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Sabbah SG, Northoff G. Global neural self-disturbance in schizophrenia: A systematic fMRI review. Schizophr Res 2024; 269:163-173. [PMID: 38820980 DOI: 10.1016/j.schres.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/04/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
There is a general consensus that schizophrenia (SZ) is characterized by major changes in the sense of self. Phenomenological studies suggest that these changes in the sense of self stem from a basic disturbance, hence the term 'basic self-disturbance'. While imaging studies demonstrate changes in various regions during self-focused tasks, the exact neural correlates of such basic self-disturbances remain unclear. If the self-disturbance is indeed basic and thereby underlies all other symptoms, one would expect it to be related to more global rather than local changes in the brain. Testing this hypothesis, we conducted a systematic review of fMRI studies on self in SZ. Our main findings are 1. Abnormal activity related to the self can be observed in a variety of different regions ranging from higher-order transmodal to lower-order unimodal regions, 2. These findings hold true across different tasks including self-reflection, self-referentiality, and self-agency, and 3. The global neural abnormalities related to the self in SZ correspond to all layers of the self, predominantly the mental and exteroceptive self. Such global neural disturbance of self converges well with the basic self-disturbance as described in phenomenology.
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Affiliation(s)
- Sami George Sabbah
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada; The Royal's Institute of Mental Health Research & University of Ottawa, Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada
| | - Georg Northoff
- The Royal's Institute of Mental Health Research & University of Ottawa, Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada
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2
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Gabbert T, Scheunemann J, Balzan RP, Doehring N, Elmers J, Moritz S. The contributions of risk-taking and impulsivity to jumping to conclusions in the psychosis spectrum. Schizophr Res 2024; 269:116-119. [PMID: 38763091 DOI: 10.1016/j.schres.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/21/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024]
Abstract
The jumping to conclusions (JTC) bias has been linked to the formation and maintenance of delusions across the psychosis spectrum. However, it remains unclear whether this bias reflects a primary cognitive deviation or is secondary to other cognitive processes. To this end, we investigated the relationship between JTC, risk-taking, impulsivity, and sensation seeking in individuals with psychotic-like experiences (PLEs) and controls. A large online community sample (N = 1151) completed the Fish Task as a measure for the JTC bias, as well as the Balloon Analogue Risk Task (BART) and the Brief Risk-Taking Propensity Scale (R-1) as measures of the propensity to take risks. Measures assessing impulsivity (Impulsive Behavior Scale-8, I-8), sensation seeking (Brief Sensation Seeking Scale, BSSS-4), and verbal intelligence (12-item Wordsum test) were also administered. We dichotomized the sample into extreme groups based on the positive subscale of the Community Assessment of Psychotic Experiences (CAPE). The present study confirms the existence of a JTC bias in psychosis-prone individuals. Of note, PLE-high individuals self-reported higher risk-taking propensity in the R-1 while at the same time displaying higher objective risk aversion in the BART relative to controls, speaking for a dissociation of subjective versus objective risk-taking behavior. PLE-high individuals showed deviances in other psychological traits (impulsivity, sensation seeking), but these were not associated with hasty decision-making as measured by JTC or risk-taking propensity. The results speak against impulsivity, sensation seeking, or verbal intelligence as driving mechanisms of JTC and risky decision-making.
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Affiliation(s)
- Tana Gabbert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ryan P Balzan
- Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | - Niels Doehring
- Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Germany
| | - Julia Elmers
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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3
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Park SW, Lee NY, Jeong HY, Chung IW, Kim YS, Jeong SH. The Mediating Role of Anxiety/Depression Between Auditory Verbal Hallucinations and the Level of Insight in Schizophrenia. Psychiatry Investig 2024; 21:403-414. [PMID: 38695048 PMCID: PMC11065532 DOI: 10.30773/pi.2023.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE Auditory verbal hallucination (AVH) is a prominent symptom of schizophrenia causing profound distress. The influence of AVHs on insight appears to be intricate and contingent on other accompanying symptoms. This study investigated the relationship and possible mediators between AVHs and the degree of insight. METHODS One hundred patients with schizophrenia participated in the study. Scales were used to evaluate the hallucinatory experience, the level of insight and other psychopathology. Complex relationships between variables were envisaged as a path model, whose initial structure was constructed via Gaussian Graphical Model. The validity of the final model was verified by Structural Equation Modeling. Separate analyses were performed for self-reported and clinician-rated data to enhance the model's robustness. RESULTS The greater the severity of the physical aspects of AVHs, the lower the level of insight observed. Conversely, higher emotional distress was associated with increased insight. These relationships were only evident in the self-reported results and were not reflected in the clinician-rated results. The path model suggested that the Positive and Negative Syndrome Scale (PANSS) anxiety/depression factor was an important mediator that linked the found association. Notably, the PANSS negative symptom had the opposite effect on the PANSS anxiety/depression factor and insight, making it difficult to define its overall effect. CONCLUSION The findings of this study provided one possible route for the positive influence of AVH experience in gaining insight. The mediating role of anxiety/depression modified by negative symptoms emerged as a valuable concept for clarifying this intricate relationship.
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Affiliation(s)
- Sang Won Park
- Inarae Psychiatry Clinic, Cheongju, Republic of Korea
| | - Nam Young Lee
- Department of Psychiatry, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Republic of Korea
| | - Hee Yeon Jeong
- Department of Psychiatry, SNU SMG Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Won Chung
- Department of Psychiatry and Yong-In Psychiatric Institute Yong-In Mental Hospital, Yongin, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Seong Hoon Jeong
- Department of Psychiatry, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
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Di Plinio S, Arnò S, Ebisch SJH. The state-trait sense of self inventory: A psychometric study of self-experience and its relation to psychosis-like manifestations. Conscious Cogn 2024; 118:103634. [PMID: 38215634 DOI: 10.1016/j.concog.2024.103634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/23/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024]
Abstract
The sense of self is a fundamental construct in the study of the mind, yet its psychological nature remains elusive. We introduce a novel 25-item inventory to investigate selfhood both as an enduring trait and a temporary state. We hypothesized two foundational aspects of the self: identity (related to self-referencing and continuity over time) and agency (the perception of controlling own's actions and thoughts). Results from two population studies highlight a singular self-trait factor combining agency and identity. In contrast, self-state measures revealed a bifactorial structure with a high-order factor and three lower-order subfactors: state-identity, state-agency, and state-technology. These factors were predictive of psychosis-like experiences, schizotypal traits, and hopelessness. Mediation analysis demonstrated that the negative association between the sense of self and hopelessness is mediated by depressive manifestations. Our research provides a tool to shed new light on the complexity of the sense of self and its mental health implications.
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Affiliation(s)
- Simone Di Plinio
- University G D'Annunzio of Chieti-Pescara, Department of Neuroscience, Imaging, and Clinical Science, Italy.
| | - Simone Arnò
- University G D'Annunzio of Chieti-Pescara, Department of Neuroscience, Imaging, and Clinical Science, Italy
| | - Sjoerd J H Ebisch
- University G D'Annunzio of Chieti-Pescara, Department of Neuroscience, Imaging, and Clinical Science, Italy
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Huang Y, Weng Y, Lan L, Zhu C, Shen T, Tang W, Lai HY. Insight in obsessive-compulsive disorder: conception, clinical characteristics, neuroimaging, and treatment. PSYCHORADIOLOGY 2023; 3:kkad025. [PMID: 38666121 PMCID: PMC10917385 DOI: 10.1093/psyrad/kkad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 04/28/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic disabling disease with often unsatisfactory therapeutic outcomes. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has broadened the diagnostic criteria for OCD, acknowledging that some OCD patients may lack insight into their symptoms. Previous studies have demonstrated that insight can impact therapeutic efficacy and prognosis, underscoring its importance in the treatment of mental disorders, including OCD. In recent years, there has been a growing interest in understanding the influence of insight on mental disorders, leading to advancements in related research. However, to the best of our knowledge, there is dearth of comprehensive reviews on the topic of insight in OCD. In this review article, we aim to fill this gap by providing a concise overview of the concept of insight and its multifaceted role in clinical characteristics, neuroimaging mechanisms, and treatment for OCD.
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Affiliation(s)
- Yueqi Huang
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Yazhu Weng
- Fourth Clinical School of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lan Lan
- Department of Psychology and Behavior Science, Zhejiang University, Hangzhou 310058, China
| | - Cheng Zhu
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Ting Shen
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia 19104, PA, USA
| | - Wenxin Tang
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Hsin-Yi Lai
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310029, China
- MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-machine Intelligence, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou 311121, China
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
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Rodolico A, Cutrufelli P, Brondino N, Caponnetto P, Catania G, Concerto C, Fusar-Poli L, Mineo L, Sturiale S, Signorelli MS, Petralia A. Mental Pain Correlates with Mind Wandering, Self-Reflection, and Insight in Individuals with Psychotic Disorders: A Cross-Sectional Study. Brain Sci 2023; 13:1557. [PMID: 38002517 PMCID: PMC10670292 DOI: 10.3390/brainsci13111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
Understanding the cognitive processes that contribute to mental pain in individuals with psychotic disorders is important for refining therapeutic strategies and improving patient outcomes. This study investigated the potential relationship between mental pain, mind wandering, and self-reflection and insight in individuals diagnosed with psychotic disorders. We included individuals diagnosed with a 'schizophrenia spectrum disorder' according to DSM-5 criteria. Patients in the study were between 18 and 65 years old, clinically stable, and able to provide informed consent. A total of 34 participants, comprising 25 males and 9 females with an average age of 41.5 years (SD 11.5) were evaluated. The Psychache Scale (PAS), the Mind Wandering Deliberate and Spontaneous Scale (MWDS), and the Self-Reflection and Insight Scale (SRIS) were administered. Statistical analyses involved Spearman's rho correlations, controlled for potential confounders with partial correlations, and mediation and moderation analyses to understand the indirect effects of MWDS and SRIS on PAS and their potential interplay. Key findings revealed direct correlations between PAS and MWDS and inverse correlations between PAS and SRIS. The mediation effects on the relationship between the predictors and PAS ranged from 9.22% to 49.8%. The largest statistically significant mediation effect was observed with the SRIS-I subscale, suggesting that the self-reflection and insight component may play a role in the impact of mind wandering on mental pain. No evidence was found to suggest that any of the variables could function as relationship moderators for PAS. The results underscore the likely benefits of interventions aimed at reducing mind wandering and enhancing self-reflection in psychotic patients (e.g., metacognitive therapy, mindfulness). Further research will be essential to elucidate the underlying mechanisms.
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Affiliation(s)
- Alessandro Rodolico
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
| | - Pierfelice Cutrufelli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Via Agostino Bassi 21, 27100 Pavia, Italy;
| | - Pasquale Caponnetto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
- Department of Educational Sciences, Section of Psychology, University of Catania, Via Teatro Greco 84, 95124 Catania, Italy
| | | | - Carmen Concerto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
| | - Laura Fusar-Poli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
- Department of Brain and Behavioral Sciences, University of Pavia, Via Agostino Bassi 21, 27100 Pavia, Italy;
| | - Ludovico Mineo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
| | - Serena Sturiale
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
| | - Maria Salvina Signorelli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
| | - Antonino Petralia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (A.R.); (P.C.); (P.C.); (L.F.-P.); (L.M.); (M.S.S.); (A.P.)
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7
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Stendardi D, De Luca F, Gambino S, Ciaramelli E. Retrograde amnesia abolishes the self-reference effect in anterograde memory. Exp Brain Res 2023:10.1007/s00221-023-06661-2. [PMID: 37450003 PMCID: PMC10386963 DOI: 10.1007/s00221-023-06661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Is retrograde amnesia associated with an ability to know who we are and imagine what we will be like in the future? To answer this question, we had S.G., a patient with focal retrograde amnesia following hypoxia, two brain-damaged (control) patients with no retrograde memory deficits, and healthy controls judge whether each of a series of trait adjectives was descriptive of their present self, future self, another person, and that person in the future, and later recognize studied traits among distractors. Healthy controls and control patients were more accurate in recognizing self-related compared to other-related traits, a phenomenon known as the self-reference effect (SRE). This held for both present and future self-views. By contrast, no evidence of (present or future) SRE was observed in SG, who concomitantly showed reduced certainty about his personality traits. These findings indicate that retrograde amnesia can weaken the self-schema and preclude its instantiation during self-related processing.
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Affiliation(s)
- Debora Stendardi
- Dipartimento di Psicologia, Università di Bologna, Bologna, Italy.
- Centro Studi e Ricerche in Neuroscienze Cognitive, Cesena, Italy.
| | - Flavia De Luca
- Centro Studi e Ricerche in Neuroscienze Cognitive, Cesena, Italy
- School of Psychology, University of Sussex, Falmer, BN1 9QH, UK
| | - Silvia Gambino
- Centro Studi e Ricerche in Neuroscienze Cognitive, Cesena, Italy
| | - Elisa Ciaramelli
- Dipartimento di Psicologia, Università di Bologna, Bologna, Italy
- Centro Studi e Ricerche in Neuroscienze Cognitive, Cesena, Italy
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8
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Gundogmus AG, Gerretsen P, Song J, Erdi Akdag F, Demirel C, Kokurcan A, Orsel S, Karadag H, Ozdel K. Insight in schizophrenia is associated with psychoeducation and social support: Testing a new more comprehensive insight tool in Turkish schizophrenia patients. PLoS One 2023; 18:e0288177. [PMID: 37418428 DOI: 10.1371/journal.pone.0288177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
Insight is a continuous and multidimensional phenomenon, including awareness of having an illness, the presence of symptoms and accurate symptom attribution, the need for treatment, and the consequences of treatment. Good insight into illness is associated with better adherence to treatment, better cognitive, psychosocial, and vocational functioning along with less symptom severity, decreased relapses, and hospitalizations. Several tools are used for insight evaluation. We recruited 90 patients diagnosed with schizophrenia and analyzed the forms of 58 patients. The patients completed the VAGUS-SR (self-rated), Beck Cognitive Insight Scale, Knowledge About Schizophrenia Questionnaire, and Multidimensional Scale of Perceived Social Support (MSPSS). Clinicians performed a mental status examination and completed the Positive and Negative Syndrome Scale, Schedule for the Assessment of Insight, VAGUS-CR (clinician-rated), Calgary Depression Scale for Schizophrenia, and Clinical Global Impressions. We found that the level of insight evaluated using the VAGUS forms increased with knowledge regarding schizophrenia. Upon investigating the relationship between perceived social support and insight, we identified a relationship between VAGUS-CR and only significant other subscales of MSPSS, and between one of the VAGUS-SR scale sub-dimensions and significant other and total scores of MSPSS. Our findings also suggest that the VAGUS-SR and VAGUS-CR scales can be used to evaluate insight in Turkish populations. The positive relationship between perceived social support and insight emphasizes the importance of increasing social support through interventions aimed at improving insight. Our data also highlighted the value of psychoeducational studies in this patient group. Considering the multidimensional effects of insight on patients with schizophrenia, it would be beneficial to use scales such as VAGUS, which allow the insights of individuals to be evaluated in detail by both the clinician and the patient.
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Affiliation(s)
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jianmeng Song
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Funda Erdi Akdag
- Department of Psychiatry, Bergama Necla-Mithat Ozture State Hospital, Izmir, Turkey
| | - Cagri Demirel
- Department of Psychiatry, Ankara Etlik City Hospital, Ankara, Turkey
| | - Ahmet Kokurcan
- Department of Psychiatry, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Sibel Orsel
- Department of Psychiatry, Ankara Etlik City Hospital, Ankara, Turkey
| | - Hasan Karadag
- Department of Psychiatry, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Kadir Ozdel
- Department of Psychiatry, Ankara Etlik City Hospital, Ankara, Turkey
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Kim J, Song J, Kambari Y, Plitman E, Shah P, Iwata Y, Caravaggio F, Brown EE, Nakajima S, Chakravarty MM, De Luca V, Remington G, Graff-Guerrero A, Gerretsen P. Cortical thinning in relation to impaired insight into illness in patients with treatment resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:27. [PMID: 37120642 PMCID: PMC10148890 DOI: 10.1038/s41537-023-00347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/12/2023] [Indexed: 05/01/2023]
Abstract
Impaired insight into illness is a common element of schizophrenia that contributes to treatment nonadherence and negative clinical outcomes. Previous studies suggest that impaired insight may arise from brain abnormalities. However, interpretations of these findings are limited due to small sample sizes and inclusion of patients with a narrow range of illness severity and insight deficits. In a large sample of patients with schizophrenia, the majority of which were designated as treatment-resistant, we investigated the associations between impaired insight and cortical thickness and subcortical volumes. A total of 94 adult participants with a schizophrenia spectrum disorder were included. Fifty-six patients (60%) had treatment-resistant schizophrenia. The core domains of insight were assessed with the VAGUS insight into psychosis scale. We obtained 3T MRI T1-weighted images, which were analysed using CIVET and MAGeT-Brain. Whole-brain vertex-wise analyses revealed impaired insight, as measured by VAGUS average scores, was related to cortical thinning in left frontotemporoparietal regions. The same analysis in treatment-resistant patients showed thinning in the same regions, even after controlling for age, sex, illness severity, and chlorpromazine antipsychotic dose equivalents. No association was found in non-treatment-resistant patients. Region-of-interest analyses revealed impaired general illness awareness was associated with cortical thinning in the left supramarginal gyrus when controlling for covariates. Reduced right and left thalamic volumes were associated with VAGUS symptom attribution and awareness of negative consequences subscale scores, respectively, but not after correction for multiple testing. Our results suggest impaired insight into illness is related to cortical thinning in left frontotemporoparietal regions in patients with schizophrenia, particularly those with treatment resistance where insight deficits may be more chronic.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jianmeng Song
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yasaman Kambari
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Eric Plitman
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yusuke Iwata
- University of Yamanashi, Faculty of Medicine, Department of Neuropsychiatry, Yamanashi, Japan
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eric E Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Schizophrenia Division, CAMH, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada
- Schizophrenia Division, CAMH, Toronto, ON, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada.
- Schizophrenia Division, CAMH, Toronto, ON, Canada.
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10
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Amador X. Denial of anosognosia in schizophrenia. Schizophr Res 2023; 252:242-243. [PMID: 36682314 DOI: 10.1016/j.schres.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Xavier Amador
- Psychiatry and Psychology, The University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, United States.
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11
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Zhang S, Li W, Xiang Q, Kuai X, Zhuo K, Wang J, Xu Y, Li Y, Liu D. Longitudinal alterations of modular functional-metabolic coupling in first-episode schizophrenia. J Psychiatr Res 2022; 156:705-712. [PMID: 36410309 DOI: 10.1016/j.jpsychires.2022.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/16/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
Altered network organization and aberrant neurometabolic levels have been associated with schizophrenia. However, modular alterations of functional-neurometabolic coupling in various stages of schizophrenia remain unclear. This longitudinal study enrolled 34 drug-naïve first-episode schizophrenia (FES) patients and 30 healthy controls (HC). The FES patients underwent resting-state functional magnetic resonance imaging (rs-fMRI) and proton magnetic resonance spectroscopy (1H-MRS) at baseline, 2 months, and 6 months of treatment. For 1H-MRS, the concentrations of γ-aminobutyric acid (GABA), N-acetylaspartate (NAA) and glutamate + glutamine in the ventromedial prefrontal cortex region were measured. A graph theoretical approach was applied for functional connectivity-based modular parcellation. We found that intra-default mode network (DMN) connectivity, inter-modular connectivity between the DMN and the hippocampus, and inter-modular connectivity between the DMN and the frontoparietal module were significantly different across 6-month treatment in the FES patients. The inter-module connectivity of the DMN and hippocampus correlated positively with NAA concentration in the HC group, while this correlation was absent in FES patients. This exploratory study suggests an altered modular connectivity in association with neurometabolite concentrations in FES patients and provides insights into multimodal neuroimaging biomarkers in schizophrenia. Future studies with larger sample sizes are needed to consolidate our findings.
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Affiliation(s)
- Suzhen Zhang
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China; First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenli Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qiong Xiang
- First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinping Kuai
- First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiming Zhuo
- First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinhong Wang
- Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifeng Xu
- First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Mental Health, Fudan University, Shanghai, China
| | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Dengtang Liu
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China; First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Mental Health, Fudan University, Shanghai, China.
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12
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Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis. SCHIZOPHRENIA 2022; 8:74. [PMID: 36114173 PMCID: PMC9481626 DOI: 10.1038/s41537-022-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.
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13
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Self-Enhancement and the Medial Prefrontal Cortex: The Convergence of Clinical and Experimental Findings. Brain Sci 2022; 12:brainsci12081103. [PMID: 36009167 PMCID: PMC9405933 DOI: 10.3390/brainsci12081103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
Self-enhancement (SE) is often overlooked as a fundamental cognitive ability mediated via the Prefrontal Cortex (PFC). Here, we present research that establishes the relationship between the PFC, SE, and the potential evolved beneficial mechanisms. Specifically, we believe there is now enough evidence to speculate that SE exists to provide significant benefits and should be considered a normal aspect of the self. Whatever the metabolic or social cost, the upside of SE is great enough that it is a core and fundamental psychological construct. Furthermore, though entirely theoretical, we suggest that a critical reason the PFC has evolved so significantly in Homo sapiens is to, in part, sustain SE. We, therefore, elaborate on its proximate and ultimate mechanisms.
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14
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Salgado-Pineda P, Fuentes-Claramonte P, Spanlang B, Pomes A, Landin-Romero R, Portillo F, Bosque C, Franquelo JC, Teixido C, Sarró S, Salvador R, Pomarol-Clotet E. Neural correlates of disturbance in the sense of agency in schizophrenia: An fMRI study using the 'enfacement' paradigm. Schizophr Res 2022; 243:395-401. [PMID: 34218983 DOI: 10.1016/j.schres.2021.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/26/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
An altered sense of self-awareness and agency has been proposed to underlie symptoms of schizophrenia. In this study, we used the enfacement illusion paradigm - in which perception of another person's face leads to changes in perception of one's own peri-personal space - to examine the brain correlates of the sense of agency and its potential disruption in schizophrenia. Thirty-three schizophrenic patients and 27 healthy controls underwent fMRI scanning during performance of a task designed to elicit the enfacement illusion. Activations were examined using whole-brain analysis and also in an a priori identified region of interest (ROI) in the temporoparietal junction (TPJ), a region that has been described as involved in self/other differentiation and sense of agency. Both groups showed a pattern of cortical activation involving the pre and postcentral cortex, Rolandic operculum, insula, parietal, temporal and occipital cortex bilaterally as well as TPJ (but only right-side in patients). Examination of the TPJ ROI revealed significantly reduced activation on the left in the patients that was associated with poorer insight. The findings suggest brain functional abnormality in schizophrenia related to the formation or maintenance of processes related to self and/or agency. Decreased function in the TPJ may have a role in the impaired insight seen in patients with the disorder.
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Affiliation(s)
- Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
| | - P Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Bernhard Spanlang
- Event Lab, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institute of Neuroscience of the University of Barcelona, Barcelona, Spain; Virtual Bodyworks S.L., Barcelona, Spain
| | - Ausias Pomes
- Event Lab, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Accenture, Barcelona, Spain
| | - Ramón Landin-Romero
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; The University of Sydney, Brain & Mind Centre, Sydney, NSW, Australia; Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney,NSW, Australia
| | | | - Clara Bosque
- Benito Menni Complex Assistencial en Salut Mental, Barcelona, Spain
| | | | - Cristina Teixido
- Hospital Mare de Dèu de la Mercé, Unitat Polivalent Barcelona Nord, Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
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15
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Wu Z, Jiang Z, Wang Z, Ji Y, Wang F, Ross B, Sun X, Liu Z, Long Y. Association Between Wisdom and Psychotic-Like Experiences in the General Population: A Cross-Sectional Study. Front Psychiatry 2022; 13:814242. [PMID: 35509888 PMCID: PMC9058059 DOI: 10.3389/fpsyt.2022.814242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Wisdom has been empirically researched as a complex psychological characteristic that is associated with many mental health outcomes. However, its association with psychotic-like experiences (PLEs) remains unclear. This is the first work to assess wisdom, explore its association with PLEs, and test its moderating effect on the relation between the frequency of PLEs and their associated distress in the general population. METHODS From January 29th to February 5th, 2021, our online self-administered survey recruited 927 participants (ages 14 to 65) from thirteen Chinese provinces. Convenience sampling was employed. We measured wisdom with the 12-item three-dimensional wisdom scale (3D-WS-12) and PLEs with the 15-item positive subscale of the Community Assessment of Psychic Experiences (CAPE-P15). RESULTS Using the cut-off value of 1.47 in the mean frequency score, we divided our participants into high-PLEs group (188, 22.1%) and low-PLEs group (663, 77.9%). Three-dimensional wisdom score was decreased in the high-PLEs group compared to the low-PLEs group (Kruskal-Wallis t = 59.9, p < 0.001). Wisdom was associated with less frequent PLEs (Spearman's rho = -0.21, p < 0.01) and lower distress related to PLEs (Spearman's rho = -0.28) in the high-PLEs group (all above p < 0.001), which were replicated in the low-PLEs group. Notably, wisdom significantly attenuated the distress associated with PLEs [coefficient = -0.018, Bootstrap 95% CI (-0.029, -0.008)], but only in the low-PLEs group. CONCLUSION Our results implicated that wisdom could protect individuals from distressful subclinical psychotic symptoms and wiser individuals have better general mental health.
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Affiliation(s)
- Zhipeng Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Zhengqian Jiang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhipeng Wang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuqiao Ji
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Feiwen Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Brendan Ross
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Xiaoqi Sun
- Department of Psychology, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
| | - Zhening Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Yicheng Long
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
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16
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Chang YC, Hsing YC. Emotion-infused deep neural network for emotionally resonant conversation. Appl Soft Comput 2021. [DOI: 10.1016/j.asoc.2021.107861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Mäntylä T, Kieseppä T, Suvisaari J, Raij TT. Delineating insight-processing-related functional activations in the precuneus in first-episode psychosis patients. Psychiatry Res Neuroimaging 2021; 317:111347. [PMID: 34403968 DOI: 10.1016/j.pscychresns.2021.111347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/19/2021] [Accepted: 04/18/2021] [Indexed: 11/24/2022]
Abstract
Poor insight is a central characteristic of psychotic disorders, and it has been suggested to result from a general dysfunction in self-reflection. However, brain processing of clinical insight and more general self-reflection has not been directly compared. We compared tasks on (1) self-reflection on psychosis-related mental functioning (clinical insight, in patients only), (2) self-reflection on mental functioning unrelated to psychosis (general metacognition), and (3) semantic control during blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging with 19 first-episode psychosis patients and 24 control participants. Arterial-spin-labeling (ASL) images were collected at rest. Clinical insight was evaluated with the Schedule for the Assessment of Insight. In patients, posterosuperior precuneus showed stronger activation during the insight task than during the semantic control task, while anteroinferior precuneus and posterior cingulate cortex (PCC) showed stronger activation during the insight task than during the general metacognition task. No significant group differences in brain activation emerged during the general metacognition task. Although the BOLD measures did not correlate with clinical insight measures, ASL-measured cerebral blood flow (CBF) values did correlate when extracted from the task-selective precuneus/PCC areas: higher CBF correlated with higher clinical insight scores. These results suggest that regions in the posteromedial cortex are selective for clinical insight.
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Affiliation(s)
- Teemu Mäntylä
- Mental Health Team, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; P.O. Box 13000, FI-00076 Aalto, Finland; Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, FIN-00014 Helsinki, Finland.
| | - Tuula Kieseppä
- Mental Health Team, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland; Department of Psychiatry, Helsinki University and Helsinki University Hospital, P.O. Box 590, FIN-00029, Helsinki, Finland.
| | - Jaana Suvisaari
- Mental Health Team, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Tuukka T Raij
- Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; P.O. Box 13000, FI-00076 Aalto, Finland; Department of Psychiatry, Helsinki University and Helsinki University Hospital, P.O. Box 590, FIN-00029, Helsinki, Finland.
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18
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Underwood R, Mason L, O'Daly O, Dalton J, Simmons A, Barker GJ, Peters E, Kumari V. You read my mind: fMRI markers of threatening appraisals in people with persistent psychotic experiences. NPJ SCHIZOPHRENIA 2021; 7:49. [PMID: 34635671 PMCID: PMC8505497 DOI: 10.1038/s41537-021-00173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 08/06/2021] [Indexed: 11/09/2022]
Abstract
Anomalous perceptual experiences are relatively common in the general population. Evidence indicates that the key to distinguishing individuals with persistent psychotic experiences (PEs) with a need for care from those without is how they appraise their anomalous experiences. Here, we aimed to characterise the neural circuits underlying threatening and non-threatening appraisals in people with and without a need for care for PEs, respectively. A total of 48 participants, consisting of patients with psychosis spectrum disorder (clinical group, n = 16), non-need-for-care participants with PEs (non-clinical group, n = 16), and no-PE healthy control participants (n = 16), underwent functional magnetic resonance imaging while completing the Telepath task, designed to induce an anomalous perceptual experience. Appraisals of the anomalous perceptual experiences were examined, as well as functional brain responses during this window, for significant group differences. We also examined whether activation co-varied with the subjective threat appraisals reported in-task by participants. The clinical group reported elevated subjective threat appraisals compared to both the non-clinical and no-PE control groups, with no differences between the two non-clinical groups. This pattern of results was accompanied by reduced activation in the superior and inferior frontal gyri in the clinical group as compared to the non-clinical and control groups. Precuneus activation scaled with threat appraisals reported in-task. Resilience in the context of persistent anomalous experiences may be explained by intact functioning of fronto-parietal regions, and may correspond to the ability to contextualise and flexibly evaluate psychotic experiences.
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Affiliation(s)
- Raphael Underwood
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK. .,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK.
| | - Liam Mason
- University College London, Max Planck Centre for Computational Psychiatry and Ageing Research, London, UK.,University College London, Research Department of Clinical, Educational and Health Psychology, London, UK
| | - Owen O'Daly
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Jeffrey Dalton
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Andrew Simmons
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Gareth J Barker
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Emmanuelle Peters
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Veena Kumari
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK.,Brunel University London, College of Health, Medicine and Life Sciences, Centre for Cognitive Neuroscience, Uxbridge, UK
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19
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Jeong H, Lee SH, Lee SY, Kim J, Kim G, Kwon H, Waterreus A, Yim HW. Validation of the Korean Version of the Psychosis Screener to Identify Patients With Psychosis. Psychiatry Investig 2021; 18:736-742. [PMID: 34333895 PMCID: PMC8390939 DOI: 10.30773/pi.2020.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/30/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to validate the Korean version of a short screening tool for psychosis as the first stage in finding undiagnosed psychosis in the community. METHODS The sample contained 126 consecutive psychiatric outpatients in National Medical Center, Seoul, Korea, between July 20 and July 22, 2020. The Psychosis Screener (PS) comprises 7 items covering psychotic symptoms. The presence of each psychotic symptom was determined by a trained mental health professional and coded "yes" or "no." Two psychiatrists reviewed the medical records independently and extracted the ICD-10-based diagnoses. Any differences between the two clinicians were resolved by consensus, and the agreed diagnosis was used as a gold standard in the study. RESULTS Among 126 psychiatric outpatients who were enrolled in a consecutive manner during the study period, the proportion of psychosis was 15.1%. The PS showed 78.9% sensitivity and 72.0% specificity when the optimal cut-off was 2, indicating that a score of 2 or more on the screener identified a likely case of psychosis. The area under the curve for the PS was 0.78 (95% CI: 0.67-0.87). CONCLUSION The Korean version of the PS has an ability to discriminate between those who meet the diagnostic criteria for psychosis and those who do not in a high-prevalence group.
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Affiliation(s)
- Hyunsuk Jeong
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Seung-Yup Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jangrae Kim
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Gyeongmin Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hanseul Kwon
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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20
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Larabi DI, Marsman JBC, Aleman A, Tijms BM, Opmeer EM, Pijnenborg GHM, van der Meer L, van Tol MJ, Ćurčić-Blake B. Insight does not come at random: Individual gray matter networks relate to clinical and cognitive insight in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110251. [PMID: 33493651 DOI: 10.1016/j.pnpbp.2021.110251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/11/2020] [Accepted: 01/13/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Impaired clinical and cognitive insight are prevalent in schizophrenia and relate to poorer outcome. Good insight has been suggested to depend on social cognitive and metacognitive abilities requiring global integration of brain signals. Impaired insight has been related to numerous focal gray matter (GM) abnormalities distributed across the brain suggesting dysconnectivity at the global level. In this study, we test whether global integration deficiencies reflected in gray matter network connectivity underlie individual variations in insight. METHODS We used graph theory to examine whether individual GM-network metrics relate to insight in patients with a psychotic disorder (n = 114). Clinical insight was measured with the Schedule for the Assessment of Insight-Expanded and item G12 of the Positive and Negative Syndrome Scale, and cognitive insight with the Beck Cognitive Insight Scale. Individual GM-similarity networks were created from GM-segmentations of T1-weighted MRI-scans. Graph metrics were calculated using the Brain Connectivity Toolbox. RESULTS Networks of schizophrenia patients with poorer clinical insight showed less segregation (i.e. clustering coefficient) into specialized subnetworks at the global level. Schizophrenia patients with poorer cognitive insight showed both less segregation and higher connectedness (i.e. lower path length) of their brain networks, making their network topology more "random". CONCLUSIONS Our findings suggest less segregated processing of information in patients with poorer cognitive and clinical insight, in addition to higher connectedness in patients with poorer cognitive insight. The ability to take a critical perspective on one's symptoms (clinical insight) or views (cognitive insight) might depend especially on segregated specialized processing within distinct subnetworks.
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Affiliation(s)
- Daouia I Larabi
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Wilhelm-Johnen-Straße, 52428 Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Gurlittstraße 55, 40223 Düsseldorf, Germany.
| | - Jan-Bernard C Marsman
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands; Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - Betty M Tijms
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Esther M Opmeer
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands; Department of Health and Welfare, University of Applied Sciences Windesheim, Campus 2, 8017 CA Zwolle, the Netherlands
| | - Gerdina H M Pijnenborg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - Lisette van der Meer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Department of Psychiatric Rehabilitation, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE Zuidlaren, the Netherlands; Rob Giel Research Center, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Marie-José van Tol
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands
| | - Branislava Ćurčić-Blake
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands
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21
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Shan X, Liao R, Ou Y, Pan P, Ding Y, Liu F, Chen J, Zhao J, Guo W, He Y. Increased regional homogeneity modulated by metacognitive training predicts therapeutic efficacy in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:783-798. [PMID: 32215727 PMCID: PMC8119286 DOI: 10.1007/s00406-020-01119-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/11/2020] [Indexed: 02/07/2023]
Abstract
Previous studies have demonstrated the efficacy of metacognitive training (MCT) in schizophrenia. However, the underlying mechanisms related to therapeutic effect of MCT remain unknown. The present study explored the treatment effects of MCT on brain regional neural activity using regional homogeneity (ReHo) and whether these regions' activities could predict individual treatment response in schizophrenia. Forty-one patients with schizophrenia and 20 healthy controls were scanned using resting-state functional magnetic resonance imaging. Patients were randomly divided into drug therapy (DT) and drug plus psychotherapy (DPP) groups. The DT group received only olanzapine treatment, whereas the DPP group received olanzapine and MCT for 8 weeks. The results revealed that ReHo in the right precuneus, left superior medial prefrontal cortex (MPFC), right parahippocampal gyrus and left rectus was significantly increased in the DPP group after 8 weeks of treatment. Patients in the DT group showed significantly increased ReHo in the left ventral MPFC/anterior cingulate cortex (ACC), left superior MPFC/middle frontal gyrus (MFG), left precuneus, right rectus and left MFG, and significantly decreased ReHo in the bilateral cerebellum VIII and left inferior occipital gyrus (IOG) after treatment. Support vector regression analyses showed that high ReHo levels at baseline in the right precuneus and left superior MPFC could predict symptomatic improvement of Positive and Negative Syndrome Scale (PANSS) after 8 weeks of DPP treatment. Moreover, high ReHo levels at baseline and alterations of ReHo in the left ventral MPFC/ACC could predict symptomatic improvement of PANSS after 8 weeks of DT treatment. This study suggests that MCT is associated with the modulation of ReHo in schizophrenia. ReHo in the right precuneus and left superior MPFC may predict individual therapeutic response for MCT in patients with schizophrenia.
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Affiliation(s)
- Xiaoxiao Shan
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Rongyuan Liao
- grid.412990.70000 0004 1808 322XThe Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan China
| | - Yangpan Ou
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Pan Pan
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Yudan Ding
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Feng Liu
- grid.412645.00000 0004 1757 9434Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300000 China
| | - Jindong Chen
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Jingping Zhao
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China. .,National Clinical Research Center on Mental Disorders, Changsha, 410011, Hunan, China.
| | - Yiqun He
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China.
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22
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He H, Luo C, He C, He M, Du J, Biswal BB, Yao D, Yao G, Duan M. Altered Spatial Organization of Dynamic Functional Network Associates With Deficient Sensory and Perceptual Network in Schizophrenia. Front Psychiatry 2021; 12:687580. [PMID: 34421674 PMCID: PMC8374440 DOI: 10.3389/fpsyt.2021.687580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/08/2021] [Indexed: 12/31/2022] Open
Abstract
Schizophrenia is currently thought as a disorder with dysfunctional communication within and between sensory and cognitive processes. It has been hypothesized that these deficits mediate heterogeneous and comprehensive schizophrenia symptomatology. In this study, we investigated as to how the abnormal dynamic functional architecture of sensory and cognitive networks may contribute to these symptoms in schizophrenia. We calculated a sliding-window-based dynamic functional connectivity strength (FCS) and amplitude of low-frequency fluctuation (ALFF) maps. Then, using group-independent component analysis, we characterized spatial organization of dynamic functional network (sDFN) across various time windows. The spatial architectures of FCS/ALFF-sDFN were similar with traditional resting-state functional networks and cannot be accounted by length of the sliding window. Moreover, schizophrenic subjects demonstrated reduced dynamic functional connectivity (dFC) within sensory and perceptual sDFNs, as well as decreased connectivity between these sDFNs and high-order frontal sDFNs. The severity of patients' positive and total symptoms was related to these abnormal dFCs. Our findings revealed that the sDFN during rest might form the intrinsic functional architecture and functional changes associated with psychotic symptom deficit. Our results support the hypothesis that the dynamic functional network may influence the aberrant sensory and cognitive function in schizophrenia, further highlighting that targeting perceptual deficits could extend our understanding of the pathophysiology of schizophrenia.
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Affiliation(s)
- Hui He
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu, China
| | - Chuan He
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu, China
| | - Manxi He
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jing Du
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Bharat B Biswal
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu, China
| | - Gang Yao
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingjun Duan
- The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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23
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Collin G, Bauer CCC, Anteraper SA, Gabrieli JDE, Molokotos E, Mesholam-Gately R, Thermenos HW, Seidman LJ, Keshavan MS, Shenton ME, Whitfield-Gabrieli S. Hyperactivation of Posterior Default Mode Network During Self-Referential Processing in Children at Familial High-Risk for Psychosis. Front Psychiatry 2021; 12:613142. [PMID: 33633608 PMCID: PMC7900488 DOI: 10.3389/fpsyt.2021.613142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022] Open
Abstract
Patients with schizophrenia spectrum disorders show disturbances in self-referential processing and associated neural circuits including the default mode network (DMN). These disturbances may precede the onset of psychosis and may underlie early social and emotional problems. In this study, we examined self-referential processing in a group of children (7-12 years) at familial high risk (FHR) for psychosis (N = 17), compared to an age and sex-matched group of healthy control (HC) children (N = 20). The participants were presented with a list of adjectives and asked to indicate whether or not the adjectives described them (self-reference condition) and whether the adjectives described a good or bad trait (semantic condition). Three participants were excluded due to chance-level performance on the semantic task, leaving N = 15 FHR and N = 19 HC for final analysis. Functional MRI (fMRI) was used to measure brain activation during self-referential vs. semantic processing. Internalizing and externalizing problems were assessed with the Child Behavior Checklist (CBCL). Evaluating main effects of task (self > semantic) showed activation of medial prefrontal cortex in HC and precuneus/posterior cingulate cortex (PCC) in FHR. Group-comparison yielded significant results for the FHR > HC contrast, showing two clusters of hyperactivation in precuneus/ PCC (p = 0.004) and anterior cerebellum / temporo-occipital cortex (p = 0.009). Greater precuneus/PCC activation was found to correlate with greater CBCL internalizing (r = 0.60, p = 0.032) and total (r = 0.69, p = 0.009) problems. In all, this study shows hyperactivity of posterior DMN during self-referential processing in pre-adolescent FHR children. This finding posits DMN-related disturbances in self-processing as a developmental brain abnormality associated with familial risk factors that predates not just psychosis, but also the prodromal stage. Moreover, our results suggest that early disturbances in self-referential processing may be related to internalizing problems in at-risk children.
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Affiliation(s)
- Guusje Collin
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, Netherlands
| | - Clemens C C Bauer
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
| | - Sheeba Arnold Anteraper
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
| | - John D E Gabrieli
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Elena Molokotos
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Raquelle Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Heidi W Thermenos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
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24
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van der Meer L, Jonker T, Wadman H, Wunderink C, van Weeghel J, Pijnenborg GHM, van Setten ERH. Targeting Personal Recovery of People With Complex Mental Health Needs: The Development of a Psychosocial Intervention Through User-Centered Design. Front Psychiatry 2021; 12:635514. [PMID: 33897494 PMCID: PMC8060492 DOI: 10.3389/fpsyt.2021.635514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 12/21/2022] Open
Abstract
Long-term admissions in psychiatric facilities often result in a gradual erosion of the identity of people diagnosed with severe mental illnesses (SMIs) into merely "patient." Moreover, experiences of loss often reduced people's sense of purpose. Although regaining a multidimensional identity and a sense of purpose are essential for personal recovery, few interventions specifically address this, while at the same time take people's often considerable cognitive and communicative disabilities into consideration. This study describes the development process of a new intervention through user-centered design (UCD). UCD is an iterative process in which a product (in this case, an intervention) is developed in close cooperation with future users, such that the final product matches their needs. The design process included three phases: an analysis, design, and evaluation phase. In the analysis phase, the "problem" was defined, users' needs were identified, and design criteria were established. In the design phase, the collected information served as input to create a testable prototype using a process of design and redesign, in close collaboration with service users and other stakeholders. This resulted in an intervention entitled "This is Me" (TiM) in which service users, together with a self-chosen teammate, actively engage in new experiences on which they are prompted to reflect. Finally, in the evaluation phase, TiM was implemented and evaluated in a real-life setting. In a small feasibility pilot, we found indications that some people indeed demonstrated increased reflection on their identity during the intervention. Furthermore, TiM seemed to benefit the relationship between the service users and the mental health professionals with whom they underwent the experiences. The pilot also revealed some aspects of the (implementation of) TiM that can be improved. Overall, we conclude that UCD is a useful method for the development of a new psychosocial intervention. The method additionally increased our knowledge about necessary factors in targeting personal recovery for people with complex mental health needs. Moreover, we conclude that TiM is a promising tool for supporting people with SMI in redeveloping a multidimensional identity and a renewed sense of purpose.
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Affiliation(s)
- Lisette van der Meer
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - Tessa Jonker
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands
| | - Heleen Wadman
- BuurtzorgT Mental Health Institution, Groningen, Netherlands
| | - Charlotte Wunderink
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Jaap van Weeghel
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Parnassia Group, Parnassia Noord Holland, Castricum, Netherlands.,Phrenos Center of Expertise on Severe Mental Illness, Utrecht, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Psychotic Disorders, GGZ-Drenthe, Assen, Netherlands
| | - Ellie R H van Setten
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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25
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Cognitive insight in psychotic patients institutionalized and living in the community: an examination using the Beck Cognitive Insight Scale. Psychiatry Res 2021; 295:113586. [PMID: 33250207 DOI: 10.1016/j.psychres.2020.113586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/18/2020] [Indexed: 01/10/2023]
Abstract
Improving cognitive insight can reduce delusions in patients with psychotic disorders. Although institutionalized patients usually have more severe delusions than outpatients, little is known about the differences in cognitive insight between these two groups. In this study, we evaluated the psychometric properties of the Beck Cognitive Insight Scale (BCIS) for a sample of Portuguese patients with psychotic disorders and compared the cognitive insight of institutionalized patients with patients living in the community. Participants in this study were 150 patients diagnosed with psychotic disorder (78 institutionalized patients and 72 outpatients). The tested model of the BCIS was a very good fit. Our study shows that patients living in the community showed higher levels of cognitive insight (total BCIS and self-reflectiveness) than institutionalized patients. Future studies assessing cognitive insight should take into account differences between the cognitive insights of institutionalized psychotic patients and psychotic patients living in the community.
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26
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Ebisch SJH. The Self and Its Nature: A Psychopathological Perspective on the Risk-Reducing Effects of Environmental Green Space for Psychosis. Front Psychol 2020; 11:531840. [PMID: 33262717 PMCID: PMC7686509 DOI: 10.3389/fpsyg.2020.531840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
Epidemiological studies have shown that environmental green space contributes to the reduction of psychosis incidence in the population. Clarifying the psychological and neuro-functional mechanisms underlying the risk-decreasing effects of green surroundings could help optimize preventive environmental interventions. This perspective article specifically aims to open a new window on the link between environmental green space and psychosis by considering its core psychopathological features. Psychotic disorders, such as schizophrenia, are essentially characterized by self-disturbances. The psychological structure of the self has been described as a multidimensional phenomenon that emerges from the reciprocal interaction with the environment through intrinsic and extrinsic self-processes. The intrinsic self refers to the experience of mental activity and environmental information as inherently related to one’s own person, which involves self-referential processing, self-reflection, memory, interoception, and emotional evaluation. The extrinsic self refers to sensorimotor interactions with the environment and the sense of agency, that is, the experience of being the source of one’s own actions and the multisensory consequences thereof. In psychosis, anomalous self-processing has been related to a functional fragmentation of intrinsic and extrinsic self-processes and related brain networks. Moreover, evidence from cognitive neuroscience suggests that green space could have beneficial effects on self-related processing. Based on the literature, it could be hypothesized that self-processing is involved in mediating the beneficial effects of green space for psychosis. Considering the multidimensionality of the self, it is proposed that urban green space design aimed at improving mental health ideally impacts the complexity of self-facets and thus restores the individual’s self.
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Affiliation(s)
- Sjoerd J H Ebisch
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies (ITAB), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
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27
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Abstract
Academic interest in the concept of insight in psychosis has increased markedly over the past 30 years, prompting this selective appraisal of the current state of the art. Considerable progress has been made in terms of measurement and confirming a number of clinical associations. More recently, the relationship between insight and involuntary treatment has been scrutinised more closely alongside the link between decision-making capacity and insight. Advances in the clinical and cognitive neurosciences have influenced conceptual development, particularly the field of 'metacognition'. New therapies, including those that are psychologically and neurophysiologically based, are being tested as ways to enhance insight.
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Affiliation(s)
- Anthony S David
- Director, UCL Institute of Mental Health, University College London, UK
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28
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Chang CC, Kao YC, Chao CY, Tzeng NS, Chang HA. The Effects of Bi-Anodal tDCS Over the Prefrontal Cortex Regions With Extracephalic Reference Placement on Insight Levels and Cardio-Respiratory and Autonomic Functions in Schizophrenia Patients and Exploratory Biomarker Analyses for Treatment Response. Int J Neuropsychopharmacol 2020; 24:40-53. [PMID: 32808025 PMCID: PMC7816677 DOI: 10.1093/ijnp/pyaa063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/05/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We previously showed the efficacy of bi-anodal transcranial direct current stimulation (tDCS) over the prefrontal cortex (PFC) regions with extracephalic reference placement in improving negative symptoms in schizophrenia. In this ancillary investigation, the effects of this intervention on insight levels, other clinical outcomes, and cardio-respiratory and autonomic functions were examined and the potential of biomarkers for treatment response was explored. METHODS Schizophrenia patients were randomly allocated to receive 10 sessions of bi-anodal tDCS over the PFC regions with extracephalic reference placement (2 mA, 20 minutes, twice daily for 5 weeks) or sham stimulation. We examined, in 60 patients at baseline, immediately after stimulation and at follow-up visits, the insight levels, other clinical outcomes, blood pressure, respiratory rate, heart rate, and heart rate variability. RESULTS Insight levels as assessed by the abbreviated version of the Scale to Assess Unawareness in Mental Disorder in schizophrenia awareness of the disease, positive and negative symptoms dimensions, and beliefs about medication compliance as assessed by Medication Adherence Rating Scale were significantly enhanced by active stimulation relative to sham. No effects were observed on cognitive insight, other clinical outcomes, or cardio-respiratory and autonomic functions. Heart rate variability indices as biomarkers were not associated with the clinical response to the intervention. CONCLUSIONS Our results provide evidence for bi-anodal tDCS over the PFC regions with extracephalic reference placement in heightening the levels of insight into the disease and symptoms, as well as beliefs about medication compliance in schizophrenia, without impacting other clinical outcomes and cardio-respiratory/autonomic functions.
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Affiliation(s)
- Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Correspondence: Hsin-An Chang, MD, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, 114, Taiwan, Tel/Fax: 011-886-2-8792-7220 / 011-886-2-8792-7221 ()
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Che-Yi Chao
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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29
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Pijnenborg GHM, Larabi DI, Xu P, Hasson-Ohayon I, de Vos AE, Ćurčić-Blake B, Aleman A, Van der Meer L. Brain areas associated with clinical and cognitive insight in psychotic disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 116:301-336. [PMID: 32569706 DOI: 10.1016/j.neubiorev.2020.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023]
Abstract
In the past years, ample interest in brain abnormalities related to clinical and cognitive insight in psychosis has contributed several neuroimaging studies to the literature. In the current study, published findings on the neural substrates of clinical and cognitive insight in psychosis are integrated by performing a systematic review and meta-analysis. Coordinate-based meta-analyses were performed with the parametric coordinate-based meta-analysis approach, non-coordinate based meta-analyses were conducted with the metafor package in R. Papers that could not be included in the meta-analyses were systematically reviewed. Thirty-seven studies were retrieved, of which 21 studies were included in meta-analyses. Poorer clinical insight was related to smaller whole brain gray and white matter volume and gray matter volume of the frontal gyri. Cognitive insight was predominantly positively associated with structure and function of the hippocampus and ventrolateral prefrontal cortex. Impaired clinical insight is not associated with abnormalities of isolated brain regions, but with spatially diffuse global and frontal abnormalities suggesting it might rely on a range of cognitive and self-evaluative processes. Cognitive insight is associated with specific areas and appears to rely more on retrieving and integrating self-related information.
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Affiliation(s)
- G H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands; Department of Clinical and Developmental Neuropsychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
| | - D I Larabi
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - P Xu
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China; Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen 518054, China; Great Bay Neuroscience and Technology Research Institute (Hong Kong), Kwun Tong, Hong Kong
| | - I Hasson-Ohayon
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - A E de Vos
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands
| | - B Ćurčić-Blake
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands
| | - A Aleman
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands; Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China
| | - L Van der Meer
- Department of Rehabilitation, Lentis Mental Health Care, PO box 128, 9470 KA, Zuidlaren, the Netherlands; Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
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30
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Ifrah C, Ospina LH, Shagalow S, Beck-Felts K, Kimhy D. Cognitive insight and autonomic regulation during daily functioning in individuals with schizophrenia. Schizophr Res 2020; 218:300-301. [PMID: 32178930 DOI: 10.1016/j.schres.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Chloe Ifrah
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shaina Shagalow
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katie Beck-Felts
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
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31
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Thirioux B, Harika-Germaneau G, Langbour N, Jaafari N. The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms. Front Psychiatry 2020; 10:966. [PMID: 32116810 PMCID: PMC7020772 DOI: 10.3389/fpsyt.2019.00966] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 12/06/2019] [Indexed: 01/12/2023] Open
Abstract
Lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions. Insight is the capacity to recognize (psychical insight) and accept one's mental illness (emotional insight). Insight growth necessitates developing an objective perspective on one's subjective pathological experiences. Therefore, insight has been posited to require undamaged self-reflexion and cognitive perspective-taking capacities. These enable patients to look objectively at themselves from the imagined perspective of someone else. Preserved theory-of-mind performances have been reported to positively impact insight in psychosis. However, some patients with schizophrenia or obsessive-compulsive disorders, although recognizing their mental disease, are still not convinced of this and do not accept it. Hence, perspective-taking explains psychical insight (recognition) but not emotional insight (acceptance). Here, we propose a new conceptual model. We hypothesize that insight growth relies upon the association of intact self-reflexion and empathic capacities. Empathy (feeling into someone else) integrates heterocentered visuo-spatial perspective (feeling into), embodiment, affective (feeling into) and cognitive processes, leading to internally experience the other's thought. We posit that this subjective experience enables to better understand the other's thought about oneself and to affectively adhere to this. We propose that the process of objectification, resulting from empathic heterocentered, embodiment, and cognitive processes, generates an objective viewpoint on oneself. It enables to recognize one's mental illness and positively impacts psychical insight. The process of subjectification, resulting from empathic affective processes, enables to accept one's illness and positively impacts emotional insight. That is, affectively experiencing the thought of another person about oneself reinforces the adhesion of the emotional system to the objective recognition of the disease. Applying our model to different psychiatric disorders, we predict that the negative effect of impaired self-reflexion and empathic capacities on insight is a transnosographic state and that endophenotypical differences modulate this common state, determining a psychiatric disease as specific.
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Affiliation(s)
- Bérangère Thirioux
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Ghina Harika-Germaneau
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nicolas Langbour
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, CHU de Poitiers, INSERM U 1084, Experimental and Clinical Neuroscience Laboratory, Groupement de Recherche CNRS 3557, Poitiers, France
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Jacob KS. Insight in psychosis: A critical review of the contemporary confusion. Asian J Psychiatr 2020; 48:101921. [PMID: 31918309 DOI: 10.1016/j.ajp.2019.101921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/19/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
This commentary highlights the context, complexity, conflicting claims and the contemporary confusion related to insight in people with psychosis. Traditional psychiatric precepts suggests that good insight is inversely related to the severity of psychotic symptoms and directly related to depression scores, better clinical outcome, and treatment adherence. However, recent studies have recognised that insight does not predict outcomes, changes over time, and is dependent on the trajectory of the individual's illness and the social and cultural context arguing that "insight" is an explanatory model and a coping strategy. Methodological issues related to the assessment of insight, the limitations of psychiatric classification and complex interaction between biology and the environment make simplistic explanations of the concept of insight less than useful. The paper argues that the biomedical model should be presented without dismissing or devaluing patient beliefs and explanations. Psychiatry needs to embrace the complexity of mental illness and value diverse attempts at restoring homeostasis.
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Affiliation(s)
- K S Jacob
- Christian Medical College, Vellore, 632002, India.
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Zhang L, Ai H, Opmeer EM, Marsman JBC, van der Meer L, Ruhé HG, Aleman A, van Tol MJ. Distinct temporal brain dynamics in bipolar disorder and schizophrenia during emotion regulation. Psychol Med 2020; 50:413-421. [PMID: 30773147 PMCID: PMC7025159 DOI: 10.1017/s0033291719000217] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/16/2018] [Accepted: 01/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Disturbances in emotion regulation (ER) are characteristic of both patients with bipolar disorder (BD) and schizophrenia (SZ). We investigated the temporal dynamics of brain activation during cognitive ER in BD and SZ to understand the contribution of temporal characteristics of disturbed ER to their unique and shared symptomatology. METHOD Forty-six participants performed an ER-task (BD, n = 15; SZ, n = 16; controls, n = 15) during functional magnetic resonance imaging, in which they were instructed to use cognitive reappraisal techniques to regulate their emotional responses. Finite impulse response modeling was applied to estimate the temporal dynamics of brain responses during cognitive reappraisal (v. passive attending) of negative pictures. Group, time, and group × time effects were tested using multivariate modeling. RESULTS We observed a group × time interaction during ER in the ventrolateral prefrontal cortex (VLPFC), supplementary motor area (SMA) and inferior occipital gyrus. Patients with SZ demonstrated initial hyper-activation of the VLPFC and SMA activation that was not sustained in later regulatory phases. Response profiles in the inferior occipital gyrus in SZ showed abnormal activation in the later phases of regulation. BD-patients showed general blunted responsivity in these regions. CONCLUSIONS These results suggest that ER-disturbances in SZ are characterized by an inefficient initialization and failure to sustain regulatory control, whereas in BD, a failure to recruit regulatory resources may represent initial deficits in formulating adequate representations of the regulatory needs. This may help to further understand how ER-disturbances give rise to symptomatology of BD and SZ.
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Affiliation(s)
- Liwen Zhang
- Department of Pharmacology, National University of Singapore, Singapore
| | - Hui Ai
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Shenzhen University, Shenzhen, China
| | - Esther M. Opmeer
- University of Groningen, University Medical Center Groningen, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - Jan-Bernard C. Marsman
- University of Groningen, University Medical Center Groningen, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
| | - Henricus G. Ruhé
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Cognitive Neuroscience Center, Groningen, the Netherlands
- Department of Psychology, University of Groningen, Groningen, the Netherlands
| | - Marie-José van Tol
- University of Groningen, University Medical Center Groningen, Cognitive Neuroscience Center, Groningen, the Netherlands
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Shan X, Liao R, Ou Y, Ding Y, Liu F, Chen J, Zhao J, Guo W, He Y. Metacognitive Training Modulates Default-Mode Network Homogeneity During 8-Week Olanzapine Treatment in Patients With Schizophrenia. Front Psychiatry 2020; 11:234. [PMID: 32292360 PMCID: PMC7118222 DOI: 10.3389/fpsyt.2020.00234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Previous studies have revealed the efficacy of metacognitive training for schizophrenia. However, the underlying mechanisms of metacognitive training on brain function alterations, including the default-mode network (DMN), remain unknown. The present study explored treatment effects of metacognitive training on functional connectivity of the brain regions in the DMN. METHODS Forty-one patients with schizophrenia and 20 healthy controls were scanned using resting-state functional magnetic resonance imaging. Patients were randomly assigned to drug plus psychotherapy (DPP) and drug therapy (DT) groups. The DPP group received olanzapine and metacognitive training, and the DT group received only olanzapine for 8 weeks. Network homogeneity (NH) was applied to analyze the imaging data, and pattern classification techniques were applied to test whether abnormal NH deficits at baseline might be used to discriminate patients from healthy controls. Abnormal NH in predicting treatment response was also examined in each patient group. RESULTS Compared with healthy controls, patients at baseline showed decreased NH in the bilateral ventral medial prefrontal cortex (MPFC), right posterior cingulate cortex (PCC)/precuneus, and bilateral precuneus and increased NH in the right cerebellum Crus II and bilateral superior MPFC. NH values in the right PCC/precuneus increased in the DPP group after 8 weeks of treatment, whereas no substantial difference in NH value was observed in the DT group. Support vector machine analyses showed that the accuracy, sensitivity, and specificity for distinguishing patients from healthy controls were more than 0.7 in the NH values of the right PCC/precuneus, bilateral ventral MPFC, bilateral superior MPFC, and bilateral precuneus regions. Support vector regression analyses showed that high NH levels at baseline in the bilateral superior MPFC could predict symptomatic improvement of positive and negative syndrome scale (PANSS) after 8 weeks of DPP treatment. No correlations were found between alterations in the NH values and changes in the PANSS scores/cognition parameters in the patients. CONCLUSION This study provides evidence that metacognitive training is related to the modulation of DMN homogeneity in schizophrenia.
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Affiliation(s)
- Xiaoxiao Shan
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Rongyuan Liao
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Yangpan Ou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Yudan Ding
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Yiqun He
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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Fuentes-Claramonte P, Martin-Subero M, Salgado-Pineda P, Santo-Angles A, Argila-Plaza I, Salavert J, Arévalo A, Bosque C, Sarri C, Guerrero-Pedraza A, Capdevila A, Sarró S, McKenna PJ, Pomarol-Clotet E, Salvador R. Brain imaging correlates of self- and other-reflection in schizophrenia. NEUROIMAGE-CLINICAL 2019; 25:102134. [PMID: 31877452 PMCID: PMC6931228 DOI: 10.1016/j.nicl.2019.102134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/29/2019] [Accepted: 12/13/2019] [Indexed: 01/06/2023]
Abstract
Self- and other-reflection in schizophrenia were studied with fMRI. Patients failed to activate the right temporo-parietal junction in other-reflection. They also hyperactivated lateral prefrontal cortex for self and other-reflection. These findings might be linked to altered self/other processing in schizophrenia.
Background An alteration in self/other differentiation has been proposed as a basis for several symptoms in schizophrenia, including delusions of reference and social functioning deficits. Dysfunction of the right temporo-parietal junction (TPJ), a region linked with social cognition, has been proposed as the basis of this alteration. However, imaging studies of self- and other-processing in schizophrenia have shown, so far, inconsistent results. Methods Patients with schizophrenia and healthy controls underwent fMRI scanning while performing a task with three conditions: self-reflection, other-reflection and semantic processing. Results Both groups activated similar brain regions for self- and other-reflection compared to semantic processing, including the medial prefrontal cortex, the precuneus and the TPJ. Compared to healthy subjects, patients hyperactivated the left lateral frontal cortex during self- and other-reflection. In other-reflection, compared to self-reflection, patients failed to increase right TPJ activity. Conclusions Altered activity in the right TPJ supports a disturbance in self/other differentiation in schizophrenia, which could be linked with psychotic symptoms and affect social functioning in patients. Hyperactivity of the lateral frontal cortex for self- and other-reflection suggests the presence of greater cognitive demand to perform the task in the patient group.
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Affiliation(s)
- Paola Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Marta Martin-Subero
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Aniol Santo-Angles
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Isabel Argila-Plaza
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain
| | - Josep Salavert
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Psychiatry Department, Hospital Sant Rafael, Barcelona, Spain
| | - Antoni Arévalo
- Psychiatry Department, Hospital Sagrat Cor Martorell Barcelona, Spain
| | - Clara Bosque
- Benito Menni Centre Assistencial en Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
| | - Carmen Sarri
- Benito Menni Centre Assistencial en Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Antoni Capdevila
- Radiology Unit, Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain; CIBER-BBN (Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina), Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain.
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
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Liu W, Gan J, Fan J, Zheng H, Li S, Chan RCK, Tan C, Zhu X. Associations of cortical thickness, surface area and subcortical volumes with insight in drug-naïve adults with obsessive-compulsive disorder. NEUROIMAGE-CLINICAL 2019; 24:102037. [PMID: 31704545 PMCID: PMC6978222 DOI: 10.1016/j.nicl.2019.102037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/30/2019] [Accepted: 10/15/2019] [Indexed: 12/27/2022]
Abstract
• We first used the SBM method to explore the neuroanatomical basis underlying insight in OCD. • OCD-GI and OCD-PI displayed mostly shared, but partly distinct brain structural alterations. • Decreased cortical thickness in the left dmPFC, the left ACC and the right lateral parietal cortex was associated with poorer insight. • The potential effect of other clinical variables on the results has been ruled out.
Poor insight in obsessive-compulsive disorder (OCD) is associated with several adverse clinical outcomes. However, the neurobiological basis of this insight deficit is not clearly understood. The present study thus aimed to investigate associations of cortical thickness, cortical surface area and subcortical volumes with insight in a sample of drug-naïve adults with OCD. Forty-seven OCD patients and 42 healthy controls (HCs) underwent MRI scanning, depression and anxiety assessments. The Brown Assessment of Beliefs Scale (BABS) measured insight levels and patients were divided into two groups: poor insight (OCD-PI; n = 21), and good insight (OCD-GI; n = 26). Cortical thickness and surface area between groups were compared with whole-brain exploratory vertex-by-vertex analyses, while subcortical volumes were compared on a structure-by-structure basis. Partial correlation analyses were then performed to assess associations between regional cortical and subcortical measures and insight levels. OCD-GI and OCD-PI groups displayed partly shared, but also partly distinct brain structural alterations. Strikingly, OCD-PI showed decreased cortical thickness in the left superior frontal gyrus, left anterior cingulate cortex (ACC) and right inferior parietal gyrus, compared to both OCD-GI and HCs. Average cortical thickness extracted from these areas was further negatively correlated with BABS scores in the OCD-PI patients. Our findings suggest that poor insight in patients with OCD may have a neural substrate involving the left medial frontal and the right inferior parietal cortices.
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Affiliation(s)
- Wanting Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute of Central South University, Changsha, Hunan, China
| | - Jun Gan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Fan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Zheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sihui Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Changlian Tan
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute of Central South University, Changsha, Hunan, China.
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Potvin S, Gamache L, Lungu O. A Functional Neuroimaging Meta-Analysis of Self-Related Processing in Schizophrenia. Front Neurol 2019; 10:990. [PMID: 31572296 PMCID: PMC6749044 DOI: 10.3389/fneur.2019.00990] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/30/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Schizophrenia is characterized by self-disturbances, including impaired self-evaluation abilities and source monitoring. The cortical midline structures (e.g., medial prefrontal cortex, anterior and posterior cingulate cortex, and precuneus) and the temporoparietal junction are known to play a key role in self-related processing. In theory, self-disturbances in schizophrenia may arise from impaired activity in these regions. We performed a functional neuroimaging meta-analysis to verify this hypothesis. Methods: A literature search was performed with PubMed and Google Scholar to identify functional neuroimaging studies examining the neural correlates of self-processing in schizophrenia, using self-other or source monitoring paradigms. Fourteen studies were retrieved, involving 245 patients and 201 controls. Using peak coordinates to recreate an effect-size map of contrast results, a standard random-effects variance weighted meta-analysis for each voxel was performed with the Seed-based d Mapping software. Results: During self-processing, decreased activations were observed in schizophrenia patients relative to controls in the bilateral thalamus and the left dorsal anterior cingulate cortex (dACC) and dorso-medial prefrontal cortex. Importantly, results were homogeneous across studies, and no publication bias was observed. Sensitivity analyses revealed that results were replicable in 93-100% of studies. Conclusion: The current results partially support the hypothesized impaired activity of cortical midline brain regions in schizophrenia during self-processing. Decreased activations were observed in the dACC and dorsomedial prefrontal cortex, which are involved in cognitive control and/or salience attribution, as well as decision-making, respectively. These alterations may compromise patients' ability to direct their attention toward themselves and/or others and to make the decision whether a certain trait applies to one's self or to someone else. In addition, decreased activations were observed in the thalamus, which is not a core region of the default-mode network, and is involved in information integration. These thalamic alterations may compromise self-coherence in schizophrenia.
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Affiliation(s)
- Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Lydia Gamache
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Ovidiu Lungu
- Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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Jacob A, Shukla A, Thonse U, Nagendra B, Chacko DM, Hiremath C, Devi P, Korann V, Dey A, Kunte M, Philip M, Bharath RD, Varambally S, Venkatasubramanian G, Rao NP. Cultural differences and neural correlates of cognitive insight in schizophrenia. Schizophr Res 2019; 209:98-104. [PMID: 31101512 DOI: 10.1016/j.schres.2019.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/23/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
Cognitive insight refers to a person's ability to examine their psychotic experiences and the inferences they draw from these experiences. Several studies suggest that cultural factors influence cognitive insight and the processes involved therein; a few studies have suggested differences between Western and Asian societies. However, there are no studies on cognitive insight and its neural correlates in non-Western populations. Hence, we examined factor structure of Beck's cognitive insight scale (BCIS) in a large sample of patients with schizophrenia (SCZ) and healthy volunteers (HV) from India and assessed the relationship between cortical thickness and cognitive insight. We recruited 240 participants (SCZ-140; HV-100). Of these, 58 participants (SCZ-33; HV-25) underwent magnetic resonance imaging. We found a three-factor structure for BCIS which is different from the original two factor structure; self-reflection (SR) of original two-factor structure was sub-divided into- SR1, introspection and SR2, openness to feedback. There was a significant difference between HV and SCZ in the new factors, SR1 and SR2 but not in the original SR factor. Difference was also seen on MRI analysis; while there was a significant positive correlation between original SR factor and thickness of right posterior cingulate cortex, SR2 was positively correlated with thickness of left ventrolateral prefrontal cortex. The difference in factor structure in Indian participants and their distinct neural correlates point to cultural differences in cognitive insight. While in western societies the constructs of introspection and openness to feedback might integrate, they might be separate entities in Asian population.
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Affiliation(s)
- Arpitha Jacob
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Ayushi Shukla
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Umesh Thonse
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Bhargavi Nagendra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Dona Maria Chacko
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Chaitra Hiremath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Priyanka Devi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Vittal Korann
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Avyarthana Dey
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Mugdha Kunte
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Mariamma Philip
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Rose Dawn Bharath
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India.
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Sorella S, Lapomarda G, Messina I, Frederickson JJ, Siugzdaite R, Job R, Grecucci A. Testing the expanded continuum hypothesis of schizophrenia and bipolar disorder. Neural and psychological evidence for shared and distinct mechanisms. Neuroimage Clin 2019; 23:101854. [PMID: 31121524 PMCID: PMC6529770 DOI: 10.1016/j.nicl.2019.101854] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/24/2019] [Accepted: 05/02/2019] [Indexed: 12/21/2022]
Abstract
Despite the traditional view of Schizophrenia (SZ) and Bipolar disorder (BD) as separate diagnostic categories, the validity of such a categorical approach is challenging. In recent years, the hypothesis of a continuum between Schizophrenia (SZ) and Bipolar disorder (BD), postulating a common pathophysiologic mechanism, has been proposed. Although appealing, this unifying hypothesis may be too simplistic when looking at cognitive and affective differences these patients display. In this paper, we aim to test an expanded version of the continuum hypothesis according to which the continuum extends over three clusters: the psychotic, the cognitive, and the affective. We applied an innovative approach known as Source-based Morphometry (SBM) to the structural images of 46 individuals diagnosed with SZ, 46 with BD and 66 healthy controls (HC). We also analyzed the psychological profiles of the three groups using cognitive, affective, and clinical tests. At a neural level, we found evidence for a shared psychotic core in a distributed network involving portions of the medial parietal and temporo-occipital areas, as well as parts of the cerebellum and the middle frontal gyrus. We also found evidence of a cognitive core more compromised in SZ, including alterations in a fronto-parietal circuit, and mild evidence of an affective core more compromised in BD, including portions of the temporal and occipital lobes, cerebellum, and frontal gyrus. Such differences were confirmed by the psychological profiles, with SZ patients more impaired in cognitive tests, while BD in affective ones. On the bases of these results we put forward an expanded view of the continuum hypothesis, according to which a common psychotic core exists between SZ and BD patients complemented by two separate cognitive and affective cores that are both impaired in the two patients' groups, although to different degrees.
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Affiliation(s)
- Sara Sorella
- Department of Psychology and Cognitive Science (DiPSCo), University of Trento, Rovereto, Italy.
| | - Gaia Lapomarda
- Department of Psychology and Cognitive Science (DiPSCo), University of Trento, Rovereto, Italy.
| | | | | | - Roma Siugzdaite
- Department of Experimental Psychology, Faculty of Psychological and Pedagogical Sciences, Ghent University, Ghent, Belgium.
| | - Remo Job
- Department of Psychology and Cognitive Science (DiPSCo), University of Trento, Rovereto, Italy.
| | - Alessandro Grecucci
- Department of Psychology and Cognitive Science (DiPSCo), University of Trento, Rovereto, Italy.
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Gerretsen P, Rajji TK, Shah P, Shahab S, Sanches M, Graff-Guerrero A, Menon M, Pollock BG, Mamo DC, Mulsant BH, Voineskos AN. Impaired illness awareness in schizophrenia and posterior corpus callosal white matter tract integrity. NPJ SCHIZOPHRENIA 2019; 5:8. [PMID: 31036809 PMCID: PMC6488582 DOI: 10.1038/s41537-019-0076-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/19/2019] [Indexed: 12/17/2022]
Abstract
Impaired illness awareness (Imp-IA) in schizophrenia is associated with interhemispheric imbalance, resulting in left hemisphere dominance, primarily within the posterior parietal area (PPA). This may represent an interhemispheric “disconnection syndrome” between PPAs. To test this hypothesis, we aimed to determine if diffusion-based measures of white matter integrity were disrupted in the corpus callosal tracts linking PPAs (i.e., splenium) in patients with Imp-IA in schizophrenia. T1-weighted and diffusion-weighted scans were acquired on a 1.5T GE scanner for 100 participants with a DSM-IV-TR diagnosis of schizophrenia and 134 healthy controls aged 18 to 79 years. The corpus callosal white matter tracts were compared among patients with Imp-IA (n = 40), intact illness awareness (n = 60), and healthy controls. White matter disruption was measured with fractional anisotropy (FA) and mean diffusivity (MD). Group differences in FA were found in the splenium, with patients with Imp-IA having the lowest FA, which remained significant after controlling for sex, age, global cognition, and premorbid intelligence. No group differences in MD were observed. Splenial white matter tracts of the corpus callosum appear compromised in patients with Imp-IA. Transcallosal interhemispheric PPA white matter disruption may represent a “disconnection syndrome”, manifesting as Imp-IA in schizophrenia. Future studies are required to investigate the effects of noninvasive brain stimulation interventions, such as transcranial direct current or magnetic stimulation, on Imp-IA in association with white matter changes in patients with schizophrenia.
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Affiliation(s)
- Philip Gerretsen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada. .,University of Toronto, Toronto, ON, Canada.
| | - Tarek K Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Parita Shah
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Saba Shahab
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Marcos Sanches
- University of Toronto, Toronto, ON, Canada.,Krembil Centre for Neuroinformatics - CAMH, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Bruce G Pollock
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
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Damme KSF, Pelletier-Baldelli A, Cowan HR, Orr JM, Mittal VA. Distinct and opposite profiles of connectivity during self-reference task and rest in youth at clinical high risk for psychosis. Hum Brain Mapp 2019; 40:3254-3264. [PMID: 30941844 DOI: 10.1002/hbm.24595] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
Self-reference is impaired in psychotic disorders such as schizophrenia, associated with disability, and closely related to characteristic patterns of aberrant brain connectivity. However, at present, it is unclear whether self-reference is impacted in pathogenesis of the disorder. Alterations in connectivity during a self-reference task or resting-state in the psychosis risk (i.e., prodromal) period may yield important clues for biomarker development, as well as for novel treatment targets. This study examined a task-based and resting-state functional magnetic resonance imaging in individuals at clinical high risk (CHR) for psychosis (n = 22) and healthy control unaffected peers (n = 20). The self-reference task comprised three task conditions where subjects were asked if an adjective was relevant to themselves (self), a designated other individual (other), or to evaluate the word's spelling (letter). Connectivity analyses examined medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC), regions commonly found in conjunction analyses of self-reference, during both the self-reference task and rest. In task connectivity analyses, CHR individuals exhibited decreased mPFC-PCC connectivity when compared to controls. In resting-state analyses, CHR participants showed greater mPFC-PCC connectivity. Taken together, results suggest that psychosis-like alterations in mPFC-PCC connectivity is present prior to psychosis onset across both task and rest.
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Affiliation(s)
| | | | - Henry R Cowan
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Joseph M Orr
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas.,Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois.,Department of Psychiatry, Northwestern University, Chicago, Illinois.,Medical Social Sciences, Northwestern University, Chicago, Illinois.,Institute for Policy Research (IPR), Northwestern University, Chicago, Illinois.,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston, Illinois
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42
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Pijnenborg GHM, de Vos AE, Timmerman ME, Van der Gaag M, Sportel BE, Arends J, Koopmans EM, Van der Meer L, Aleman A. Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial. Schizophr Res 2019; 206:362-369. [PMID: 30429078 DOI: 10.1016/j.schres.2018.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention 'REFLEX' aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms. METHOD A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012-2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes. RESULTS Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, p < .001, PANSS G12, p < .005) and at follow-up (SAI-E Rater, p < .01, SAI-E interview, p < .001, PANSS G12, p < .0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, p < .05). Other outcomes (self-esteem, quality of life and depression) remained unchanged. CONCLUSION Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.
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Affiliation(s)
- G H M Pijnenborg
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands; Dept. of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands.
| | - A E de Vos
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - M E Timmerman
- Dept. of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - M Van der Gaag
- Dept. of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Dept. of Psychosis Research, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - B E Sportel
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - J Arends
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - E M Koopmans
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
| | - L Van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands; Rob Giel Research Center, University Medical Center Groningen, Groningen, the Netherlands
| | - A Aleman
- Dept. of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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43
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Abstract
Cognitive impairments in substance use disorders have been extensively researched, especially since the advent of cognitive and computational neuroscience and neuroimaging methods in the last 20 years. Conceptually, altered cognitive function can be viewed as a hallmark feature of substance use disorders, with documented alterations in the well-known "executive" domains of attention, inhibition/regulation, working memory, and decision-making. Poor cognitive (sometimes referred to as "top-down") regulation of downstream motivational processes-whether appetitive (reward, incentive salience) or aversive (stress, negative affect)-is recognized as a fundamental impairment in addiction and a potentially important target for intervention. As addressed in this special issue, cognitive impairment is a transdiagnostic domain; thus, advances in the characterization and treatment of cognitive dysfunction in substance use disorders could have benefit across multiple psychiatric disorders. Toward this general goal, we summarize current findings in the abovementioned cognitive domains of substance use disorders, while suggesting a potentially useful expansion to include processes that both precede (precognition) and supersede (social cognition) what is usually thought of as strictly cognition. These additional two areas have received relatively less attention but phenomenologically and otherwise are important features of substance use disorders. The review concludes with suggestions for research and potential therapeutic targeting of both the familiar and this more comprehensive version of cognitive domains related to substance use disorders.
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Fuentes-Claramonte P, Martín-Subero M, Salgado-Pineda P, Alonso-Lana S, Moreno-Alcázar A, Argila-Plaza I, Santo-Angles A, Albajes-Eizagirre A, Anguera-Camós M, Capdevila A, Sarró S, McKenna PJ, Pomarol-Clotet E, Salvador R. Shared and differential default-mode related patterns of activity in an autobiographical, a self-referential and an attentional task. PLoS One 2019; 14:e0209376. [PMID: 30608970 PMCID: PMC6319771 DOI: 10.1371/journal.pone.0209376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/04/2018] [Indexed: 01/17/2023] Open
Abstract
The default-mode network (DMN) comprises a set of brain regions that show deactivations during performance of attentionally demanding tasks, but also activation during certain processes including recall of autobiographical memories and processing information about oneself, among others. However, the DMN is not activated in a homogeneous manner during performance of such tasks, so it is not clear to what extent its activation patterns correspond to deactivation patterns seen during attention-demanding tasks. In this fMRI study we compared patterns of activation in response to an autobiographical memory task to those observed in a self/other-reflection task, and compared both to deactivations observed during the n-back working memory task. Autobiographical recall and self-reflection activated several common DMN areas, which were also deactivated below baseline levels by the n-back task. Activation in the medial temporal lobe was seen during autobiographical recall but not the self/other task, and right angular gyrus activity was specifically linked to other-reflection. ROI analysis showed that most, but not all DMN regions were activated above baseline levels during the autobiographical memory and self-reflection tasks. Our results provide evidence for the usefulness of the autobiographical memory task to study DMN activity and support the notion of interacting subsystems within this network.
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Affiliation(s)
- Paola Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Marta Martín-Subero
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Silvia Alonso-Lana
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Ana Moreno-Alcázar
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
- Institut de Neuropsiquiatria i Addiccions, Centre Fòrum Research Unit, Parc de Salut Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | - Anton Albajes-Eizagirre
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | | | - Antoni Capdevila
- Radiology Unit, Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain
- CIBER-BBN (Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina), Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Peter J. McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
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45
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Jia S, Liu M, Huang P, Zhao Y, Tan S, Go R, Yan T, Wu J. Abnormal Alpha Rhythm During Self-Referential Processing in Schizophrenia Patients. Front Psychiatry 2019; 10:691. [PMID: 31632304 PMCID: PMC6779928 DOI: 10.3389/fpsyt.2019.00691] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia patients exhibited a psychological abnormal appearance when they recognized objects related to themselves. This cognitive process is associated with self-referential processing. In this study, the self-referential memory (SRM) task was performed by 18 schizophrenia patients and 18 healthy controls. In the encoding stage of the SRM task, the behavioral experiment data and electroencephalogram (EEG) data were recorded in three experimental conditions (self-referential condition, other-referential condition, and physical condition). For data analysis, the electrophysiological performance of the time-frequency distribution, phase lag index (PLI) strengths, phase synchronization connectivity, and brain-network properties were assessed in schizophrenia patients compared to healthy controls. We found that schizophrenia patients exhibited abnormal alpha oscillation characteristics at the time of 100-300 ms poststimulus during the self-referential condition, which consisted of diminished time-frequency distributions over the prefrontal, parietal, and occipital regions; lower functional connectivity strengths of the PLI in the parietal and occipital areas; higher global efficiency and the lower characteristic path length; and nodal efficiency of local areas (increased nodal efficiency in temporal regions and decreased nodal efficiency in occipital region) for dynamic network topology properties. Furthermore, the evoked power of the alpha band during the self-referential condition was significantly correlated with the SRM bias score in the patients (r = 0.595, p = 0.009). These results provided electrophysiological evidence and supported the hypothesis that an abnormal alpha rhythm might be the principal factor of dysfunctional self-referential processing in schizophrenia patients.
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Affiliation(s)
- Shikui Jia
- Intelligent Robotics Institute, School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Miaomiao Liu
- Graduate School of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Peiwen Huang
- Intelligent Robotics Institute, School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Yanli Zhao
- Center for Psychiatric Research, Beijing Huilongguan Hospital, Beijing, China
| | - Shuping Tan
- Center for Psychiatric Research, Beijing Huilongguan Hospital, Beijing, China
| | - Ritsu Go
- Intelligent Robotics Institute, School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Tianyi Yan
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jinglong Wu
- Intelligent Robotics Institute, School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
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46
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Kim JY, Jeon H, Kwon A, Jin MJ, Lee SH, Chung YC. Self-Awareness of Psychopathology and Brain Volume in Patients With First Episode Psychosis. Front Psychiatry 2019; 10:839. [PMID: 31803084 PMCID: PMC6873658 DOI: 10.3389/fpsyt.2019.00839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/22/2019] [Indexed: 01/06/2023] Open
Abstract
Memory impairment, excessive rumination, and increased interpersonal sensitivity are major characteristics of high psychosis risk or first episode psychosis (FEP). Herein, we investigated the relationship between brain volume and self-awareness of psychopathology in patients with FEP. All participants (FEP: 34 and HCs: 34) completed clinical assessments and the following self-reported psychopathology evaluations: prospective and retrospective memory questionnaire (PRMQ), ruminative response scale (RRS), and interpersonal sensitivity measure (IPSM). Structural magnetic resonance imaging was then conducted. The PRMQ, RRS, and IPSM scores were significantly higher in the FEP group than in the healthy controls (HCs). The volumes of the amygdala, hippocampus, and superior temporal gyrus (STG) were significantly lower in the FEP group than in the HCs. There was a significant group-dependent moderation effect between self-awareness of psychopathology (PRMQ, RRS, and IPSM scores) and right STG (rSTG) volume. In the FEP group, self-awareness of psychopathology was positively associated with rSTG volume, while in the HCs, this correlation was negative. Our results indicate that self-awareness of psychopathology impacts rSTG volume in the opposite direction between patients with FEP and HCs. In patients with FEP, awareness of impairment may induce increases in rSTG brain volume. However, HCs showed decreased rSTG volume when they were aware of impairment.
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Affiliation(s)
- Jeong-Youn Kim
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea
| | - Hyeonjin Jeon
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea
| | - Aeran Kwon
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea
| | - Min Jin Jin
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea.,Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea.,Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, South Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, South Korea
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47
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Pinkham AE, Klein HS, Hardaway GB, Kemp KC, Harvey PD. Neural correlates of social cognitive introspective accuracy in schizophrenia. Schizophr Res 2018; 202:166-172. [PMID: 30077432 DOI: 10.1016/j.schres.2018.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/24/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
Abstract
Introspective accuracy (IA) refers to the ability to accurately assess one's own skills and capabilities. Recent work provides evidence of IA deficits in schizophrenia that are predictive of everyday functioning. Thus, IA deficits are an important target to understand mechanistically. The current study used fMRI to assess neural activation in 32 healthy controls and 31 individuals with schizophrenia as they completed IA and control versions of a social cognitive task (i.e., emotion recognition). Analyses revealed different areas of IA-specific neural activity between groups including activations of rostrolateral prefrontal cortex (rlPFC) and dorsal anterior cingulate cortex in healthy individuals that were absent in patients. Direct group comparisons revealed greater IA-specific activation for healthy individuals in right rlPFC, a region thought to be critical for successful IA. For healthy individuals only, activation in rlPFC was positively correlated with IA ability, but no association was observed for patients. Further, among individuals with schizophrenia, increased activation of rlPFC during judgments of IA was positively correlated with better informant-reported interpersonal functioning. These results suggest that reduced specialization of IA-related neural activation may contribute to impaired IA in schizophrenia and also highlight IA as a potential target for remediation programs aimed at improving real-world functioning.
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Affiliation(s)
- Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA.
| | - Hans S Klein
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Grant B Hardaway
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Kathryn C Kemp
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Miami VA Healthcare System, USA
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48
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Vaccaro AG, Fleming SM. Thinking about thinking: A coordinate-based meta-analysis of neuroimaging studies of metacognitive judgements. Brain Neurosci Adv 2018; 2:2398212818810591. [PMID: 30542659 PMCID: PMC6238228 DOI: 10.1177/2398212818810591] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 09/28/2018] [Indexed: 11/15/2022] Open
Abstract
Metacognition supports reflection upon and control of other cognitive processes.
Despite metacognition occupying a central role in human psychology, its neural
substrates remain underdetermined, partly due to study-specific differences in
task domain and type of metacognitive judgement under study. It is also unclear
how metacognition relates to other apparently similar abilities that depend on
recursive thought such as theory of mind or mentalising. Now that neuroimaging
studies of metacognition are more prevalent, we have an opportunity to
characterise consistencies in neural substrates identified across different
analysis types and domains. Here we used quantitative activation likelihood
estimation methods to synthesise findings from 47 neuroimaging studies on
metacognition, divided into categories based on the target of metacognitive
evaluation (memory and decision-making), analysis type (judgement-related
activation, confidence-related activation, and predictors of metacognitive
sensitivity), and, for metamemory judgements, temporal focus (prospective and
retrospective). A domain-general network, including medial and lateral
prefrontal cortex, precuneus, and insula was associated with the level of
confidence in self-performance in both decision-making and memory tasks. We
found preferential engagement of right anterior dorsolateral prefrontal cortex
in metadecision experiments and bilateral parahippocampal cortex in metamemory
experiments. Results on metacognitive sensitivity were inconclusive, likely due
to fewer studies reporting this contrast. Finally, by comparing our results to
meta-analyses of mentalising, we obtain evidence for common engagement of the
ventromedial and anterior dorsomedial prefrontal cortex in both metacognition
and mentalising, suggesting that these regions may support second-order
representations for thinking about the thoughts of oneself and others.
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Affiliation(s)
- Anthony G Vaccaro
- Division of Psychology and Language Sciences, University College London, London, UK.,Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Stephen M Fleming
- Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
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49
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Insight and emotion regulation in schizophrenia: A brain activation and functional connectivity study. NEUROIMAGE-CLINICAL 2018; 20:762-771. [PMID: 30261360 PMCID: PMC6154769 DOI: 10.1016/j.nicl.2018.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/10/2018] [Accepted: 09/13/2018] [Indexed: 11/21/2022]
Abstract
Background Insight is impaired in the majority of schizophrenia patients. The exact neural correlates of impaired insight remain unclear. We assume that the ability to regulate emotions contributes to having good clinical insight, as patients should be able to regulate their emotional state in such a way that they can adapt adequately in order to cope with impaired functioning and negative stigma associated with a diagnosis of schizophrenia. Numerous studies have shown emotional dysregulation in schizophrenia. We investigated the association between insight and brain activation and connectivity during emotion regulation. Methods Brain activation during emotion regulation was measured with functional MRI in 30 individuals with schizophrenia. Two emotion regulation strategies were examined: cognitive reappraisal and expressive suppression. Clinical insight was measured with the Schedule for the Assessment of Insight – Expanded, and cognitive insight was measured with the Beck Cognitive Insight Scale. Whole brain random effects multiple regression analyses were conducted to assess the relation between brain activation during emotion regulation and insight. Generalized psychophysiological interaction (gPPI) was used to investigate the relation between task-related connectivity and insight. Results No significant associations were found between insight and neural correlates of cognitive reappraisal. For clinical insight and suppression, significant positive associations were found between symptom relabeling and activation in the left striatum, thalamus and insula, right insula and caudate, right pre- and postcentral gyrus, left superior occipital gyrus and cuneus and right middle and superior occipital gyrus and cuneus. Furthermore, reduced clinical insight was associated with more connectivity between midline medial frontal gyrus and right middle occipital gyrus. For cognitive insight and suppression, significant positive associations were found between self-reflectiveness and activation in pre- and postcentral gyrus and left middle cingulate gyrus. Conclusions Our results suggest an association between the capacity to relabel symptoms and activation of brain systems involved in cognitive-emotional control and visual processing of negative stimuli. Furthermore, poorer self-reflectiveness may be associated with brain systems subserving control and execution. We examined the association between emotion regulation and insight in schizophrenia. Patients with poorer insight engage different neural pathways during suppression. This finding was strengthened by connectivity measures of corresponding brain areas. No relationship between cognitive reappraisal and insight was found.
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50
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Affiliation(s)
- Anthony S David
- PO Box 68, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF, UK.
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