Impaired Insight in Schizophrenia is Associated with Higher Frontoparietal Cerebral Blood Flow: an Arterial Spin Labeling Study

Overview

Journal Schizophrenia (Heidelb)

Date 2025 Jan 10

PMID 39794339

Authors

Jianmeng Song

Edgardo Carmona-Torres

Yasaman Kambari

Sofia Chavez

Fumihiko Ueno

Teruki Koizum

Aron Amaev

Ali Abdolizadeh

Vincenzo De Luca

Daniel M Blumberger

Gary Remington

Bruce Pollock

Ariel Graff-Guerrero

Philip Gerretsen

Affiliations

Soon will be listed here.

Abstract

Impaired insight into illness occurs in up to 98% of patients with schizophrenia, depending on the stage of illness, and leads to negative clinical outcomes. Previous neuroimaging studies suggest that impaired insight in patients with schizophrenia may be related to structural and functional anomalies in frontoparietal brain regions. To date, limited studies have investigated the association between regional cerebral blood flow (CBF) and impaired insight in schizophrenia. Therefore, we sought to investigate the relationship between regional CBF, as measured by arterial spin labeling (ASL), and impaired insight in participants with schizophrenia. A total of 32 participants were included in the analysis. Impaired insight in patients with schizophrenia was measured using the VAGUS, Self-report (VAGUS-SR). Resting-state regional CBF was measured using pseudo-continuous ASL (pCASL) and extracted using SPM12 and REX toolbox. Whole brain analysis found that impaired insight was associated with higher regional CBF in the right angular gyrus, left supramarginal gyrus, and right superior frontal region when controlling for age, gender, smoking status, and illness severity. The results indicate that impaired insight in schizophrenia is related to regional CBF in frontoparietal areas. These neuroimaging findings can serve as therapeutic targets for intervention, such as with non-invasive brain stimulation.

References

Chang C, Tzeng N, Chao C, Yeh C, Chang H . The Effects of Add-on Fronto-Temporal Transcranial Direct Current Stimulation (tDCS) on Auditory Verbal Hallucinations, Other Psychopathological Symptoms, and Insight in Schizophrenia: A Randomized, Double-Blind, Sham-Controlled Trial. Int J Neuropsychopharmacol. 2018; 21(11):979-987. PMC: 6209860. DOI: 10.1093/ijnp/pyy074. View

Tzourio-Mazoyer N, Landeau B, Papathanassiou D, Crivello F, Etard O, Delcroix N . Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. Neuroimage. 2002; 15(1):273-89. DOI: 10.1006/nimg.2001.0978. View

Ye F, Frank J, Weinberger D, Mclaughlin A . Noise reduction in 3D perfusion imaging by attenuating the static signal in arterial spin tagging (ASSIST). Magn Reson Med. 2000; 44(1):92-100. DOI: 10.1002/1522-2594(200007)44:1<92::aid-mrm14>3.0.co;2-m. View

Gerretsen P, Diaz P, Mamo D, Kavanagh D, Menon M, Pollock B . Transient insight induction with electroconvulsive therapy in a patient with refractory schizophrenia: a case report and systematic literature review. J ECT. 2010; 27(3):247-50. DOI: 10.1097/YCT.0b013e3181f816f6. View

Haesebaert F, Mondino M, Saoud M, Poulet E, Brunelin J . Efficacy and safety of fronto-temporal transcranial random noise stimulation (tRNS) in drug-free patients with schizophrenia: a case study. Schizophr Res. 2014; 159(1):251-2. DOI: 10.1016/j.schres.2014.07.043. View

Pinkham A, Loughead J, Ruparel K, Wu W, Overton E, Gur R . Resting quantitative cerebral blood flow in schizophrenia measured by pulsed arterial spin labeling perfusion MRI. Psychiatry Res. 2011; 194(1):64-72. PMC: 3185150. DOI: 10.1016/j.pscychresns.2011.06.013. View

Laroi F, Fannemel M, Ronneberg U, Flekkoy K, Opjordsmoen S, Dullerud R . Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Res. 2000; 100(1):49-58. DOI: 10.1016/s0925-4927(00)00063-9. View

Koren D, Viksman P, Giuliano A, Seidman L . The nature and evolution of insight in schizophrenia: a multi-informant longitudinal study of first-episode versus chronic patients. Schizophr Res. 2013; 151(1-3):245-51. DOI: 10.1016/j.schres.2013.10.013. View

Song W, Du B, Xu Q, Hu J, Wang M, Luo Y . Low-frequency transcranial magnetic stimulation for visual spatial neglect: a pilot study. J Rehabil Med. 2009; 41(3):162-5. DOI: 10.2340/16501977-0302. View

10.

McEvoy J, Hartman M, Gottlieb D, Godwin S, Apperson L, Wilson W . Common sense, insight, and neuropsychological test performance in schizophrenia patients. Schizophr Bull. 1996; 22(4):635-41. DOI: 10.1093/schbul/22.4.635. View

11.

Bose A, Shivakumar V, Narayanaswamy J, Nawani H, Subramaniam A, Agarwal S . Insight facilitation with add-on tDCS in schizophrenia. Schizophr Res. 2014; 156(1):63-5. DOI: 10.1016/j.schres.2014.03.029. View

12.

Shad M, Keshavan M, Tamminga C, Cullum C, David A . Neurobiological underpinnings of insight deficits in schizophrenia. Int Rev Psychiatry. 2007; 19(4):437-46. DOI: 10.1080/09540260701486324. View

13.

Hirayasu Y, Tanaka S, Shenton M, Salisbury D, DeSantis M, Levitt J . Prefrontal gray matter volume reduction in first episode schizophrenia. Cereb Cortex. 2001; 11(4):374-81. DOI: 10.1093/cercor/11.4.374. View

14.

Alkan E, L H Evans S . Relationships between cognitive performance, clinical insight and regional brain volumes in schizophrenia. Schizophrenia (Heidelb). 2022; 8(1):33. PMC: 9261092. DOI: 10.1038/s41537-022-00243-x. View

15.

Berge D, Carmona S, Rovira M, Bulbena A, Salgado P, Vilarroya O . Gray matter volume deficits and correlation with insight and negative symptoms in first-psychotic-episode subjects. Acta Psychiatr Scand. 2010; 123(6):431-9. DOI: 10.1111/j.1600-0447.2010.01635.x. View

16.

Dlabac-de Lange J, Bais L, van Es F, Visser B, Reinink E, Bakker B . Efficacy of bilateral repetitive transcranial magnetic stimulation for negative symptoms of schizophrenia: results of a multicenter double-blind randomized controlled trial. Psychol Med. 2014; 45(6):1263-75. DOI: 10.1017/S0033291714002360. View

17.

Buchy L, Ad-Dabbagh Y, Malla A, Lepage C, Bodnar M, Joober R . Cortical thickness is associated with poor insight in first-episode psychosis. J Psychiatr Res. 2010; 45(6):781-7. DOI: 10.1016/j.jpsychires.2010.10.016. View

18.

de Natale E, Wilson H, Pagano G, Politis M . Imaging Transplantation in Movement Disorders. Int Rev Neurobiol. 2018; 143:213-263. DOI: 10.1016/bs.irn.2018.10.002. View

19.

Hu M, Zong X, Mann J, Zheng J, Liao Y, Li Z . A Review of the Functional and Anatomical Default Mode Network in Schizophrenia. Neurosci Bull. 2016; 33(1):73-84. PMC: 5567552. DOI: 10.1007/s12264-016-0090-1. View

20.

Detre J, Leigh J, Williams D, Koretsky A . Perfusion imaging. Magn Reson Med. 1992; 23(1):37-45. DOI: 10.1002/mrm.1910230106. View