Brain areas associated with clinical and cognitive insight in psychotic disorders: A systematic review and meta-analysis

• Published in: Neuroscience and biobehavioral reviews 2020-09, Vol.116, p.301-336
• Main Authors: Pijnenborg, G.H.M., Larabi, D.I., Xu, P., Hasson-Ohayon, I., de Vos, A.E., Ćurčić-Blake, B., Aleman, A., Van der Meer, L.
• Format: Article
• Language: English
• Subjects: Awareness; MRI; Neuroimaging; Psychosis; Schizophrenia
• ISSN: 0149-7634; 1873-7528
• DOI: 10.1016/j.neubiorev.2020.06.022

•Clinical and cognitive insight are associated with different brain areas.•Clinical insight is associated with spatially diffuse abnormalities across the brain.•Clinical insight might rely on a broad range of (social/meta-) cognitive functions.•Cognitive insight is mainly associated with ventrolateral prefrontal cortex and hippocampal areas.•Cognitive insight appears to rely more on the retrieval and integration of self-related information. In the past years, ample interest in brain abnormalities related to clinical and cognitive insight in psychosis has contributed several neuroimaging studies to the literature. In the current study, published findings on the neural substrates of clinical and cognitive insight in psychosis are integrated by performing a systematic review and meta-analysis. Coordinate-based meta-analyses were performed with the parametric coordinate-based meta-analysis approach, non-coordinate based meta-analyses were conducted with the metafor package in R. Papers that could not be included in the meta-analyses were systematically reviewed. Thirty-seven studies were retrieved, of which 21 studies were included in meta-analyses. Poorer clinical insight was related to smaller whole brain gray and white matter volume and gray matter volume of the frontal gyri. Cognitive insight was predominantly positively associated with structure and function of the hippocampus and ventrolateral prefrontal cortex. Impaired clinical insight is not associated with abnormalities of isolated brain regions, but with spatially diffuse global and frontal abnormalities suggesting it might rely on a range of cognitive and self-evaluative processes. Cognitive insight is associated with specific areas and appears to rely more on retrieving and integrating self-related information.