Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests

Larøi, Frank; Fannemel, Madeleine; Rønneberg, Unni; Flekkøy, Kjell; Opjordsmoen, Stein; Dullerud, R.; Haakonsen, Monika

doi:10.1016/s0925-4927(00)00063-9

Cited by 117 publications

(75 citation statements)

References 37 publications

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“…Similarly, most patients showed awareness of the symptoms they presented, and yet moderate to high misattribution of these to causes other than mental illness. This pattern of results is consistent with descriptions of insight in samples of similar characteristics using the SUMD Laroi et al, 2000; . Lack of direct significant associations between ToM and each of the insight dimensions was in line with previous preliminary findings in the literature using global (Boos, MPhil thesis; or dimensional insight measures, indicating that clinical manifestation of these phenomena are distinct, although this should be interpreted with caution given substantial differences regarding sample characteristics and ToM measures between studies.…”

Section: Discussionsupporting

confidence: 87%

“…Además fueron comparables a los resultados obtenidos con muestras de similares característi-cas [35][36][37][38] . Por otra parte, las subescalas de conciencia y atribución, aunque parcialmente dependientes, no se correlacionaron entre ellas, corroborando la idea de que las dos subescalas están valorando fenómenos al menos parcialmente independientes.…”

Section: Discussionunclassified

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Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients

Pousa

Duñó

Navarro

et al. 2008

Cognitive Neuropsychiatry

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Section: Discussionsupporting

confidence: 87%

Section: Discussionunclassified

Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients

Pousa

Duñó

Navarro

et al. 2008

Cognitive Neuropsychiatry

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“…The differences between subgroup with poor/fair insight and with good insight approached statistical significance (p = 0.055), and subjects with good insight did not differ from controls. Our results are in agreement with the theory that unawareness of illness in schizophrenia may be due to atrophy of the IPL 18 and of the PFC 7,18 . The data suggest that lack of insight in schizophrenia may be associated with a deficit in oligodendrocytes in the grey matter of the IPL.…”

Section: Oligodendrocyte Density and Insightsupporting

confidence: 92%

“…A study using computerized tomography (CT) reported frontal lobe atrophy 7 . Eleven studies used magnetic resonance imaging (MRI); three reported that lack of insight was associated with ventricular enlargement 8 ,brain size 9 or cortical thickness 10 , four reported associations with frontal lobe structures [11][12][13][14] , and the cingulate and precuneus [15][16][17] and/or temporal and inferior parietal areas 18 .…”

Section: Introductionmentioning

confidence: 99%

Reduced oligodendroglial density in the inferior parietal lobule and lack of insight in schizophrenia

2013

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-Background and Objectives: Alterations and deficits of oligodendrocytes reported in the grey and white matter in schizophrenia may contribute to neuronal disconnectivity. Prefrontal-parietal functional disconnections have been implicated in diverse clinical symptoms of schizophrenia, including poor insight. We studied the effects of schizophrenia diagnosis and insight on numerical density (Nv) of oligodendrocytes in the inferior parietal lobule (IPL).Methods: Nissl-stained sections from the Stanley "Parietal Collection" from male schizophrenia subjects (n = 24) having poor, fair, or good insight and healthy matched controls (n = 24) were examined. The Nv of oligodendrocytes was estimated in layer 3 of BA 39 and BA 40 of the IPL and in white matter underlying layer 6 by optical dissector method.Results: In BA 39 we found a significant 15% decrease in the Nv of oligodendrocytes in layer 3 in the schizophrenia group. Nv of oligodendrocytes in the poor+fair insight subgroup was 20% lower compared to controls (p< 0.05) and to good insight subgroup (p = 0.055). Nv of oligodendrocytes in the good insight subgroup did not differ from the control group. A significant lateralization of oligodendrocyte density was detected in layer 3 (L>R) only in the control group. There were no significant group differences in the Nv of oligodendrocytes in BA 40 or in the white matter underlying BA 39/40 areas.Conclusions: Lack of insight in schizophrenia may be associated with a deficit of oligodendroglia in the grey matter of IPL.

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“…7,23,63 However, it is unclear whether frontal lobe volume loss is a cause or a consequence of ongoing symptoms; some data suggest that volume loss is exacerbated with repeated episodes of psychosis. 5,118 The reason for this progression has not been fully elucidated, but it has been proposed that prefrontal dysfunction is secondary to aberrant dopamine release and corresponding alterations in D 1/2 -receptor signaling.…”

Section: Structural Pathology In Schizophreniamentioning

confidence: 99%

Neurosurgery for schizophrenia: an update on pathophysiology and a novel therapeutic target

Mikell

Sinha

Sheth

2016

JNS

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Schizophrenia is a heterogeneous disorder characterized by varying degrees of positive psychotic symptoms, negative symptoms, and cognitive impairment. 48 With a prevalence of 1.1% in the US, 93 schizophrenia is a major health burden, increasing the risk for numerous adverse outcomes, including the inability to maintain a stable residence, maintain a job, or find a spouse. 39Moreover, 10%-30% of patients with schizophrenia have little or no response to antipsychotic treatment. 68 Limited treatment options are available after first-line therapies have failed. Potential therapies for refractory schizophrenia include clozapine, electroconvulsive therapy, and repetitive transcranial magnetic stimulation (rTMS), but many patients continue to have symptoms despite maximal medical management.57 New treatment strategies are therefore needed.Although deep brain stimulation (DBS) is chiefly used in the treatment of movement disorders, its use in behavioral disorders is expanding. In 2009, the FDA awarded DBS a humanitarian device exemption (HDE) for obsessive-compulsive disorder (OCD). Given preliminary evidence of efficacy in OCD, 29,33,69,91 the use of DBS to treat other psychiatric disorders, including depression, Tourette syndrome, and even autism, is expanding. 111 Currently, interest in treating schizophrenia using DBS is growing, and a clinical trial is now open in Canada for the treatment of refractory schizophrenia. 16 Moreover, the growing use of DBS for behavioral indications has been accompanied by an expansion in understanding of the underlying pathophysiology of psychiatric disease. In the case of schizophrenia, there is increasing acceptance that the disorder is characterized by dysfunction in the hippocampus and striatum, suggesting possible targets for intervention. 54Given our increasing understanding of the neuroanatomy of schizophrenia, the time is ripe for the development of novel circuit-based therapies, including DBS.abbreviatioNs AST = associative striatum; BOLD = blood oxygen level-dependent; cSP = cortical silent period; DBS = deep brain stimulation; DLPFC = dorsolateral prefrontal cortex; fMRI = functional MRI; GABA = gamma-aminobutyric acid; HDE = humanitarian device exemption; MDD = major depressive disorder; NMDA = N-methyl-daspartate; OCD = obsessive-compulsive disorder; rCBF = regional cerebral blood flow; rTMS = repetitive TMS; SICI = short-interval intracortical inhibition; TMS = transcranial magnetic stimulation; VBM = voxel-based morphometry; VS = ventral striatum; VTA = ventral tegmental area. The main objectives of this review were to provide an update on the progress made in understanding specific circuit abnormalities leading to psychotic symptoms in schizophrenia and to propose rational targets for therapeutic deep brain stimulation (DBS). Refractory schizophrenia remains a major unsolved clinical problem, with 10%-30% of patients not responding to standard treatment options. Progress made over the last decade was analyzed through reviewing structural and functional neuroimaging s...

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Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests

Cited by 117 publications

References 37 publications

Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients

Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients

Reduced oligodendroglial density in the inferior parietal lobule and lack of insight in schizophrenia

Neurosurgery for schizophrenia: an update on pathophysiology and a novel therapeutic target

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