精神分裂症谱系障碍中的疾病洞察力受损与认知洞察力：静息态功能连接性
Impaired insight into illness and cognitive insight in schizophrenia spectrum disorders: resting state functional connectivity.
作者信息
Gerretsen Philip, Menon Mahesh, Mamo David C, Fervaha Gagan, Remington Gary, Pollock Bruce G, Graff-Guerrero Ariel
机构信息
Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Canada; Department of Psychiatry, University of Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada; Department of Psychiatry, University of British Columbia, Canada.
出版信息
Schizophr Res. 2014 Dec;160(1-3):43-50. doi: 10.1016/j.schres.2014.10.015. Epub 2014 Nov 8.
BACKGROUND
Impaired insight into illness (clinical insight) in schizophrenia has negative effects on treatment adherence and clinical outcomes. Schizophrenia is described as a disorder of disrupted brain connectivity. In line with this concept, resting state networks (RSNs) appear differentially affected in persons with schizophrenia. Therefore, impaired clinical, or the related construct of cognitive insight (which posits that impaired clinical insight is a function of metacognitive deficits), may reflect alterations in RSN functional connectivity (fc). Based on our previous research, which showed that impaired insight into illness was associated with increased left hemisphere volume relative to right, we hypothesized that impaired clinical insight would be associated with increased connectivity in the DMN with specific left hemisphere brain regions.
METHODS
Resting state MRI scans were acquired for participants with schizophrenia or schizoaffective disorder (n=20). Seed-to-voxel and ROI-to-ROI fc analyses were performed using the CONN-fMRI fc toolbox v13 for established RSNs. Clinical and cognitive insight were measured with the Schedule for the Assessment of Insight-Expanded Version and Beck Cognitive Insight Scale, respectively, and included as the regressors in fc analyses.
RESULTS
As hypothesized, impaired clinical insight was associated with increased connectivity in the default mode network (DMN) with the left angular gyrus, and also in the self-referential network (SRN) with the left insula. Cognitive insight was associated with increased connectivity in the dorsal attention network (DAN) with the right inferior frontal cortex (IFC) and left anterior cingulate cortex (ACC).
CONCLUSION
Increased connectivity in DMN and SRN with the left angular gyrus and insula, respectively, may represent neural correlates of impaired clinical insight in schizophrenia spectrum disorders, and is consistent with the literature attributing impaired insight to left hemisphere dominance. Increased connectivity in the DAN with the IFC and ACC in relation to cognitive insight may facilitate enhanced mental flexibility in this sample.
背景
精神分裂症患者对疾病的洞察力受损（临床洞察力）对治疗依从性和临床结果具有负面影响。精神分裂症被描述为一种大脑连接中断的疾病。与此概念一致，静息态网络（RSN）在精神分裂症患者中似乎受到不同程度的影响。因此，受损的临床洞察力或相关的认知洞察力结构（该结构认为受损的临床洞察力是元认知缺陷的一种表现）可能反映了RSN功能连接性（fc）的改变。基于我们之前的研究，该研究表明对疾病的洞察力受损与左半球相对于右半球体积增加有关，我们假设受损的临床洞察力将与默认模式网络（DMN）与特定左半球脑区的连接性增加有关。
方法
对患有精神分裂症或分裂情感性障碍的参与者（n = 20）进行静息态MRI扫描。使用CONN-fMRI fc工具箱v13对已建立的RSN进行种子点到体素和感兴趣区域到感兴趣区域的fc分析。分别使用洞察力扩展版评估量表和贝克认知洞察力量表测量临床和认知洞察力，并将其作为fc分析中的回归变量。
结果
如假设所示，受损的临床洞察力与默认模式网络（DMN）与左角回的连接性增加有关，也与自我参照网络（SRN）与左岛叶的连接性增加有关。认知洞察力与背侧注意网络（DAN）与右额下回（IFC）和左前扣带回皮质（ACC）的连接性增加有关。
结论
DMN和SRN分别与左角回和岛叶的连接性增加可能代表精神分裂症谱系障碍中受损临床洞察力的神经关联，并且与将洞察力受损归因于左半球优势的文献一致。DAN与IFC和ACC在认知洞察力方面的连接性增加可能有助于该样本中增强的心理灵活性。
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