Abstract
Although prior studies identified a relationship between cognitive insight and subjective quality of life (QOL) in patients with schizophrenia, the brain regions mediating this relationship remain unknown. Recent studies have shown that the ventrolateral prefrontal cortex may be particularly important for cognitive insight in individuals with schizophrenia. Here, we examined whether frontotemporal function mediates the relationship between cognitive insight and QOL in 64 participants, including 32 patients with schizophrenia and 32 healthy controls. Cognitive insight was measured using the Beck Cognitive Insight Scale (BCIS), while participants’ subjective QOL was assessed using the Medical Outcomes Study 36-item Short-form Health Survey. Frontotemporal function was evaluated during a verbal fluency task using multichannel near-infrared spectroscopy. Consistent with previous findings, we found that frontotemporal function was impaired in patients with schizophrenia. Interestingly, our data also revealed that the right ventrolateral PFC and the right anterior part of the temporal cortex significantly mediated the relationship between the self-reflectiveness (SR) subscale of the BCIS and subjective QOL. These findings suggest that cognitive insight, particularly SR, is associated with subjective QOL in patients with schizophrenia via right frontotemporal function. The findings of this study provide important insight into a QOL model of schizophrenia, which may guide the development of cost-effective interventions that target frontotemporal function in patients with schizophrenia.
Highlights
Previous research has demonstrated that individuals with schizophrenia tend to show a lack of insight that affects their symptom, psychosocial functioning, and treatment outcomes [1, 2]
The level of cognitive insight as well as the level of subjective quality of life (QOL) were related to neural activity in the right ventrolateral prefrontal cortex (VLPFC)/aTC regions, demonstrating a relationship between the neurobiological characteristics of schizophrenia and cognitive insight and subjective QOL
verbal fluency task (VFT)-related neural activity in the right VLPFC/aTC regions fully mediated the relationship between cognitive insight and subjective QOL, indicating that the disease-related level of cognitive insight may affect the subjective QOL through abnormalities in frontotemporal function
Summary
Previous research has demonstrated that individuals with schizophrenia tend to show a lack of insight that affects their symptom, psychosocial functioning, and treatment outcomes [1, 2]. Interest in research on the neural correlates of cognitive insight in patients with schizophrenia has been increasing [14] Studies on this topic suggest that the ventrolateral prefrontal cortex (VLPFC) may be important for cognitive insight in individuals with schizophrenia [14]. We revealed that the ventrolateral PFC and other PFC regions played a significant role in the subjective quality of life (QOL) of individuals with schizophrenia [17, 18] These findings suggest that ventrolateral PFC function may mediate the relationship between cognitive insight and subjective QOL in schizophrenia. This hypothesis has not been fully examined
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