Kim Jeong-Hee, Son Young-Don, Kim Hang-Keun, Kim Jong-Hoon
Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea.
Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Republic of Korea.
Neuropsychiatr Dis Treat. 2021 Oct 21;17:3195-3203. doi: 10.2147/NDT.S336126. eCollection 2021.
Previous studies suggested a link between serotonergic neurotransmission and impaired insight in schizophrenia. In this study, we examined the relationship between serotonin transporter (SERT) availability in regions of the prefrontal cortex (dorsolateral, ventrolateral, ventromedial, and orbitofrontal cortices) and insight deficits in antipsychotic-free patients with schizophrenia using high-resolution positron emission tomography (PET) with [C]DASB.
Nineteen patients underwent [C]DASB PET and 7-Tesla magnetic resonance imaging scans. To assess SERT availability, the binding potential with respect to non-displaceable compartment (BP) was derived using the simplified reference tissue model. Patients' level of insight was assessed using the Insight and Treatment Attitude Questionnaire (ITAQ). The relationship between ITAQ scores and [C]DASB BP values was examined using the region-of-interest (ROI)- and voxel-based analyses with relevant variables as covariates. The prefrontal cortex and its four subregions were selected as a priori ROIs since the prefrontal cortex has been implicated as the critical neuroanatomical substrate of impaired insight in schizophrenia.
The ROI-based analysis revealed that the ITAQ illness insight dimension had significant negative correlations with the [C]DASB BP in the left dorsolateral, left orbitofrontal, and bilateral ventrolateral prefrontal cortices. The ITAQ treatment insight dimension had significant negative correlations with the [C]DASB BP in the bilateral dorsolateral, left orbitofrontal, and bilateral ventrolateral prefrontal cortices. The ITAQ total score showed significant negative correlations with the [C]DASB BP in the bilateral prefrontal cortex and three subregions (dorsolateral, ventrolateral, and orbitofrontal cortices). A supplementary voxel-based analysis corroborated a significant negative association between the ITAQ score and the [C]DASB BP in the prefrontal cortices.
Our study provides in vivo evidence of significant negative correlations between insight deficits and prefrontal SERT availability in patients with schizophrenia, suggesting significant involvement of prefrontal serotonergic signaling in impaired insight, one of the core symptoms of schizophrenia.
先前的研究表明，血清素能神经传递与精神分裂症患者洞察力受损之间存在联系。在本研究中，我们使用[C]DASB进行高分辨率正电子发射断层扫描（PET），研究了未服用抗精神病药物的精神分裂症患者前额叶皮质区域（背外侧、腹外侧、腹内侧和眶额叶皮质）中血清素转运体（SERT）可用性与洞察力缺陷之间的关系。
19名患者接受了[C]DASB PET和7特斯拉磁共振成像扫描。为了评估SERT可用性，使用简化参考组织模型得出相对于不可置换区室的结合潜力（BP）。使用洞察力与治疗态度问卷（ITAQ）评估患者的洞察力水平。使用感兴趣区（ROI）和基于体素的分析，并将相关变量作为协变量，研究ITAQ评分与[C]DASB BP值之间的关系。由于前额叶皮质被认为是精神分裂症患者洞察力受损的关键神经解剖学底物，因此将前额叶皮质及其四个亚区域选为先验ROI。
基于ROI的分析显示，ITAQ疾病洞察力维度与左侧背外侧、左侧眶额叶和双侧腹外侧前额叶皮质中的[C]DASB BP呈显著负相关。ITAQ治疗洞察力维度与双侧背外侧、左侧眶额叶和双侧腹外侧前额叶皮质中的[C]DASB BP呈显著负相关。ITAQ总分与双侧前额叶皮质和三个亚区域（背外侧、腹外侧和眶额叶皮质）中的[C]DASB BP呈显著负相关。补充的基于体素的分析证实了ITAQ评分与前额叶皮质中[C]DASB BP之间存在显著负相关。
我们的研究提供了体内证据，表明精神分裂症患者的洞察力缺陷与前额叶SERT可用性之间存在显著负相关，这表明前额叶血清素能信号传导在洞察力受损（精神分裂症的核心症状之一）中起重要作用。
