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Insight, grey matter and cognitive function in first-onset psychosis

  • Kevin D. Morgan (a1), Paola Dazzan (a1), Craig Morgan (a1), Julia Lappin (a1), Gerard Hutchinson (a1), John Suckling (a2), Paul Fearon (a1), Peter B. Jones (a3), Julian Leff (a4), Robin M. Murray (a4) and Anthony S. David (a4)...
Abstract
Background

Several studies have suggested that neuropsychological and structural brain deficits are implicated in poor insight. Few insight studies however have combined neurocognitive and structural neuroanatomical measures.

Aims

Focusing on the ability to relabel psychotic symptoms as pathological, we examined insight, brain structure and neurocognition in first-onset psychosis.

Method

Voxel-based magnetic resonance imaging data were acquired from 82 individuals with psychosis and 91 controls assessed with a brief neuropsychological test battery. Insight was measured using the Schedule for the Assessment of Insight.

Results

The principal analysis showed reduced general neuropsychological function was linked to poor symptom relabelling ability. A subsequent between-psychosis group analysis found those with no symptom relabelling ability had significant global and regional grey matter deficits primarily located at the posterior cingulate gyrus and right precuneus/cuneus.

Conclusions

The cingulate gyrus (as part of a midline cortical system) along with right hemisphere regions may be involved in illness and symptom self-appraisal in first-onset psychosis.

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Copyright
Corresponding author
Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, 309 Regent Street, London W1B 2UW, UK. Email: k.d.morgan@westminster.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Morgan, KD, David, A. Neuropsychological studies of insight in patients with psychotic disorders. In Insight and Psychosis (eds Amador, X, David, A): 177196. Oxford University Press, 2004.
2 Aleman, A, Agrawal, N, Morgan, KD, David, AS. Insight in psychosis and neuropsychological function. Meta-analysis. Br J Psychiatry 2006; 189: 204–12.
3 Shad, MU, Muddasani, S, Keshavan, MS. Prefrontal subregions and dimensions of insight in first-episode schizophrenia – a pilot study. Psychiatry Res 2006; 146: 3542.
4 Flashman, LA, McAllister, TW, Andreasen, NC, Saykin, AJ. Smaller brain size associated with unawareness of illness in patients with schizophrenia. Am J Psychiatry 2000; 157: 1167–9.
5 McEvoy, JP, Johnson, J, Perkins, D, Lieberman, JA, Hamer, RM, Keefe, RS, et al. Insight in first-episode psychosis. Psychol Med 2006; 36: 1385–93.
6 Takai, A, Uematsu, M, Ueki, H, Sone, K, Kaiya, H. Insight and its related factors in chronic-schizophrenic patients – a preliminary study. Euro J Psychiatry 1992; 6: 159–70.
7 Laroi, F, Fannemel, M, Ronneberg, U, Flekkoy, K, Opjordsmoen, S, Dullerud, R, et al. Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Res 2000; 100: 4958.
8 Flashman, LA, McAllister, TW, Johnson, SC, Rick, JH, Green, RL, Saykin, AJ. Specific frontal lobe subregions correlated with unawareness of illness in schizophrenia: a preliminary study. J Neuropsychiatry Clin Neurosci 2001; 13: 255–7.
9 Sapara, A, Cooke, M, Fannon, D, Francis, A, Buchanan, RW, Anilkumar, AP, et al. Prefrontal cortex and insight in schizophrenia: a volumetric MRI study. Schizophr Res 2007; 89: 2234.
10 Haa, T, Youna, T, Haa, K, Rhoc, K, Leed, J, Kimd, I, et al. Grey matter abnormalities in paranoid schizophrenia and their clinical correlations. Psychiatry Res: Neuroimaging 2004; 132: 251–60.
11 Cooke, MA, Fannon, D, Kulpers, E, Peters, E, Williams, SC, Kumari, V. Neurological basis of poor insight in psychosis: a voxel-based MRI study. Schizophr Res 2008; 103: 4051.
12 Bassitt, D, Neto, M, de Castro, C, Busatto, G. Insight and regional brain volumes in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2006; 257: 5862.
13 Rossell, SL, Coakes, J, Shapleske, J, Woodruff, PW, David, AS. Insight: its relationship with cognitive function, brain volume and symptoms in schizophrenia. Psychol Med 2003; 33: 111–9.
14 David, A, van Os, J, Jones, P, Harvey, I, Foerster, A, Fahy, T. Insight and psychotic illness. Cross-sectional and longitudinal associations. Br J Psychiatry 1995; 167: 621–8.
15 David, AS. Insight and psychosis. Br J Psychiatry 1990; 156: 798808.
16 Morgan, C, Dazzan, P, Morgan, K, Jones, P, Harrison, G, Leff, J, et al. First episode psychosis and ethnicity: initial findings from the AESOP study. World Psychiatry 2006; 5: 40–6.
17 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. WHO, 1992.
18 World Health Organization. Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.0). WHO, 1994.
19 Bebbington, P, Nayani, T. The Psychosis Screening Questionnaire. Int J Methods Psychiatric Res 1995; 5: 11–9.
20 Nelson, H, Willison, J. National Adult Reading Test (Part II) Test Manual. nferNelson, 1991.
21 Morgan, KD, Dazzan, P, Orr, KG, Hutchinson, G, Chitnis, X, Suckling, J, et al. Grey matter abnormalities in first-episode schizophrenia and affective psychosis. Br J Psychiatry 2007; 191 (suppl 51): s1116.
22 Wing, JK SE. The PSE-ID-CATEGO System: Supplementary Manual. Medical Research Council, 1978.
23 Kemp, R, David, A. Insight and compliance. In Treatment Compliance and the Therapeutic Alliance (ed Blackwell, B): 6184. Wisconsin, 1997.
24 David, AS, Morgan, KD, Mallett, RM, Leff, J, Murray, R. Insight: unitary or multidimensional phenomenon? Schizophr Res 2003; 60: 14.
25 Weschsler, D. The Wechsler Adult Intelligence Scale – Revised. The Psychological Corporation, 1981.
26 Ravens, J. Coloured Progressive Matrices: Sets A, Ab, B. Oxford Psychologists Press, 1947.
27 Rey, A. L'examen Clinique en Psychologie. [Clinical Examination in Psychology.] Presses Universitaires de France, 1964.
28 Weschsler, D. Wechsler Memory Scale Revised. Psychological Corporation, 1987.
29 Gold, J, Carpenter, C, Randolph, C, Goldberg, T, Weinberger, D. Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Gen Psychiatry 1997; 54: 159–65.
30 Yeudall, L, Fromm, D, Reddon, J, Stefanyk, W. Normative data stratified by age and sex for 12 neuropsychological tests. J Clin Psychol 1986; 42: 918–46.
31 Reitan, R. Validity of the Trail Making Test as an indicator of brain damage. Percept Mot Skills 1958; 8: 271–6.
32 Bullmore, ET, Suckling, J, Overmeyer, S, Rabe-Hesketh, S, Taylor, E, Brammer, MJ. Global, voxel, and cluster tests, by theory and permutation, for a difference between two groups of structural MR images of the brain. IEEE Trans Med Imaging 1999; 18: 3242.
33 Suckling, J, Sigmundsson, T, Greenwood, K, Bullmore, ET. A modified fuzzy clustering algorithm for operator independent brain tissue classification of dual echo MR images. Magn Reson Imaging 1999; 17: 1065–76.
34 Shenton, ME, Dickey, CC, Frumin, M, McCarley, RW. A review of MRI findings in schizophrenia. Schizophr Res 2001; 49: 152.
35 Heinrichs, RW, Zakzanis, KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychol 1998; 12: 426–45.
36 Gusnard, DA, Raichle, ME, Raichle, ME. Searching for a baseline: functional imaging and the resting human brain. Nat Rev Neurosci 2001; 2: 685–94.
37 Spence, SA, Brooks, DJ, Hirsch, SR, Liddle, PF, Meehan, J, Grasby, PM. A PET study of voluntary movement in schizophrenic patients experiencing passivity phenomena (delusions of alien control). Brain 1997; 120 (Pt 11): 19972011.
38 Berti, A, Bottini, G, Gandola, M, Pia, L, Smania, N, Stracciari, A, et al. Shared cortical anatomy for motor awareness and motor control. Science 2005; 309: 488–91.
39 Northoff, G, Heinzel, A, de Greck, M, Bermpohl, F, Dobrowolny, H, Panksepp, J. Self-referential processing in our brain–a meta-analysis of imaging studies on the self. Neuroimage 2006; 31: 440–57.
40 Ries, ML, Jabbar, BM, Schmitz, TW, Trivedi, MA, Gleason, CE, Carlsson, CM, et al. Anosognosia in mild cognitive impairment: relationship to activation of cortical midline structures involved in self-appraisal. J Int Neuropsychol Soc 2007; 13: 450–61.
41 Shergill, SS, Bullmore, ET, Brammer, MJ, Williams, SC, Murray, RM, McGuire, PK. A functional study of auditory verbal imagery. Psychol Med 2001; 31: 241–53.
42 Blakemore, SJ, Rees, G, Frith, CD. How do we predict the consequences of our actions? A functional imaging study. Neuropsychologia 1998; 36: 521–9.
43 Barta, PE, Pearlson, GD, Powers, RE, Richards, SS, Tune, LE. Auditory hallucinations and smaller superior temporal gyral volume in schizophrenia. Am J Psychiatry 1990; 147: 1457–62.
44 Shergill, SS, Cameron, LA, Brammer, MJ, Williams, SC, Murray, RM, McGuire, PK. Modality specific neural correlates of auditory and somatic hallucinations. J Neurol Neurosurg Psychiatry 2001; 71: 688–90.
45 McGlynn, SM, Schacter, DL. Unawareness of deficits in neuropsychological syndromes. J Clin Exp Neuropsychol 1989; 11: 143205.
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Insight, grey matter and cognitive function in first-onset psychosis

  • Kevin D. Morgan (a1), Paola Dazzan (a1), Craig Morgan (a1), Julia Lappin (a1), Gerard Hutchinson (a1), John Suckling (a2), Paul Fearon (a1), Peter B. Jones (a3), Julian Leff (a4), Robin M. Murray (a4) and Anthony S. David (a4)...
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