Aix-Marseille University, Research Unit EA 3279, Marseille; Hôpital Sainte Marguerite, Département de psychiatrie, Marseille, France.
J Psychiatry Neurosci. 2012 Sep;37(5):297-304. doi: 10.1503/jpn.110125.
Preserved insight into illness has been suggested to be predictive of outcome in patients with schizophrenia. We aimed to investigate the functional substrate underlying preserved insight in these patients.
We recruited patients with paranoid schizophrenia and healthy controls matched for age and sex. Patients were grouped according to preserved or impaired insight into illness using the Scale to assess Unawareness of Mental Disorder (SUMD). Whole-brain technetium-99m ethyl cysteinate dimer single photon emission computed tomography regional cerebral blood flow was compared at the voxel level between the 2 groups using a statistical parametric map (voxel-level significance of p < 0.001, uncorrected; cluster level significance of p < 0.05, uncorrected).
We enrolled 31 right-handed patients with schizophrenia and 18 controls in our study. Twenty-one (67.7%) patients had preserved insight. The 2 groups did not differ significantly in demographic and clinical characteristics or in treatment. Compared with controls, the whole group of patients showed bilateral frontotemporal hypoperfusions, with no statistical difference between patients with preserved or impaired insight for these areas. Patients with preserved insight showed significantly increased perfusion of the bilateral precuneus relative to those with impaired insight.
Patients with subtypes other than paranoid schizophrenia have to be investigated to assess whether involvement of the precuneus in patients with preserved insight can be identified across the full spectrum of subtypes and symptoms of schizophrenia. Moreover, our study concerned only the central dimension (awareness of mental disorder) of 1 scale (SUMD); other dimensions of insight could be studied.
Our results show that schizophrenia with preserved insight is associated with greater perfusion of the precuneus, a brain area known to be involved in self- consciousness, suggesting a compensatory mechanism of fronto-temporal impairment.
有研究表明，精神病患者的病感认知保持完好与预后相关。本研究旨在探讨精神分裂症患者病感认知保持完好的功能基础。
我们招募了符合入组条件的偏执型精神分裂症患者和年龄、性别相匹配的健康对照者。使用精神疾病自知力评定量表（SUMD）评估患者的病感认知，根据患者病感认知是否完好分为病感认知完好组和病感认知缺失组。采用单光子发射计算机断层扫描技术（SPECT）检测患者脑血流灌注情况，使用统计参数图（SPM）比较两组患者的脑血流灌注差异（体素水平 p < 0.001，未校正；簇水平 p < 0.05，未校正）。
本研究共纳入 31 名右利手精神分裂症患者和 18 名健康对照者。21 名（67.7%）患者病感认知完好。两组患者在人口学资料、临床特征和治疗方案方面无显著差异。与对照组相比，所有患者均存在双侧额颞叶血流灌注减少，但病感认知完好组和缺失组之间无显著差异。与病感认知缺失组相比，病感认知完好组患者双侧楔前叶血流灌注增加。
本研究纳入的患者均为偏执型精神分裂症，需要进一步纳入其他亚型的患者，以评估在精神分裂症的所有亚型和症状中，是否都存在楔前叶参与病感认知完好的现象。此外，本研究仅关注了 SUMD 量表中心理疾病自知维度（意识心理疾病）的情况，其他自知维度也需要进一步研究。
本研究结果表明，精神分裂症患者的病感认知保持完好与楔前叶血流灌注增加有关，楔前叶是与自我意识有关的脑区，提示病感认知完好可能与额颞叶损伤有关。
