Clarifying associations between cortical thickness, subcortical structures, and a comprehensive assessment of clinical insight in enduring schizophrenia

Schizophr Res. 2019 Feb;204:245-252. doi: 10.1016/j.schres.2018.08.024. Epub 2018 Aug 24.


Background: The relationship between poor insight and less favorable outcomes in schizophrenia has promoted research efforts to understand its neurobiological basis. Thus far, research on neural correlates of insight has been constrained by small samples, incomplete insight assessments, and a focus on frontal lobes. The purpose of this study was to examine associations of cortical thickness and subcortical volumes, with a comprehensive assessment of clinical insight, in a large sample of enduring schizophrenia patients.

Methods: Two dimensions of clinical insight previously identified by a factor analysis of 4 insight assessments were used: Awareness of Illness and Need for Treatment (AINT) and Awareness of Symptoms and Consequences (ASC). T1-weighted structural images were acquired on a 3 T MRI scanner for 110 schizophrenia patients and 69 healthy controls. MR images were processed using CIVET (version 2.0) and MAGeT and quality controlled pre and post-processing. Whole-brain and region-of-interest, vertex-wise linear models were applied between cortical thickness, and levels of AINT and ASC. Partial correlations were conducted between volumes of the amygdala, thalamus, striatum, and hippocampus and insight levels.

Results: No significant associations between both insight factors and cortical thickness were observed. Moreover, no significant associations emerged between subcortical volumes and both insight factors.

Conclusions: These results do not replicate previous findings obtained with smaller samples using single-item measures of insight into illness, suggesting a limited role of neurobiological factors and a greater role of psychological processes in explaining levels of clinical insight.

Keywords: Awareness of illness; Clinical insight; Cortical thickness; Enduring schizophrenia; Magnetic resonance imaging; Subcortical volume.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Amygdala / diagnostic imaging
  • Amygdala / pathology
  • Awareness / physiology*
  • Basal Ganglia / diagnostic imaging
  • Basal Ganglia / pathology*
  • Cerebral Cortex / diagnostic imaging
  • Cerebral Cortex / pathology*
  • Corpus Striatum / diagnostic imaging
  • Corpus Striatum / pathology
  • Diagnostic Self Evaluation*
  • Female
  • Hippocampus / diagnostic imaging
  • Hippocampus / pathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Schizophrenia / diagnostic imaging
  • Schizophrenia / pathology*
  • Schizophrenia / physiopathology*
  • Thalamus / diagnostic imaging
  • Thalamus / pathology*
  • Young Adult

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