Self-evaluation in schizophrenia: an fMRI study with implications for the understanding of insight.
Self-evaluation in schizophrenia: an fMRI study with implications for the understanding of insight.
复制标题
DOI：
10.1186/1471-244x-12-106
复制
发表时间：
2012-08-09
期刊：
影响因子：
4.4
通讯作者：
David AS
中科院分区：
文献类型：
--
作者：
Bedford NJ;Surguladze S;Giampietro V;Brammer MJ;David AS
缺乏自知力是精神分裂症的一个核心特征，并与大脑结构异常有关。洞察力的功能神经解剖学直到最近才被研究。当人们将自己的个性特征与他人进行比较时，大脑的中央中线结构(CMS)就会被激活。这项研究旨在比较精神分裂症患者和对照组在自我评估任务中的大脑激活情况，自我评估任务包括积极和消极特征以及精神和身体疾病术语。研究对象为年龄匹配的11例精神分裂症患者和8例健康对照。使用洞察力评估表-扩展版(SAI-E)评估洞察力。使用1.5Tesla GE系统获得fMRI数据，并记录参与者组之间的相互作用，自我与他人之间的相互作用，在簇水平上具有显著意义。在对所有特征的自我评估中，患者组与对照组相比，额叶内侧上回(背内侧前额叶皮质)的活动显著降低。在后扣带回也检测到第二簇低活性。当探索对个体特征的反应时，其他额叶区域和右顶下小叶的激活不足出现，这往往是相关的，尽管与较低的自知力分数有微弱的相关性。此外，在前扣带回、额叶和顶叶区域(特别是楔前叶)，与对照组相比存在过度激活的区域，这些区域与自知力评分呈中度负相关。我们已经证明，CMS被认为是支持自我评估的关键系统，在精神分裂症患者中是功能失调的，特别是在前额叶背内侧。这可能对精神分裂症缺乏洞察力有一定的影响。背内侧前额叶区域的功能低下似乎特别重要，尽管其他后部和外侧皮质区域也起到了一定作用，并可能调节自我评估反应，这取决于所考虑的特征类型。
Lack of insight is a core feature of schizophrenia and is associated with structural brain abnormalities. The functional neuroanatomy of insight has only recently been investigated. When people evaluate their personality traits compared to those of another, activation is seen in central midline structures (CMS) of the brain. This study set out to compare cerebral activation in schizophrenia patients versus controls during a self-evaluation task which included positive and negative traits as well as mental and physical illness terms. Eleven schizophrenia patients and 8 healthy controls, matched for age were studied. Insight was assessed using the Schedule for the Assessment of Insight-expanded version (SAI-E). FMRI data were obtained with a 1.5 Tesla GE system and interactions between participant group, self versus other, significant at the cluster level, were recorded. Significant hypoactivation in the medial superior frontal gyrus (dorsomedial prefrontal cortex) was observed in patients vs. controls during self-evaluation of all traits combined. A second cluster of hypoactivation in the posterior cingulate was also detected. When the response to individual traits was explored, underactivation in other frontal regions plus right inferior parietal lobule emerged and this tended to correlate, albeit weakly with lower insight scores. Further, there were areas of hyperactivation relative to controls in anterior cingulate, frontal and parietal regions (especially precuneus) which showed moderate inverse correlations with insight scores. We have demonstrated that the CMS, identified as a key system underpinning self-evaluation, is dysfunctional in patients with schizophrenia, particularly dorso-medial PFC. This may have implications for lack of insight in schizophrenia. Hypofunction within the dorsomedial prefrontal region seems to be particularly important although other posterior and lateral cortical regions play a part and may modulate self-evaluative responses depending on the type of trait under consideration.