Division of Psychiatry, University of Nottingham, A Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
Prog Neuropsychopharmacol Biol Psychiatry. 2011 Mar 30;35(2):523-7. doi: 10.1016/j.pnpbp.2010.12.008. Epub 2010 Dec 21.
Poor insight is one of the most prominent clinical features of psychosis. Loss of insight in schizophrenia is characterised by abnormalities in awareness and attribution of the origin of pathological mental phenomena. Converging lines of investigations suggest that in healthy individuals, right posterior insula plays an important role in awareness and self-attribution of mental phenomena, contributing to the emergence of a sense of self (Craig, 2002; Farrer et al., 2003). In addition, neuroimaging studies investigating brain morphometry in schizophrenia have consistently reported deficits in the structure of insula (Glahn et al., 2008; Ellison-Wright and Bullmore, 2010). In the present study, we investigated the relationship between the morphometry of posterior insula and degree of insight in a sample of 57 patients in a stable phase of illness using high resolution Magnetic Resonance Imaging. We measured the cortical surface area and local white matter volume of posterior insula. A significant inverse relationship was found between right posterior insular structure and degree of insight in schizophrenia. No such relationship was noted for left posterior insula. Our results highlight the importance of a predominantly right-sided network that includes posterior insula as the neural basis of insight. Abnormalities in interoceptive awareness and self-appraisal of emotional states may contribute to the loss of insight seen in schizophrenia.
洞察力差是精神病最突出的临床特征之一。精神分裂症患者的洞察力丧失的特征是对病理性精神现象的起源的认识和归因异常。越来越多的研究表明，在健康个体中，右侧后岛发挥着重要作用，对精神现象的认识和自我归因，有助于自我意识的出现（Craig，2002；Farrer 等人，2003）。此外，研究精神分裂症脑形态计量学的神经影像学研究一致报告了岛叶结构的缺陷（Glahn 等人，2008；Ellison-Wright 和 Bullmore，2010）。在本研究中，我们使用高分辨率磁共振成像对 57 名处于稳定期的患者样本进行了研究，探讨了后岛形态与洞察力程度之间的关系。我们测量了后岛的皮质表面积和局部白质体积。右侧后岛结构与精神分裂症患者洞察力程度呈显著负相关。左侧后岛则无此关系。我们的研究结果强调了以右侧后岛为主的网络作为洞察力的神经基础的重要性，该网络包括后岛。对内脏感觉的认识和对情绪状态的自我评估异常可能导致精神分裂症患者的洞察力丧失。
