Brain Imaging Group, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Verdun, Quebec, Canada H4H 1R3.
J Psychiatr Res. 2011 Jun;45(6):781-7. doi: 10.1016/j.jpsychires.2010.10.016. Epub 2010 Nov 19.
Through conceptualizing poor insight in psychotic disorders as a form of anosognosia (neurological deficit), frontal lobe dysfunction is often ascribed a vital role in its pathogenesis. Whether non-frontal brain regions are important for insight remains to be investigated. We used a multi-method approach to examine the neural morphometry of all cortical regions for insight in first-episode psychosis. Insight was rated in 79 people with a first-episode psychosis with the awareness of illness and awareness of treatment need and efficacy items of the Scale for assessment of Unawareness of Mental Disorder. Participants were assessed with magnetic resonance imaging. Cortical thickness analysis and voxel-based morphometry were utilized to identify the possible neuroanatomical basis of insight. Cortical thickness technique revealed that poorer awareness of illness was associated with regional thinning in left middle frontal and inferior temporal gyri. Poorer awareness of treatment need and efficacy was associated with cortical thinning in left medial frontal gyrus, precuneus and temporal gyri. No significant associations emerged between any insight measure and gray matter density using voxel-based morphometry. The results confirm predictions derived from the anosognosia/neuropsychology account and assert that regional thickness in frontal cortex is associated with awareness of illness in the early phase of psychosis. The fact that prominent thickness reductions emerged in non-frontal regions of the brain in parietal and temporal cortices for both awareness of illness and awareness of treatment need and efficacy suggests that the neural signature of insight involves a network of brain structures, and not only the frontal lobes as previously suggested.
通过将精神障碍中的洞察力不足概念化为一种认知障碍（神经缺陷），额叶功能障碍通常被认为在其发病机制中起着重要作用。非额叶脑区是否对洞察力很重要仍有待研究。我们使用多方法方法来检查首发精神病患者所有皮质区域的神经形态计量学与洞察力。使用精神障碍认识和治疗需求及疗效评估量表中的疾病认识和治疗需求及疗效评估量表对 79 名首发精神病患者的洞察力进行了评分。参与者接受了磁共振成像评估。皮质厚度分析和基于体素的形态计量学用于确定洞察力的可能神经解剖学基础。皮质厚度技术显示，较差的疾病认识与左中额回和下颞回的区域性变薄有关。较差的治疗需求和疗效认识与左内侧额回、楔前叶和颞回的皮质变薄有关。基于体素的形态计量学没有发现任何洞察力测量与灰质密度之间存在显著相关性。研究结果证实了来自认知障碍/神经心理学的预测，并断言在精神病早期，额叶皮质的区域厚度与疾病的认识有关。事实上，对于疾病的认识和治疗需求和疗效的认识，在大脑的非额叶区域，如顶叶和颞叶中都出现了明显的厚度减少，这表明洞察力的神经特征涉及到一个大脑结构网络，而不仅仅是以前所认为的额叶。
