M90. Associations of Cortical Thickness With Awareness of Illness in Enduring Schizophrenia
Bibliographic record
Abstract
Background: The relationship between poor insight and less favorable outcomes in schizophrenia has led to research efforts to understand its neurobiological basis. Thus far, research on the neural correlates of insight has been restricted by small sample sizes and a focus on regions of interest related to neuropsychological theories of insight. Moreover, few studies have assessed the neural correlates of specific insight dimensions in enduring schizophrenia and instead have relied on single-item measures of insight. Therefore, the purpose of this study was to examine the association of cortical thickness with the insight dimension of awareness of illness, in a large sample of enduring schizophrenia patients, using a whole-brain approach. We hypothesized that compared to patients with intact insight, patients with impaired insight would have thinner cortex in a network of brain structures associated with self-reflectiveness and metacognition in the temporal, and medial frontal regions. Methods: We used a categorical approach to insight and classified a group of 110 enduring schizophrenia patients in 2 groups according to their summed scores on 3 items of the Scale to Assess Insight (Expanded), which assess awareness of illness. Forty-one patients were classified as having impaired insight into illness (score of 0–5), and 69 patients as intact insight (score >6). T1-weighted structural images were acquired on a 3T MRI scanner for the 2 patient subgroups, and for 69 healthy control subjects matched to patients for age and sex. MR images were processed using CIVET (version 2.0) and quality controlled pre- and post-processing. Whole-brain, vertex-wise linear models were applied to evaluate cortical thickness differences between the 2 patient subgroups and controls. All analyses were controlled for age and sex. Results: There was no significant difference in cortical thickness in either hemisphere between the 2 patient subgroups. However, the impaired insight group displayed significantly thinner cortex within the right insula, temporal gyri, and anterior cingulate cortex compared to healthy controls (P < .05, FDR corrected). There was no significant cortical thickness difference between the intact insight group and healthy controls. Conclusion: These results do not replicate previous findings obtained with smaller samples using single-item measures of insight into illness, and instead suggest that insight into illness may not have a clear neuroanatomical basis at the level of the cortex. Poor awareness of illness may instead be a latent symptom, emerging as a result of a combination of schizophrenia-related deficits, that cannot be captured at the level of the brain. Accordingly, the cortical thinning observed in individuals with impaired insight, but not those with intact insight, compared to controls, may suggest that individuals with impaired insight represent a subset of patients with more severe pathology.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".