first-episode of psychosis, those with poorer clinical insight show neuroanatomical abnormalities in frontal, temporal and parietal cortices compared to those with better clinical insight. Whether changes in clinical insight are associated with progressive structural brain changes is unknown. We aimed to evaluate 1) associations between clinical insight and cortical thickness at a baseline assessment, 2) covariation between clinical insight and cortical thickness across baseline, one-year and two-year follow-up assessments, and 3) the predictive value of clinical insight for cortical thickness at one-year and two-year follow-ups. Scale for the assessment of Unawareness of Mental Disorder ratings and magnetic resonance imaging scans were acquired at baseline, one-year, and two-year follow-ups in 128, 74, and 44 individuals with a first-episode psychosis, respectively. Cortical thickness metrics were then computed at baseline, one-year and two-year follow-ups and analyzed with linear mixed models. At baseline, clinical insight was not significantly associated with cortical thickness in any region. Longitudinal mixed effects models showed that a worsening in clinical insight between the one-year and two-year assessments was significantly associated with cortical thinning in dorsal pre-central and post-central gyri. Cortical thinning in left fusiform gyrus at two-years was predicted by poorer clinical insight at baseline. Results suggest that poor clinical insight soon after the onset of a first-episode psychosis may lead to progressive cortical changes in temporal lobe, while changes in clinical insight during the second year covary with cortical thinning in circumscribed dorsal frontal and parietal cortices.
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Buchy
authors.affiliation: McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada; McGill Centre for Integrative Neuroscience, McGill University, Montréal, Québec, Canada.
authors.forename: Carolina
authors.initials: C
authors.lastname: Makowski
authors.affiliation: Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Québec, Canada; Department of Psychiatry, McGill University, Montreal, Québec, Canada.
authors.forename: Ashok
authors.initials: A
authors.lastname: Malla
authors.affiliation: Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Québec, Canada; Department of Psychiatry, McGill University, Montreal, Québec, Canada.
authors.forename: Ridha
authors.initials: R
authors.lastname: Joober
authors.affiliation: McGill Centre for Integrative Neuroscience, McGill University, Montréal, Québec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Québec, Canada; Department of Psychiatry, McGill University, Montreal, Québec, Canada. Electronic address: martin.lepage@mcgill.ca.
authors.forename: Martin
authors.initials: M
authors.lastname: Lepage
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011379:Prognosis; D011618:Psychotic Disorders / Q000000981:diagnostic imaging* / Q000628:therapy; D011792:Quebec; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
keywords: Clinical insight; Cortical thickness; First-episode schizophrenia; Magnetic resonance imaging; Neuroimaging