Brain activation during self- and other-reflection in bipolar disorder with a history of psychosis: Comparison to schizophrenia
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OBJECTIVES: Reflecting on the self and on others activates specific brain areas and contributes to metacognition and social cognition. The aim of the current study is to investigate brain activation during self- and other-reflection in patients with bipolar disorder (BD). In addition, we examined whether potential abnormal brain activation in BD patients could distinguish BD from patients with schizophrenia (SZ). METHODS: During functional magnetic resonance imaging (fMRI), 17 BD patients, 17 SZ patients and 21 healthy controls (HCs) performed a self-reflection task. The task consisted of sentences divided into three conditions: self-reflection, other-reflection and semantic control. RESULTS: BD patients showed less activation in the posterior cingulate cortex (PCC) extending to the precuneus during other-reflection compared to HCs (p = 0.028 FWE corrected on cluster-level within the regions of interest). In SZ patients, the level of activation in this area was in between BD patients and HCs, with no significant differences between patients with SZ and BD. There were no group differences in brain activation during self-reflection. Moreover, there was a positive correlation between the PCC/precuneus activation during other-reflection and cognitive insight in SZ patients, but not in BD patients. CONCLUSIONS: BD patients showed less activation in the PCC/precuneus during other-reflection. This may support an account of impaired integration of emotion and memory (evaluation of past and current other-related information) in BD patients. Correlation differences of the PCC/precuneus activation with the cognitive insight in patients with BD and SZ might reflect an important difference between these disorders, which may help to further explore potentially distinguishing markers.
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Poor insight may arise from abnormalities in brain function, as indicated by neuroimaging studies implicating various areas and networks.
“Consistent with this, studies employing both structural 99 and functional 100-105 neuroimaging have implicated a number of areas and networks in the development and maintenance of insight.”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [105]
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- Authors
- Zhang, L., Opmeer, E. M., Ruhé, H. G., Aleman, A., & van der Meer, L.
- Affiliations
- University Medical Center Groningen (NL)
- Corresponding author
- Zhang, Liwen
- Venue
- NeuroImage: Clinical
- Publisher
- Elsevier BV
- Published
- 2015
- Volume
- 8
- Pages
- 202-209
- ISSN
- 2213-1582 (ISSN-L)
- PMC
- PMC4473805
- OpenAlex
- W2023053471
- Cited by
- 51
- References
- 65
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 6 · 2023: 2 · 2022: 7 · 2021: 7 · 2020: 4 · 2019: 6 · 2018: 5 · 2017: 4 · 2016: 3
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- NeuroImage Clinical (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- the European Science Foundation EURYI (044.035.001)
- VENI (016.126.059)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- bipolar disorder, schizophrenia, self-reflection, posterior cingulate cortex, precuneus, cognitive insight, social cognition, metacognition, brain activation
- MeSH terms
- Adult, Bipolar Disorder, Female, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Parietal Lobe, Schizophrenia, Self-Assessment, Social Perception
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