The neuroanatomical correlates of cognitive insight in schizophrenia

Abstract

Insight has been mostly studied from a clinical perspective. Recently, attention moved to cognitive insight or the ability to monitor and correct one's erroneous convictions. Here, we investigated the neuroanatomical correlates of cognitive insight. We administered the Beck cognitive insight scale to 45 outpatients with a schizophrenia diagnosis and 45 age- and gender-matched healthy control subjects who underwent a MRI investigation, including high-resolution volumetric and diffusion tensor imaging sequences. Gray and white matter volume, mean diffusivity and fractional anisotropy were used as dependent variables and were analyzed on a voxel-by-voxel basis with reference to the cognitive insight indexes. Self-reflectiveness was positively related to gray matter volume of the right ventro-lateral prefrontal cortex (VLPFC). No statistically significant results emerged from the DTI analyses, and no significant relationships were found for self-certainty and global cognitive insight. Reduced self-reflectiveness is related to a reduced volume of the VLPFC, an area involved in generating and maintaining in working memory different hypotheses about the self. This line of research focusing on the metacognitive features of insight in schizophrenia can provide relevant information to identify patients who are most vulnerable to lack of insight and develop effective cognitive therapeutic strategies.

Meta-cognition is associated with cortical thickness in youth at clinical high risk of psychosis

“…This finding accords with neuroimaging data demonstrating a role for the frontal cortex in mentalizing about oneself (Frith and Frith, 2003;Lombardo et al, 2010). A related set of experiments using the Beck Cognitive Insight Scale has also reported that individuals' scores on the Self-Reflectiveness factor, which taps comprehension of one's own reasoning processes, is dependent on structural integrity and functional activation in circumscribed regions of the prefrontal cortex (Orfei et al, 2012;Pu et al, 2013;Buchy et al, in press;Buchy and Lepage, 2015). Interestingly, greater thickness in frontal cortical foci was also observed in the analysis of Decentration and Mastery, and this is in accordance with the notion that shared neural representations including frontal cortical foci underlie mentalizing about self and others (Lombardo et al, 2010).…”

Effects of antipsychotics on insight in schizophrenia

“…The association between higher levels of negative symptoms and poor illness insight was also confirmed in the meta-analysis carried out by Mintz et al (2003). To further support our findings, other studies showed that poor illness insight is associated with cognitive impairment that is strongly related to prefrontal cortex dysfunction (Aleman et al, 2006;Shad et al, 2006;Orfei et al, 2013), a brain region linked to negative symptoms (Pratt et al, 2008).…”

Cognitive insight in schizophrenia patients and their biological parents: A pilot study

“…In other words, our results suggest that patients' capacity to reflect upon their thinking problems and to recognize the errors and correct them is not associated with their parents' capacity of reflection, and openness to feedback. This finding suggests that abnormal cognitive insight in schizophrenia patients seems better explained by cognitive factors and abnormal brain functioning existing in patients as demonstrated by previous studies (Buchy et al, 2010(Buchy et al, , 2014Orfei et al, 2013;Pu et al, 2013) rather than influenced by familial environment, measured here by daily contact with a parent. In addition, the comparable levels of cognitive insight were demonstrated by patients and their parents in our study.…”