354
Views
60
CrossRef citations to date
0
Altmetric
Original

Neurobiological underpinnings of insight deficits in schizophrenia

, , , &
Pages 437-446 | Published online: 11 Jul 2009

References

  • Aleman A, Agrawal N, Morgan K, David AS. Insight in psychosis and neuropsychological function: Meta-analysis. British Journal of Psychiatry 2006; 2006: 204–212
  • Alexander M, Stuss DT. Frontal injury: Impairments of fundamental processes lead to functional consequences. Journal of International Neuropsychological Society 2006; 12(2)192–193
  • Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. American Journal of Psychiatry 1993; 150(6)873–879
  • Amador XF, Flaum M, Andreason NC, Strauss DH, Yale SA, Clark SC. Awareness of illness in schizophrenia, schizoaffective and mood disorders. Arch Gen Psychiatry 1994; 51: 826–836
  • Amador X, David A. Insight and psychosis: Awareness of illness in schizophrenia and related disorders. Oxford University Press, Oxford 2004
  • Ascher-Svanum H, Faries DE, Zhu B, Ernst FR, Swartz MS, Swanson JW. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry 2006; 67(3)453–460
  • Bayliss DM, Jarrold C, Baddeley AD, Gunn DM. The relationship between short-term memory and working memory: Complex span made simple?. Memory 2005; 13(3–4)414–421
  • Bolla KI, Eldreth DA, London ED, Kiehl KA, Mouratidis M, Contoreggi C, et al. Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task. NeuroImage 2003; 19(3)1085–1094
  • Bor D, Owen AM. A common prefrontal-parietal network for mnemonic and mathematical recoding strategies within working memory. Cereb Cortex 2007; 17(4)778–786
  • Buckley PF, Hasan S, Friedman L, Cerny C. Insight and schizophrenia. Compr Psychiatry 2001; 42(1)39–41
  • Buchsbaum BR, Greer S, Chang WL, Berman KF. Meta-analysis of neuroimaging studies of the Wisconsin Card-Sorting Task and component processes. Human Brain Mapping 2005; 25: 35–45
  • Catafau AM, Parellada E, Lomena FJ, Bernardo M, Pavia J, Ros D, et al. Prefrontal and temporal blood flow in schizophrenia: Resting and activation technetium-99m-HMPAO SPECT patterns in young neuroleptic-naive patients with acute disease. Journal Nuclear Medicine 1994; 35: 935–941
  • Chen EY, Kwok CL, Chen RY, Kwong PP. Insight changes in acute psychotic episodes: A prospective study of Hong Kong Chinese patients. J Nerv Ment Dis 2001; 189(1)24–30
  • Corcoran R, Upton D. A role for the hippocampus in card sorting?. Cortex 1993; 29: 293–304
  • Crowe DA, Averbeck BB, Chafee MV, Georgopoulos AP. Dynamics of parietal neural activity during spatial cognitive processing. Neuron 2005; 47(6)885–891
  • Cuesta MJ, Peralta V, Zarzuela A. Psychopathological dimensions and lack of insight in schizophrenia. Psychol Rep 1998; 83: 895–898
  • David AS. Insight and psychosis. British Journal of Psychiatry 1990; 156: 798–808
  • David A, Buchanan A, Reed A, Almeida O. The assessment of insight in psychosis. British Journal of Psychiatry 1992; 161: 599–602
  • David A, van Os J, Jones P, Harvey I, Foerster A, Fahy T. Insight and psychotic illness: Cross-sectional and longitudinal associations. British Journal of Psychiatry 1995; 167(5)621–628
  • Debowska G, Grzywa A, Kucharska-Pietura K. Insight in paranoid schizophrenia–its relationship to psychopathology and premorbid adjustment. Compr Psychiatry 1998; 39(5)255–260
  • Demakis GJ. A meta-analytic review of the sensitivity of the Wisconsin Card Sorting Test to frontal and lateralized frontal brain damage. Neuropsychology 2003; 17: 255–264
  • Dickerson FB, Boronow JJ, Ringel N, Parente F. Lack of insight among outpatients with schizophrenia. Psychiatr Serv 1997; 48: 195–199
  • Drake RJ, Lewis SW. Insight and neurocognition in schizophrenia. Schizophrenia Research 2002; 62: 165–173
  • Erickson KI, Milham MP, Colcombe SJ, Kramer AF, Banich MT, Webb A, et al. Behavioral conflict, anterior cingulate cortex, and experiment duration: Implications of diverging data. Hum Brain Mapp 2004; 21(2)98–107
  • 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(2)255–257
  • Fox MT, Barense MD, Baxter MG. Perceptual attentional set-shifting is impaired in rats with neurotoxic lesions of posterior parietal cortex. J Neurosci 2003; 23(2)676–81
  • Freudenreich O, Deckersbach T, Goff DC. Insight into current symptoms of schizophrenia. Association with frontal cortical function and affect. Acta Psychiatrica Scandinavica 2004; 110: 14–20
  • Goldstein B, Obrzut JE, John C, Ledakis G, Armstrong CL. The impact of frontal and non-frontal brain tumor lesions on Wisconsin Card Sorting Test performance. Brain Cognition 2004; 54: 110–116
  • Haro MJ, Ochoa S, Cabrero L. Insight and use of health resources in patients with schizophrenia. Actas Esp Psiquiatr 2001; 29(2)103–108
  • Hart T, Whyte J, Kim J, Vaccaro M. Executive function and self-awareness of "real-world" behavior and attention deficits following traumatic brain injury. J Head Trauma Rehabil 2005; 20(4)333–347
  • Haut MW, Cahill J, Cutlip WD, Stevenson JM, Makela EH, Bloomfield SM. On the nature of Wisconsin Card Sorting Test performance in schizophrenia. Psychiatry Research 1996; 65: 15–22
  • Heaton R. Wisconsin Card Sorting Test manual. Psychological Assessment Resources, Inc, Odessa, FL 1981
  • Hermann BP, Wyler AR. Effects of anterior temporal lobectomy on language function: A controlled study. Annals of Neurology 1988; 23: 585–588
  • Hui CL, Chen EY, Kan CS, Yip KC, Law CW, Chiu CP. Detection of non-adherent behaviour in early psychosis. Aust N Z J Psychiatry 2006; 40(5)446–451
  • Johnson SC, Baxter LC, Wilder LS, Pipe JG, Heiserman JE, Prigatano GP. Neural correlates of self-reflection. Brain 2002; 125: 1808–1814
  • Kapur S. Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry 2003; 160(1)13–23
  • Kashiwa Y, Kitabayashi Y, Narumoto J, Nakamura K, Ueda H, Fukui K. Anosognosia in Alzheimer's disease: Association with patient characteristics, psychiatric symptoms and cognitive deficits. Psychiatry Clin Neurosci 2005; 59(6)697–704
  • Kelley WM, Macrae CN, Wyland CL, Caglar S, Inati S, Heatherton TF. Finding the self? An event-related fMRI study. J Cogn Neurosci 2002; 14(5)785–794
  • Kelly BD, Clarke M, Browne S, McTigue O, Kamali M, Gervin M, et al. Clinical predictors of admission status in first episode schizophrenia. Eur Psychiatry 2004; 19(2)67–71
  • Kemp RA, Lambert TJ. Insight in schizophrenia and the relationship to psychopathology. Schizophr Res 1995; 18: 21–28
  • Kemp R, David A. Insight and compliance. Compliance and the treatment alliance in serious mental illness, B Blackwell. Gordon & Breach, Newark, NJ 1996
  • Kerns JG, Cohen JD, MacDonald AW, Johnson MK, Stenger VA, Aizenstein H, et al. Decreased conflict- and error-related activity in the anterior cingulate cortex in subjects with schizophrenia. Am J Psychiatry 2005; 162(10)1833–1839
  • Keshavan MS, Rabinowitz J, DeSmedt G, Harvey PD, Schooler N. Correlates of insight in first episode psychosis. Schizophr Res 2004; 70(2–3)187–194
  • Kester HM, Sevy S, Yechiam E, Burdick KE, Cervellione KL, Kumra S. Decision-making impairments in adolescents with early-onset schizophrenia. Schizophr Res 2006; 85(1–3)113–123
  • Kim Y, Sakamoto K, Kamo T, Sakamura Y, Miyaoka H. Insight and clinical correlates in schizophrenia. Comp Psychiatry 1997; 38: 117–123
  • Koren D, Seidman LJ, Poyurovsky M, Goldsmith M, Viksman P, Zichel S, et al. The neuropsychological basis of insight in first-episode schizophrenia: A pilot metacognitive study. Schizophrenia Research 2004; 70: 195–202
  • Krain AL, Wilson AM, Arbuckle R, Castellanos FX, Milham MP. Distinct neural mechanisms of risk and ambiguity: A meta-analysis of decision-making. NeuroImage 2006; 32(1)477–484
  • Kurtz MM, Wexler BE. Differences in performance and learning proficiency on the Wisconsin Card Sorting Test in schizophrenia: Do they reflect distinct neurocognitive subtypes with distinct functional profiles?. Schizophr Res 2006; 81(2-3)167–171
  • 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: Neuroimaging Section 2000; 100: 49–58
  • Leys D, Steinling M, Petit H, Salomez JL, Gaudet Y, Ovelacq E, et al. Alzheimer's disease: Study by single photon emission tomography (Hm PAO Tc99m). Rev Neurol (Paris) 1989; 145(6–7)443–450
  • Lie CH, Specht K, Marshall JC, Fink GR. Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test. NeuroImage 2006; 30: 1038–1049
  • Liston C, Matalon S, Hare TA, Davidson MC, Casey BJ. Anterior cingulate and posterior parietal cortices are sensitive to dissociable forms of conflict in a task-switching paradigm. Neuron 2006; 50(4)643–653
  • Lopez OL, Becker JT, Somsak D, Dew MA, DeKosky ST. Awareness of cognitive deficits and anosognosia in probable Alzheimer's disease. European Neurology 1994; 34(5)277–282
  • Lysaker PH, Bell MD. Insight and cognitive impairment in schizophrenia: Performance on repeated administrations of the Wisconsin Card Sorting Test. J Nerv Ment Dis 1994; 182: 656–660
  • Lysaker PH, Bell MD, Bryson G, Kaplan E. Neurocognitive function and insight in schizophrenia: Support for an association with impairments in executive function but not with impairments in global function. Acta Psychiatr Scand 1998; 97: 297–301
  • Lysaker PH, Bryson GJ, Bell MD. Insight and work performance in schizophrenia. Journal of Nervous and Mental Disease 2002; 190: 142–146
  • Lysaker PH, Bryson GJ, Lancaster RS, Evans JD, Bell MD. Insight in schizophrenia: Associations with executive function and coping style. Schizophrenia Research 2003; 59: 41–47
  • Maltby N, Tolin DF, Worhunsky P, O'Keefe TM, Kiehl KA. Dysfunctional action monitoring hyperactivates frontal-striatal circuits in obsessive-compulsive disorder: An event-related fMRI study. Neuroimage 2005; 24(2)495–503
  • Marenco S, Coppola R, Daniel DG, Zigun JR, Weinberger DR. Regional cerebral blood flow during the Wisconsin Card Sorting Test in normal subjects studied by xenon-133 dynamic SPECT: Comparison of absolute values, percent distribution values, and covariance analysis. Psychiatry Research 1993; 50: 177–192
  • Marks KA, Fastenau PS, Lysaker PH, Bond GR. Self-Appraisal of Illness Questionnaire (SAIQ): Relationship to researcher-rated insight and neuropsychological function in schizophrenia. Schizophr Res 2000; 45(3)203–211
  • Marshuetz C, Smith EE, Jonides J, DeGutis J, Chenevert TL. Order information in working memory: fMRI evidence for parietal and prefrontal mechanisms. J Cogn Neurosci 2000; 12(Suppl. 2)130–144
  • McEvoy JP, Freter S, Everett G, Geller JL, Appelbaum PS, Apperson LJ. Insight and the clinical outcome of schizophrenia patients. J Nerv Ment Dis 1989; 177: 48–51
  • McEvoy JP, Hartman M, Gottlieb D, Godwin S, Apperson LJ., Wilson W. Common sense, insight, and neuropsychological test performance in schizophrenic patients. Schizophr Bull 1996; 22: 635–641
  • McGlynn SM, Schacter DL. Unawareness of deficits in neuropsychological syndromes. Journal of Clinical & Experimental Neuropsychological 1989; 11: 143–205
  • Mendez MF, Shapira JS. Loss of insight and functional neuroimaging in frontotemporal dementia. J Neuropsychiatry Clin Neurosci 2005; 17(3)413–416
  • Michon A, Deweer B, Pillon B, Agid Y, Dubois B. Relation of anosognosia to frontal lobe dysfunction in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1994; 57(7)805–809
  • Mintz AR, Addington J, Addington D. Insight in early psychosis: A 1-year follow-up. Schizophrenia Research 2003a; 67: 213–217
  • Mintz AR, Dobson KS, Romney D. Insight in schizophrenia: A meta-analysis. Schizophrenia Research 2003b; 61: 75–88
  • Moll J, de Oliveira-Souza R, Moll FT, Bramati IE, Andreiuolo PA. The cerebral correlates of set-shifting: An fMRI study of the trail making test. Arq Neuropsiquiatr 2002; 60(4)900–905
  • Nagahama Y, Okina T, Suzuki N, Nabatame H, Matsuda M. The cerebral correlates of different types of perseveration in the Wisconsin Card Sorting Test. J Neurol Neurosurg Psychiatry 2005; 76(2)169–175
  • Pia L, Neppi-Modona M, Ricci R, Berti A. The anatomy of anosognosia for hemiplegia: A meta-analysis. Cortex 2004; 40(2)367–377
  • Picton TW, Stuss DT, Alexander MP, Shallice T, Binns MA, Gillingham S. Effects of Focal Frontal Lesions on Response Inhibition. Cereb Cortex 2007; 17: 826–838
  • Reed BR, Jagust WJ, Coulter L. Anosognosia in Alzheimer's disease: Relationships to depression, cognitive function, and cerebral perfusion. Journal of Clinical and Experimental Neuropsychology 1993; 15(2)231–244
  • Rezai K, Andreasen NC, Alliger R, Cohen G, Swayze II V, O'Leary DS. The neuropsychology of the prefrontal cortex. Archives of Neurology 1993; 50: 636–642
  • 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(1)111–119
  • Rubia K, Smith AB, Woolley J, Nosarti C, Heyman I, Taylor E, et al. Progressive increase of frontostriatal brain activation from childhood to adulthood during event-related tasks of cognitive control. Hum Brain Mapp 2006; 27(12)973–993
  • Salmon E, Lespagnard S, Marique P, Peeters F, Herholz K, Perani D, et al. Cerebral metabolic correlates of four dementia scales in Alzheimer's disease. J Neurol 2006; 252(3)283–290
  • Sanz M, Constable G, Lopez-Ibor I, Kemp R, David AS. A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychol Med 1998; 28(2)437–446
  • Sartorius N, Shapiro R, Kimura M, Barrett K. WHO international pilot study of schizophrenia. Psychol Med 1972; 2(4)422–425
  • Schmitz TW, Kawahara-Baccus TN, Johnson SC. Metacognitive evaluation, self-relevance, and the right prefrontal cortex. Neuroimage 2004; 22(2)941–947
  • Schultz W, Tremblay L, Hollerman JR. Reward processing in primate orbitofrontal cortex and basal ganglia. Cereb Cortex 2000; 10(3)272–284
  • Schwartz RC, Cohen BN, Grubaugh A. Does insight affect long-term impatient treatment outcome in chronic schizophrenia?. Compr Psychiatry 1997; 38(5)283–288
  • Schwartz RC, Petersen S. The relationship between insight and suicidality among patients with schizophrenia. J Nerv Ment Dis 1999; 187(6)376–378
  • Schwartz RC, Skaggs JI, Peterson S. Critique of recent empirical research on insight and psychopathology in schizophrenia. Psychological Reports 2000; 86: 471–474
  • Shad MU, Muddasani S, Sahni SD, Keshavan MS. Insight and Prefrontal Cortex in First-episode Schizophrenia. NeuroImage 2004; 22(3)1315–1320
  • Shad MU, Muddasani S, Keshavan MS. Prefrontal subregions and dimensions of insight in first-episode schizophrenia–a pilot study. Psychiatry Res 2006a; 146(1)35–42
  • Shad MU, Haas GL, Tamminga CA, Rilling L, Keshavan MS. Insight and prefrontal function in schizophrenia: A review. Schizophrenia Research 2006b; 86: 54–70
  • Shad MU, Muddasani S, Thomas B, Chin, Eamma, Tamminga CA. Neurobiological Correlates of insight in schizophrenia. Abstract presented at the annual meeting of Society for Biological Psychiatry in May 2006. TorontoCanada 2006C
  • Shad MU, Muddasani S, Moore D, Tamminga CA. Insight and parietal cortical volume in schizophrenia. Accepted for presentation at the International Congress of Schizophrenia Research meeting in April 2007. Colorado Spring, COUSA 2007a
  • Shad MU, Muddasani S, Thomas B, Tamminga CA. Structural correlates of poor insight in schizophrenia. Submitted to be presented at the annual meeting of Society of Biological Psychiatry in May 2007. San Diego, CAUSA 2007b
  • Sherer M, Hart T, Whyte J, Nick TG, Yablon SA. Neuroanatomic basis of impaired self-awareness after traumatic brain injury: Findings from early computed tomography. J Head Trauma Rehabil 2005; 20(4)287–300
  • Shurman B, Horan WP, Nuechterlein KH. Schizophrenia patients demonstrate a distinctive pattern of decision-making impairment on the Iowa Gambling Task. Schizophr Res 2005; 72(2–3)215–224
  • Smith AB, Taylor E, Brammer M, Rubia K. Neural correlates of switching set as measured in fast, event-related functional magnetic resonance imaging. Human Brain Mapping 2004; 21: 247–256
  • Smith EE, Jonides J. Storage and executive processes in the frontal lobes. Science 1999; 283(5408)1657–1661
  • Smith TE, Hull JW, Israel LM, Willson DF. Insight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder. Schizophr Bull 2000; 26(1)193–200
  • Starkstein SE, Vazquez S, Migliorelli R, Teson A, Sabe L, Leiguarda R. A single-photon emission computed tomographic study of anosognosia in Alzheimer's disease. Arch Neurol 1995; 52(4)415–420
  • Startup M. Insight and cognitive deficits in schizophrenia: Evidence for a curvilinear relationship. Psychological Medicine 1996; 26: 1277–1281
  • Stuss DT, Benson DF. The Frontal Lobes. Raven Press, New York 1986
  • Stuss DT, Levine B, Alexander MP, Hong J, Palumbo C, Hamer L, et al. Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: Effects of lesion location and test structure on separable cognitive processes. Neuropsychologia 2000; 38: 388–402
  • Stuss DT, Knight RT. Principles of Frontal Lobe Function. Oxford University Press, New York 2002
  • Sylvester CY, Wager TD, Lacey SC, Hernandez L, Nichols TE, Smith EE, et al. Switching attention and resolving interference: fMRI measures of executive functions. Neuropsychologia 2003; 41(3)357–370
  • Takai A, Uematsu M, Ueki H, Sone K, Kaiya H. Insight and its related factors in chronic schizophrenic patients: A preliminary study. Eur J Psychiatry 1992; 6: 159–170
  • Trouillet R, Gely-Nargeot MC, Derouesne C. Unawareness of deficits in Alzheimer's disease: A multidimentional approach. Psychol Neuropsychiatr Vieil 2003; 1(2)99–110
  • Upton D, Corcoran R. The role of the right temporal lobe in card sorting: A case study. Cortex 1995; 31: 405–409
  • Veltman DJ, Rombouts SA, Dolan RJ. Maintenance versus manipulation in verbal working memory revisited: An fMRI study. NeuroImage 2003; 18(2)247–256
  • Vogel A, Hasselbalch SG, Gade A, Ziebell M, Waldemar G. Cognitive and functional neuroimaging correlate for anosognosia in mild cognitive impairment and Alzheimer's disease. Int J Geriatr Psychiatry 2005; 20(3)238–246
  • Volkow ND, Wang GJ, Ma Y, Fowler JS, Wong C, Ding YS, et al. Activation of orbital and medial prefrontal cortex by methylphenidate in cocaine-addicted subjects but not in controls: Relevance to addiction. J Neurosci 2005; 25(15)3932–3939
  • Voruganti LN, Heslegrave RJ, Awad AG. Neurocognitive correlates of positive and negative syndromes in schizophrenia. Can J Psychiatry 1997; 42(10)1066–1071
  • Wagner AD, Maril A, Bjork RA, Schacter DL. Prefrontal contributions to executive control: fMRI evidence for functional distinctions within lateral prefrontal cortex. NeuroImage 2001; 14(6)1337–1347
  • Wager TD, Smith EE. Neuroimaging studies of working memory: A meta-analysis. Cogn Affect Behav Neurosci 2003; 3(4)255–274
  • Wager TD, Jonides J, Reading S. Neuroimaging studies of shifting attention: A meta-analysis. NeuroImage 2004; 22(4)1679–1693
  • Wallis JD, Dias R, Robbins TW, Roberts AC. Dissociable contributions of the orbitofrontal and lateral prefrontal cortex of the marmoset to performance on a detour reaching task. Eur J Neurosci 2001; 13(9)1797–1808
  • Weinberger DR, Berman KF, Zec RF. Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. I. Regional cerebral blood flow evidence. Archives of General Psychiatry 1986; 43: 114–124
  • Young DA., Davila R, Scher H. Unawareness of illness and neuropsychological performance in schizophrenia. Schizophrenia Research 1993; 10: 117–124
  • Young DA, Konstantine KZ, Bailey C, Davila R, Griese J, Sartory G, et al. Further parameters of insight and neuropsychological deficit in schizophrenia and other chronic mental disease. J Nerv Ment Dis 1998; 186: 44–50

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.