Self-evaluation in schizophrenia an fMRI study with implications for the understanding of insight 英文参考文献.docVIP

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Self-evaluation in schizophrenia an fMRI study with implications for the understanding of insight 英文参考文献.doc

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Self-evaluation in schizophrenia an fMRI study with implications for the understanding of insight 英文参考文献

Bedfordetal.BMCPsychiatry2012,12:106 /1471-244X/12/106 RESEARCH ARTICLE OpenAccess Self-evaluationinschizophrenia:anfMRIstudy withimplicationsfortheunderstandingofinsight NicholasJBedford1,SimonSurguladze1,VincentGiampietro2,MichaelJBrammer2andAnthonySDavid1* Abstract Background:Lackofinsightisacorefeatureofschizophreniaandisassociatedwithstructuralbrainabnormalities. Thefunctionalneuroanatomyofinsighthasonlyrecentlybeeninvestigated.Whenpeopleevaluatetheir personalitytraitscomparedtothoseofanother,activationisseenincentralmidlinestructures(CMS)ofthebrain. Thisstudysetouttocomparecerebralactivationinschizophreniapatientsversuscontrolsduringaself-evaluation taskwhichincludedpositiveandnegativetraitsaswellasmentalandphysicalillnessterms. Methods:Elevenschizophreniapatientsand8healthycontrols,matchedforagewerestudied.Insightwas assessedusingtheSchedulefortheAssessmentofInsight-expandedversion(SAI-E).FMRIdatawereobtainedwith a1.5TeslaGEsystemandinteractionsbetweenparticipantgroup,selfversusother,significantattheclusterlevel, wererecorded. Results:Significanthypoactivationinthemedialsuperiorfrontalgyrus(dorsomedialprefrontalcortex)was observedinpatientsvs.controlsduringself-evaluationofalltraitscombined.Asecondclusterofhypoactivationin theposteriorcingulatewasalsodetected.Whentheresponsetoindividualtraitswasexplored,underactivationin otherfrontalregionsplusrightinferiorparietallobuleemergedandthistendedtocorrelate,albeitweaklywith lowerinsightscores.Further,therewereareasofhyperactivationrelativetocontrolsinanteriorcingulate,frontal andparietalregions(especiallyprecuneus)whichshowedmoderateinversecorrelationswithinsightscores. Conclusions:WehavedemonstratedthattheCMS,identifiedasakeysystemunderpinningself-evaluation,is dysfunctionalinpatientswithschizophrenia,particularlydorso-medialPFC.Thismayhaveimplicationsforlackof insightinschizophrenia.Hypofunctionwithinthedorsomedialprefrontalregionseemstobeparticularlyimportant althoughotherposteriorandlateralcorticalregionspla