Insight and emotion regulation in schizophrenia: A brain activation and functional connectivity study

Abstract

BackgroundInsight is impaired in the majority of schizophrenia patients. The exact neural correlates of impaired insight remain unclear. We assume that the ability to regulate emotions contributes to having good clinical insight, as patients should be able to regulate their emotional state in such a way that they can adapt adequately in order to cope with impaired functioning and negative stigma associated with a diagnosis of schizophrenia. Numerous studies have shown emotional dysregulation in schizophrenia. We investigated the association between insight and brain activation and connectivity during emotion regulation.MethodsBrain activation during emotion regulation was measured with functional MRI in 30 individuals with schizophrenia. Two emotion regulation strategies were examined: cognitive reappraisal and expressive suppression. Clinical insight was measured with the Schedule for the Assessment of Insight – Expanded, and cognitive insight was measured with the Beck Cognitive Insight Scale. Whole brain random effects multiple regression analyses were conducted to assess the relation between brain activation during emotion regulation and insight. Generalized psychophysiological interaction (gPPI) was used to investigate the relation between task-related connectivity and insight.ResultsNo significant associations were found between insight and neural correlates of cognitive reappraisal. For clinical insight and suppression, significant positive associations were found between symptom relabeling and activation in the left striatum, thalamus and insula, right insula and caudate, right pre- and postcentral gyrus, left superior occipital gyrus and cuneus and right middle and superior occipital gyrus and cuneus. Furthermore, reduced clinical insight was associated with more connectivity between midline medial frontal gyrus and right middle occipital gyrus. For cognitive insight and suppression, significant positive associations were found between self-reflectiveness and activation in pre- and postcentral gyrus and left middle cingulate gyrus.ConclusionsOur results suggest an association between the capacity to relabel symptoms and activation of brain systems involved in cognitive-emotional control and visual processing of negative stimuli. Furthermore, poorer self-reflectiveness may be associated with brain systems subserving control and execution.

In search of convergent regional brain abnormality in cognitive emotion regulation: a transdiagnostic neuroimaging meta-analysis

“…Subsequently, 75 studies were excluded for the following reasons: lacking either heathy controls or group comparison analyses, restricting samples to adolescents or older adults, not analyzing the whole brain, reporting non-significant group comparisons, and including individuals at a high-risk of mental illnesses or with subclinical diagnosis (Table S1). Finally, a total of 32 publications were included in our meta-analysis ( Figure 1), with three overlapping samples that were reported in multiple publications, one sample was used in three papers (Larabi, et al, 2018;van der Meer, et al, 2014;Zhang, et al, 2020), and two samples each used in a pair of papers (Goldin, et al, 2009a;Heller, et al, 2009;Johnstone, et al, 2007;Ziv, et al, 2013). As mentioned earlier, we rigorously avoided convergence over analyses performed on the same samples both within and across papers.…”

“…Neuroimaging studies use a similar paradigm to investigate the neural substrates of reappraisal processes in healthy (see e.g., Mulej Bratec, et al, 2015;Mulej Bratec, et al, 2017;Xie, et al, 2016) and clinical populations (see e.g., Larabi, et al, 2018;Heller, et al, 2009). Successful reappraisal in healthy individuals has been shown to depend on the proper interactions between limbic regions, responsible for 'bottom-up' emotional responses and frontoparietal regions, responsible for 'top-down' cognitive control of emotions (Buhle, et al, 2014;Kohn, et al, 2014;Langner, et al, 2018;Morawetz, et al, 2020).…”

SAP97 rs3915512 Polymorphism Affects the Neurocognition of Schizophrenic Patients: A Genetic Neuroimaging Study

“…Friston and colleagues interpreted hyperactivation of the temporal lobe in schizophrenia during a verbal fluency task as a second-order effect of frontal lobe dysfunction ( Friston et al, 2003 ). The main functions of the occipital lobe (including MOG, Cu, Fu, and LG) are processing visual signals, language and abstract thinking, and the abnormality in this area manifests as cognitive dysfunction, such as memory and abstract thinking, in patients with schizophrenia ( Larabi et al, 2018 ). Our research results indicate that following previous studies, positive correlations were found between the RSFC of the STG-L and LG-L and BACS verbal memory scores, the most severe cognitive impairments in schizophrenia.…”

Self-regulation of behavior as one of the adaptation-compensatory mechanisms of the psyche in patients with paranoid schizophrenia. Article 2

“…З начимость социальной реабилитации для больных шизофренией с целью достижения максимально возможного состояния функциональной ремиссии давно доказана благодаря внушительному объему исследований [4,10,13,18,21,37,44]. Тем не менее, дальнейшее изучение особенностей нарушений адаптационнокомпенсаторных механизмов больных шизофренией не теряет своей актуальности [23,26,34], поскольку углубление знаний в этой области расширяет возможности создания новых более сфокусированных и эффективных интервенций для данного контингента больных.…”

“…Известно, что нарушения социальной адаптации являются знако-выми критериями в международных классификациях болезней, в частности, при постановке диагноза шизофрении [45] -с момента возникновения заболевания функционирование в одной или нескольких сферах (работа, межличностные отношения, самообслуживание и др.) ухудшается по мере прогрессирования болезненного процесса [44]. Несомненно, одним из факторов, ухудшающих адаптацию больных является снижения способности индивида к саморегуляции поведения.…”