Zhang Liwen, Vander Meer Lisette, Opmeer Esther M, Marsman Jan-Bernard C, Ruhé Henricus G, Aleman André
University of Groningen, University Medical Center Groningen, Department of Neuroscience, NeuroImaging Center, Section Cognitive Neuropsychiatry, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Neuroscience, NeuroImaging Center, Section Cognitive Neuropsychiatry, Groningen, The Netherlands; Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; University of Groningen, Rob Giel Research Center, Groningen, The Netherlands.
Neuropsychologia. 2016 Dec;93(Pt A):97-105. doi: 10.1016/j.neuropsychologia.2016.09.020. Epub 2016 Sep 28.
Disturbances in implicit self-processing have been reported both in psychotic patients with bipolar disorder (BD) and schizophrenia. It remains unclear whether these two psychotic disorders show disturbed functional connectivity during explicit self-reflection, which is associated with social functioning and illness symptoms. Therefore, we investigated functional connectivity during explicit self-reflection in BD with past psychosis and schizophrenia. Twenty-three BD-patients, 17 schizophrenia-patients and 21 health controls (HC) performed a self-reflection task, including the conditions self-reflection, close other-reflection and semantic control. Functional connectivity was investigated with generalized psycho-physiological interaction (gPPI). During self-reflection compared to semantic, BD-patients had decreased connectivity between several cortical-midline structures (CMS) nodes (i.e., anterior cingulate cortex, ventromedial prefrontal cortex), the insula and the head of the caudate while HC showed increased connectivities. Schizophrenia-patients, during close other-reflection compared to semantic, demonstrated reduced ventral-anterior insula-precuneus/posterior cingulate cortex (PCC) functional connectivity, whereas this was increased in HC. There were no differences between BD and schizophrenia during self- and close other-reflection. We propose that decreased functional connectivity between the CMS nodes/insula and head of the caudate in BD-patients may imply a reduced involvement of the motivational system during self-reflection; and the reduced functional connectivity between the ventral-anterior insula and precuneus/PCC during close other-reflection in schizophrenia-patients may subserve difficulties in information integration of autobiographical memory and emotional awareness in relation to close others. These distinctive impaired patterns of functional connectivity in BD and schizophrenia (compared to HC) deserve further investigation to determine their robustness and associations with differences in clinical presentation.
双相情感障碍（BD）和精神分裂症等精神病患者均存在内隐自我加工障碍。目前尚不清楚这两种精神障碍在与社会功能和疾病症状相关的外显自我反思过程中是否存在功能连接紊乱。因此，我们研究了有过精神病发作的双相情感障碍患者和精神分裂症患者在进行外显自我反思时的功能连接情况。23名双相情感障碍患者、17名精神分裂症患者和21名健康对照者（HC）完成了一项自我反思任务，包括自我反思、亲密他人反思和语义控制条件。采用广义心理生理交互作用（gPPI）研究功能连接。与语义条件相比，在自我反思过程中，双相情感障碍患者的几个皮质中线结构（CMS）节点（即前扣带回皮质、腹内侧前额叶皮质）、脑岛和尾状核头部之间的连接性降低，而健康对照者则表现出连接性增加。与语义条件相比，在亲密他人反思过程中，精神分裂症患者的腹侧前脑岛-楔前叶/后扣带回皮质（PCC）功能连接性降低，而健康对照者则增加。在自我反思和亲密他人反思过程中，双相情感障碍患者和精神分裂症患者之间没有差异。我们认为，双相情感障碍患者的CMS节点/脑岛和尾状核头部之间功能连接性降低可能意味着自我反思过程中动机系统的参与减少；精神分裂症患者在亲密他人反思过程中腹侧前脑岛与楔前叶/PCC之间功能连接性降低可能与自传体记忆信息整合困难以及与亲密他人相关的情感意识有关。双相情感障碍和精神分裂症（与健康对照者相比）中这些独特的功能连接受损模式值得进一步研究，以确定其稳健性以及与临床表现差异的关联。
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