Shad Mujeeb U, Keshavan Matcheri S
Oregon Health & Science University, Portland, OR, United States.
Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, United States.
Schizophr Res. 2015 Jul;165(2-3):220-6. doi: 10.1016/j.schres.2015.04.021. Epub 2015 May 6.
Prior research has shown insight deficits in schizophrenia to be associated with specific neuroimaging changes (primarily structural) especially in the prefrontal sub-regions. However, little is known about the functional correlates of impaired insight. Seventeen patients with schizophrenia (mean age 40.0±10.3; M/F=14/3) underwent fMRI on a Philips 3.0 T Achieva system while performing on a self-awareness task containing self- vs. other-directed sentence stimuli. SPM5 was used to process the imaging data. Preprocessing consisted of realignment, coregistration, and normalization, and smoothing. A regression analysis was used to examine the relationship between brain activation in response to self-directed versus other-directed sentence stimuli and average scores on behavioral measures of awareness of symptoms and attribution of symptoms to the illness from Scale to Assess Unawareness of Mental Disorders. Family Wise Error correction was employed in the fMRI analysis. Average scores on awareness of symptoms (1=aware; 5=unaware) were associated with activation of multiple brain regions, including prefrontal, parietal and limbic areas as well as basal ganglia. However, average scores on correct attribution of symptoms (1=attribute; 5=misattribute) were associated with relatively more localized activation of prefrontal cortex and basal ganglia. These findings suggest that unawareness and misattribution of symptoms may have different neurobiological basis in schizophrenia. While symptom unawareness may be a function of a more complex brain network, symptom misattribution may be mediated by specific brain regions.
先前的研究表明，精神分裂症的洞察力缺陷与特定的神经影像学变化（主要是结构变化）有关，尤其是前额叶亚区域的变化。然而，对于洞察力受损的功能相关性却知之甚少。17名精神分裂症患者（平均年龄40.0±10.3岁；男/女=14/3）在飞利浦3.0T Achieva系统上接受功能磁共振成像（fMRI）检查，同时进行一项自我意识任务，该任务包含自我导向与他人导向的句子刺激。使用SPM5对成像数据进行处理。预处理包括重新对齐、配准、归一化和平滑处理。采用回归分析来检验在自我导向与他人导向的句子刺激下大脑激活与精神障碍自知力评估量表中症状意识和症状归因于疾病的行为测量平均得分之间的关系。在fMRI分析中采用了家族性错误校正。症状意识平均得分（1=自知；5=不自知）与多个脑区的激活有关，包括前额叶、顶叶、边缘叶区域以及基底神经节。然而，症状正确归因平均得分（1=归因正确；5=归因错误）与前额叶皮质和基底神经节相对更局限的激活有关。这些发现表明，在精神分裂症中，症状的不自知和错误归因可能具有不同的神经生物学基础。虽然症状不自知可能是一个更复杂脑网络的功能，但症状错误归因可能由特定脑区介导。
