Neuroimaging correlates of insight in non-affective psychosis: A systematic review and meta-analysis

Pau Soldevila-Matías; Georgios Schoretsanitis; Diana Tordesillas-Gutierrez; Manuel J Cuesta; Renato de Filippis; Rosa Ayesa-Arriola; Carlos González-Vivas; Esther Setién-Suero; Norma Verdolini; Julio Sanjuán; Joaquim Radua; Benedicto Crespo-Facorro

doi:10.1016/j.rpsmen.2022.06.007

Neuroimaging correlates of insight in non-affective psychosis: A systematic review and meta-analysis

Rev Psiquiatr Salud Ment (Engl Ed). 2022 Apr-Jun;15(2):117-133. doi: 10.1016/j.rpsmen.2022.06.007.

Affiliations

¹ Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain; Research Institute of Clinic University Hospital of Valencia (INCLIVA), Valencia, Spain; National Reference Center for Psychosocial Care for People with Serious Mental Disorder (CREAP), Valencia, Spain.
² The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.
³ Marqués de Valdecilla University Hospital, Department of Radiology, IDIVAL, Santander, Spain; Marqués de Valdecilla University Hospital, Department of Psychiatry, School of Medicine, University of Cantabria, IDIVAL, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain. Electronic address: [email protected].
⁴ Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
⁵ The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA; Psychiatry Unit Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro 88100, Italy.
⁶ Marqués de Valdecilla University Hospital, Department of Radiology, IDIVAL, Santander, Spain; Marqués de Valdecilla University Hospital, Department of Psychiatry, School of Medicine, University of Cantabria, IDIVAL, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain.
⁷ Research Institute of Clinic University Hospital of Valencia (INCLIVA), Valencia, Spain.
⁸ Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel Street, 12-0, 08036 Barcelona, Spain.
⁹ Research Institute of Clinic University Hospital of Valencia (INCLIVA), Valencia, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; Department of Psychiatric, University of Valencia, School of Medicine, Valencia, Spain.
¹⁰ CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

PMID: 35840278
DOI: 10.1016/j.rpsmen.2022.06.007

Abstract

Objective: Neurological correlates of impaired insight in non-affective psychosis remain unclear. This study aimed to review and meta-analyze the studies assessing the grey matter volumetric correlates of impaired insight in non-affective psychosis.

Methods: This study consisted of a systematic review of 23 studies, and a meta-analysis with SDM-PSI of the 11 studies that were whole-brain and reported maps or peaks of correlation of studies investigating the grey matter volumetric correlates of insight assessments of non-affective psychosis, PubMed and OVID datasets were independently reviewed for articles reporting neuroimaging correlates of insight in non-affective psychosis. Quality assessment was realized following previous methodological approaches for the ABC quality assessment test of imaging studies, based on two main criteria: the statistical power and the multidimensional assessment of insight. Study peaks of correlation between grey matter volume and insight were used to recreate brain correlation maps.

Results: A total of 418 records were identified through database searching. Of these records, twenty-three magnetic resonance imaging (MRI) studies that used different insight scales were included. The quality of the evidence was high in 11 studies, moderate in nine, and low in three. Patients with reduced insight showed decreases in the frontal, temporal (specifically in superior temporal gyrus), precuneus, cingulate, insula, and occipital lobes cortical grey matter volume. The meta-analysis indicated a positive correlation between grey matter volume and insight in the right insula (i.e., the smaller the grey matter, the lower the insight).

Conclusion: Several brain areas might be involved in impaired insight in patients with non-affective psychoses. The methodologies employed, such as the applied insight scales, may have contributed to the considerable discrepancies in the findings.

Keywords: Conciencia de enfermedad; Grey matter; Imagen por resonancia magnética; Insight; Magnetic resonance imaging (MRI); Materia gris; Neuroimagen; Neuroimaging; Non-affective psychosis; Psicosis no afectiva.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Brain / diagnostic imaging
Gray Matter / diagnostic imaging
Gray Matter / pathology
Humans
Magnetic Resonance Imaging / methods
Magnetic Resonance Imaging / psychology
Neuroimaging* / methods
Neuroimaging* / psychology
Psychotic Disorders* / diagnostic imaging
Psychotic Disorders* / psychology