Abstract
It has been reported that reality evaluation and recognition are impaired in patients with schizophrenia and these impairments are related to the severity of psychotic symptoms. The current study aimed to investigate the neural basis of impairments in reality evaluation and recognition and their relationships with cognitive insight in schizophrenia. During functional magnetic resonance imaging, 20 patients with schizophrenia and 20 healthy controls performed a set of reality evaluation and recognition tasks, in which subjects judged whether scenes in a series of drawings were real or unreal and whether they were familiar or novel. During reality evaluation, patients showed decreased activity in various regions including the inferior parietal lobule, retrosplenial cortex and parahippocampal gyrus, compared with controls. Particularly, parahippocampal gyrus activity was correlated with the severity of positive symptoms in patients. During recognition, patients also exhibited decreased activity in various regions, including the dorsolateral prefrontal cortex, inferior parietal lobule and posterior cingulate cortex. Particularly, inferior parietal lobule activity and posterior cingulate cortex activity were correlated with cognitive insight in patients. These findings provide evidence that neural impairments in reality evaluation and recognition are related to psychotic symptoms. Anomalous appraisal of context by dysfunctions in the context network may contribute to impairments in the reality processing in schizophrenia, and abnormal declarative memory processes may be involved in cognitive insight in patients with schizophrenia.
Highlights
Reality evaluation is defined as the process of discriminating between things existing outside of oneself and figments of others’ imagination [1]
Consistent with our hypothesis and in agreement with our previous study [1], we found that patients with schizophrenia were less accurate during reality evaluation than healthy controls, suggesting that patients have deficits in reality evaluation
As a recent study demonstrated that patients with schizophrenia were impaired in the context processing and this impairment could lead to poor integration of information during encoding [23], deficient context appraisal may prevent a subject from getting sufficient information to judge the reality of stimuli, eventually disturbing the reality evaluation process
Summary
Reality evaluation is defined as the process of discriminating between things existing outside of oneself and figments of others’ imagination [1]. Our previous study demonstrated that patients with schizophrenia showed impairment in reality evaluation, and this impairment was related. Reality Processing and Cognitive Insight in Schizophrenia to positive symptoms such as hallucinations and delusions [1]. The processing of contextual information and relational reasoning, or the ability to consider relationships between multiple mental representations [2], is needed by subjects during the reality evaluation process. Relational reasoning is supported by a network of frontoparietal regions including the frontopolar cortex, dorsolateral prefrontal cortex, inferior frontal gyrus, and inferior parietal lobule [6,7,8]. A previous neuroimaging study showed abnormal reasoning-related activities in these brain regions in patients with schizophrenia [9]
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