Date of Award
Master of Arts (MA)
Background. Impaired insight, or unawareness of illness, is a common symptom of schizophrenia. Clinical insight is awareness of having a mental disorder; cognitive insight is ability to self-reflect (selfreflectiveness) and certainty in cognitions (selfcertainty). In schizophrenia insight is associated with brain function and improving insight is a potential early intervention point. This study investigated whether insight is impaired in youth at ultra high-risk (UHR) for psychosis, and if it is related to major brain networks. Methods. Data from a larger UHR study was used, including 55 UHR adolescents and 55 controls assessed with the Structured Interview of Prodromal Symptoms, MATRICS Consensus Cognitive Battery, Scale to Assess Unawareness of Mental Disorder, and Beck Cognitive Insight Scale, as well as resting state functional MRI scans. UHR and control groups were tested for differences in self-reflectiveness and self-certainty, and correlations between insight dimensions and clinical and cognitive measures. Functional connectivity was calculated for the default mode, the cingulo-opercular, and central executive networks and regressed on participants’ reported clinical and cognitive insight, while covarying for head motion. Results. Self-reflectiveness was higher in the UHR group (d = 1.28), but the groups did not differ in self-certainty (d = 0.28). Among UHR, poorer clinical insight was related to greater symptom severity. Default mode connectivity was negatively correlated with self-reflectiveness (R2 = .091) and clinical insight (R2 = .399) in UHR, but no such correlations were found in controls. Cerebello-prefrontal cortex connectivity was negatively associated with self-certainty in the UHR group (R2 = .089 - .138). Conclusions. Default mode connectivity appears to be associated with the facets of insight concerning self-awareness, whereas cerebello-prefrontal connectivity appears to be associated specifically with self-certainty. This is the first study to relate major brain networks to insight before the onset of psychosis, and is consistent with models proposing that different facets of insight are related to self-awareness and executive functioning through networks associated with these processes.
Clark, Sarah, "Investigating Brain Networks Associated with Insight in Adolescents at Ultra High-Risk for Schizophrenia." Thesis, Georgia State University, 2017.