Impaired insight into illness and cognitive insight in schizophrenia spectrum disorders: resting state functional connectivity.
Impaired insight into illness and cognitive insight in schizophrenia spectrum disorders: resting state functional connectivity.
复制标题
精神分裂症谱系中对疾病和认知见解的见解受损：静止状态的功能连通性。
DOI：
10.1016/j.schres.2014.10.015
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发表时间：
2014-12
影响因子：
4.5
通讯作者：
Graff-Guerrero, Ariel
中科院分区：
文献类型：
--
作者：
Gerretsen, Philip;Menon, Mahesh;Mamo, David C.;Fervaha, Gagan;Remington, Gary;Pollock, Bruce G.;Graff-Guerrero, Ariel
关键词：
精神分裂症患者对疾病的洞察力（临床洞察力）受损对治疗依从性和临床结局有负面影响。精神分裂症被描述为一种大脑连接中断的疾病。根据这一概念，静息状态网络（RSN）在精神分裂症患者中出现差异性影响。因此，受损的临床或认知洞察力的相关结构（假定受损的临床洞察力是元认知缺陷的函数）可能反映RSN功能连接（fc）的改变。基于我们之前的研究，即对疾病的洞察力受损与左半球体积相对于右半球增加有关，我们假设临床洞察力受损与DMN与特定左半球脑区域的连接增加有关。对患有精神分裂症或情感性精神障碍的参与者（n = 20）进行静息状态MRI扫描。对于已建立的RSN，使用ERF-fMRI fc工具箱v13进行种子到体素和ROI到ROI fc分析。临床和认知洞察力分别用洞察力评估计划-扩展版和Beck认知洞察力量表测量，并作为回归因素纳入fc分析。正如假设的那样，受损的临床洞察力与默认模式网络（DMN）与左角回的连接性增加有关，也与自我参照网络（SRN）与左角回的连接性增加有关。认知洞察力与背侧注意网络（DAN）与右下额叶皮层（IFC）和左前扣带皮层（ACC）的连接性增加有关。DMN和SRN分别与左角回和小脑角回的连接性增加可能代表精神分裂症谱系障碍中临床洞察力受损的神经相关性，并且与将洞察力受损归因于左半球优势的文献一致。在这个样本中，DAN与IFC和ACC在认知洞察力方面的连接增加可能有助于增强心理灵活性。
Impaired insight into illness (clinical insight) in schizophrenia has negative effects on treatment adherence and clinical outcomes. Schizophrenia is described as a disorder of disrupted brain connectivity. In line with this concept, resting state networks (RSNs) appear differentially affected in persons with schizophrenia. Therefore, impaired clinical, or the related construct of cognitive insight (which posits that impaired clinical insight is a function of metacognitive deficits), may reflect alterations in RSN functional connectivity (fc). Based on our previous research, which showed that impaired insight into illness was associated with increased left hemisphere volume relative to right, we hypothesized that impaired clinical insight would be associated with increased connectivity in the DMN with specific left hemisphere brain regions. Resting state MRI scans were acquired for participants with schizophrenia or schizoaffective disorder (n = 20). Seed-to-voxel and ROI-to-ROI fc analyses were performed using the CONN-fMRI fc toolbox v13 for established RSNs. Clinical and cognitive insight were measured with the Schedule for the Assessment of Insight—Expanded Version and Beck Cognitive Insight Scale, respectively, and included as the regressors in fc analyses. As hypothesized, impaired clinical insight was associated with increased connectivity in the default mode network (DMN) with the left angular gyrus, and also in the self-referential network (SRN) with the left insula. Cognitive insight was associated with increased connectivity in the dorsal attention network (DAN) with the right inferior frontal cortex (IFC) and left anterior cingulate cortex (ACC). Increased connectivity in DMN and SRN with the left angular gyrus and insula, respectively, may represent neural correlates of impaired clinical insight in schizophrenia spectrum disorders, and is consistent with the literature attributing impaired insight to left hemisphere dominance. Increased connectivity in the DAN with the IFC and ACC in relation to cognitive insight may facilitate enhanced mental flexibility in this sample.
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