Neuroimaging Unit, Technological Facilities,Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain.
CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Santander, Spain.
PLoS One. 2018 Jun 1;13(6):e0197715. doi: 10.1371/journal.pone.0197715. eCollection 2018.
Lack of insight is a core feature of non-affective psychosis and has been associated with poorer outcomes. Brain abnormalities underlying lack of insight have been suggested, mostly in the frontal lobe, although previous research showed mixed results. We used a voxel-based morphometry (VBM) analysis in 108 first-episode non-affective psychosis patients to investigate the pattern of brain structural abnormalities related to lack of insight. In addition, 77 healthy volunteers were compared with the patients classified as having poor and good insight. The shortened version of the Scale to Assess Unawareness of Mental Disorder was used to evaluate insight. Patients with poor insight (n = 68) compared with patients with good insight (n = 40) showed a single significant cluster (kc = 5834; PcFWE = 0.001) of reduced grey matter volume (GMV) in the right occipital lobe extending to its lateral and medial surfaces, the cuneus, and the middle temporal gyrus. In addition, GMV at this cluster showed a negative correlation with the score of the SUMD (r = -0.305; p = 0.001). When comparing patients with poor insight with healthy subjects overall reductions of GMV were found, mainly in frontal and occipital lobes. Hence, poor insight in non-affective psychosis seems to be associated with specific brain abnormalities in the right occipital and temporal cortical regions. Dysfunction in any combination of these areas may contribute to lack of insight in non-affective psychosis. Specifically, the 'right' hemisphere dysfunction underlying impaired insight in our sample is consistent with previously reported similarities between lack of insight in psychosis and anosognosia in neurological disorders.
缺乏洞察力是非情感性精神病的核心特征，与较差的预后相关。已经提出了缺乏洞察力的大脑异常基础，主要在额叶，尽管以前的研究结果喜忧参半。我们使用基于体素的形态计量学（VBM）分析了 108 例首发非情感性精神病患者，以研究与缺乏洞察力相关的大脑结构异常模式。此外，将 77 名健康志愿者与被分类为洞察力差和良好的患者进行了比较。使用简明精神病评定量表的简化版来评估洞察力。与洞察力良好的患者（n = 40）相比，洞察力差的患者（n = 68）表现出单个显著的灰质体积（GMV）减少簇（kc = 5834；PcFWE = 0.001），位于右侧枕叶，延伸至其外侧和内侧表面、楔叶和中颞回。此外，该簇的 GMV 与 SUMD 评分呈负相关（r = -0.305；p = 0.001）。当将洞察力差的患者与健康受试者进行总体比较时，发现 GMV 总体减少，主要在前额和枕叶。因此，非情感性精神病中的洞察力差似乎与右侧枕叶和颞叶皮质区域的特定大脑异常有关。这些区域中任何组合的功能障碍都可能导致非情感性精神病中的洞察力差。具体而言，我们样本中受损洞察力的“右”半球功能障碍与精神病中缺乏洞察力和神经障碍中的否认症之间的相似性一致。
