Voxel-based magnetic resonance imaging investigation of poor and preserved clinical insight in people with schizophrenia

doi:10.5498/wjp.v6.i3.311

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World Journal of Psychiatry

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Case Control Study

World J Psychiatr. Sep 22, 2016; 6(3): 311-321
Published online Sep 22, 2016. doi: 10.5498/wjp.v6.i3.311

Table 1 Demographics and clinical characteristics of the study groups

	Healthy controls (n = 20; 15 male, 5 female)		Patients insight⁺ group (n = 20; 16 male, 4 female)		Patients insight^- group (n = 20; 16 male, 4 female)
	Mean (SD)	Range	Mean (SD)	Range	Mean (SD)	Range
Demographics
Age (yr)	35.25 (10.93)	20-59	36.15 (10.54)	19-54	37.80 (7.85)	22-49
Education (yr)	15.05 (2.86)	10-20	13.45 (2.86)	9-20	13.40 (2.01)	11-19
Predicted IQ (NART)	113.10 (9.91)	91-128	109.20 (10.80)	86-122	106.10 (7.87)	90-119
Clinical characteristics
BIS			11.65 (0.57)	13-14	5.88 (2.05)	1-8
Age at illness onset (yr)			25.90 (8.72)	13-48	23.85 (5.84)	10-37
PANSS positive symptoms			16.15 (5.38)	8-25	17.05 (4.43)	8-23
PANSS negative symptoms			17.20 (4.38)	7-27	18.15 (5.46)	8-27
PANSS general psychopathology			34.35 (7.36)	24-56	31.55 (6.27)	21-40
PANSS total symptoms			67.70 (14.90)	43-108	66.75 (14.02)	37-86
Medication (chlorpromazine equivalent in mg)			461.21 (333.95)	100-1600	556.63 (366.49)	200-1367
Medication type
Atypical antipsychotics			18 (9 olanzapine, 5 risperidone, 3 clozapine, 1 quetiapine)		13 (7 olanzapine, 3 clozapine, 1 aripiprazole, 1 amisulpride, 1 risperidone)
Typical antipsychotics			2 (1 sulpiride, 1 haloperidol)		5 (2 flupenthixol, 1 fluphenazine, 1 sulpiride, 1 haloperidol)
Both			--		2 (1 on clozapine + levomepromazine, 1 zuclopenthixol + aripiprazole)

NART: National Adult Reading Test[44]; BIS: Birchwood insight scale[41]; PANSS: Positive and negative syndrome scale[43].

Table 2 Group differences in grey matter volumes (height threshold P < 0.005)

Groups	BA	Size	Side	MNI			T value	Cluster P FWE-corrected unless in italics	Voxel P FWE-corrected
				X	Y	Z
Insight⁺ > Insight^- patients
Superior temporal gyrus	22	46555	R	63	-3	5	4.91	0.001	0.020
				45	20	-33	4.74		0.034
				66	-8	4	4.68		0.040
Precentral gyrus	4			66	-5	22	4.55		0.057
Inferior frontal gyrus	47			54	19	0	4.52		0.063
Precentral gyrus	6			64	0	26	4.40		0.088
Postcentral gyrus	43			66	-8	16	4.33		0.106
parahippocampus	28			14	0	-27	4.07		0.406
Inferior frontal gyrus	47	103898	L	-41	15	-6	4.81	< 0.001	0.027
Middle frontal gyrus	9			-37	19	35	4.74		0.034
Inferior frontal gyrus	47			-37	15	-10	4.73		0.035
				-35	20	-10	4.54		0.059
Precentral gyrus	44			-59	8	7	4.39		0.091
Superior temporal gyrus	22			-62	-4	8	4.36		0.097
Precentral gyrus	6			-60	4	6	4.33		0.107
Middle temporal gyrus	21			-35	-3	-23	4.27		0.126
parahippocampal gyrus	20			-34	-5	-28	4.16		0.166
Cuneus	18	35993	L	-5	-83	5	4.43	0.003	0.082
Cerebellum	-		R	35	-90	-17	4.26		0.129
Cuneus	18		R	26	-93	-18	3.90		0.305
Cerebellum	-		R	4	-61	2	3.88		0.317
Cuneus	18		R	5	-98	10	3.50		0.630
			R	5	-96	3	3.44		0.674
Cerebellum	-		L	-36	-82	-15	3.38		0.730
Insight^- > Insight⁺ patients
Nil significant
Healthy controls > Insight^- patients
Inferior frontal gyrus	47	35300	L	-49	19	-3	4.63	0.004	0.046
Superior temporal gyrus	22			-60	1	3	4.30		0.115
Inferior frontal gyrus	47			-41	18	-5	4.21		0.144
				-38	22	-8	4.19		0.153
				-36	-1	-14	3.86		0.333
Inferior temporal gyrus	20			-28	-14	-41	3.61		0.530
Parahippocamal gyrus	34			-13	4	-23	3.58		0.552
Middle frontal gyrus	11			-42	40	-19	3.39		0.722
Inferior occipital gyrus	18	11168	L	-38	-92	-2	4.51	0.034	0.065
Middle occipital gyrus	19			-52	-76	-10	4.29		0.117
				-48	-80	-14	3.96		0.266
				-49	-81	7	3.90		0.302
Middle temporal gyrus	39/			-53	-72	22	3.37		0.740
	19			-52	-74	18	3.33		0.768
				-49	-76	20	3.29		0.797
Cerebellum	-	25235	R	35	-90	-17	4.46	0.016	0.074
(posterior lobe)				11	-90	-37	4.21		0.146
Occipital lobe	18			23	-94	-18	4.01		0.238
Cerebellum				34	-85	-40	3.93		0.355
(posterior lobe)				38	-82	-41	3.91		0.489
Insight^- patients > healthy controls
Nil significant
Healthy control > Insight⁺ patients
Nil significant
Insight⁺ patients > healthy controls
Nil significant

BA: Brodmann area; L: Left; R: Right; MNI: Montreal Neurological Institute.

Table 3 Group differences in grey matter volumes after co-varying for education and National Adult Reading Test IQ (height threshold P < 0.005)

Groups	BA	Size	Side	MNI			T value	Cluster P FWE-corrected unless shown in italics	Voxel P FWE-corrected
				X	Y	Z
Insight⁺ > Insight^- patients
Superior Temporal gyrus	22	37261	R	63	-3	5	4.70	0.002	0.044
				45	20	-33	4.56		0.066
				66	-8	4	4.45		0.088
Precentral gyrus	4			66	-5	22	4.44		0.092
Inferior frontal gyrus	47			54	19	0	4.39		0.103
Precentral gyrus	6			64	0	26	4.28		0.137
Postcentral gyrus	43			66	-8	16	4.15		0.192
Inferior frontal gyrus	47	65047	L	-42	16	-4	4.65	< 0.001	0.050
				-38	14	-8	4.65		0.052
				-36	18	-10	4.52		0.073
Middle frontal gyrus	9			-37	19	35	4.52		0.073
Superior temporal gyrus	22			-61	-2	7	4.28		0.139
Precentral gyrus	44			-59	9	9	4.17		0.184
Parahippocampual gyrus	21			-34	-3	-36	4.10		0.213
Cuneus	18	24291	L	-5	-83	5	4.32	0.014	0.125
Cerebellum	-		R	35	-90	-17	4.17		0.181
Cuneus	18		R	26	-93	-18	3.73		0.466
Cerebellum	-		R	4	-61	2	3.80		0.409
Cuneus	18		R	5	-98	10	3.35		0.787
Medial frontal gyrus	10	16854	L	0	60	3	3.98	0.050	0.285
Superior frontal gyrus	9			0	51	26	3.64		0.544
Insight^- > Insight⁺ patients
Nil significant
Healthy controls > Insight^- patients
Inferior frontal gyrus	47	9770	L	-51	19	-2	3.68	0.036	0.511
Superior temporal gyrus	38			-21	5	-24	3.35		0.786
Inferior frontal gyrus	47			-26	18	-7	3.34		0.796
Parahippocampal gyrus	34			-16	4	-23	3.29		0.827
Inferior occipital gyrus	18	4935	L	-38	-92	-2	3.92	0.122	0.323
Middle occipital gyrus	19			-52	-76	-10	3.70		0.494
				-44	-83	8	3.37		0.775
Middle temporal gyrus	18			-43	-81	13	3.22		0.873
Cerebellum (posterior lobe)	-	6085	R	35	-90	-17	3.68	0.089	0.304
				11	-90	-37	3.60		0.378
Occipital lobe	18			28	-94	-16	3.32		0.656
				23	-94	-18	3.26		0.713
Insight^- patients > healthy controls
Nil significant
Healthy controls > Insight⁺ patients
Nil significant
Insight⁺ patients > healthy controls
Nil significant

BA: Brodmann area; L: Left; R: Right; MNI: Montreal Neurological Institute.

Citation: Sapara A, Ffytche DH, Cooke MA, Williams SC, Kumari V. Voxel-based magnetic resonance imaging investigation of poor and preserved clinical insight in people with schizophrenia. World J Psychiatr 2016; 6(3): 311-321
URL: https://www.wjgnet.com/2220-3206/full/v6/i3/311.htm
DOI: https://dx.doi.org/10.5498/wjp.v6.i3.311