Poor insight is a central characteristic of psychotic disorders, and it has been suggested to result from a general dysfunction in self-reflection. However, brain processing of clinical insight and more general self-reflection has not been directly compared. We compared tasks on (1) self-reflection on psychosis-related mental functioning (clinical insight, in patients only), (2) self-reflection on mental functioning unrelated to psychosis (general metacognition), and (3) semantic control during blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging with 19 first-episode psychosis patients and 24 control participants. Arterial-spin-labeling (ASL) images were collected at rest. Clinical insight was evaluated with the Schedule for the Assessment of Insight. In patients, posterosuperior precuneus showed stronger activation during the insight task than during the semantic control task, while anteroinferior precuneus and posterior cingulate cortex (PCC) showed stronger activation during the insight task than during the general metacognition task. No significant group differences in brain activation emerged during the general metacognition task. Although the BOLD measures did not correlate with clinical insight measures, ASL-measured cerebral blood flow (CBF) values did correlate when extracted from the task-selective precuneus/PCC areas: higher CBF correlated with higher clinical insight scores. These results suggest that regions in the posteromedial cortex are selective for clinical insight.

洞察力差是精神病性障碍的一个核心特征，有人认为它是由自我反省的一般功能障碍引起的。然而，尚未直接比较临床洞察力和更一般的自我反思的大脑处理。我们比较了以下任务：（1）对精神病相关心理功能的自我反思（临床洞察力，仅限患者），（2）对与精神病无关的心理功能（一般元认知）的自我反思，以及（3）血液中的语义控制- 19 名首发精神病患者和 24 名对照参与者的氧合水平依赖性 (BOLD) 功能磁共振成像。静止时收集动脉自旋标记 (ASL) 图像。临床洞察力通过洞察力评估表进行评估。在患者中，楔前叶在洞察任务期间表现出比语义控制任务更强的激活，而楔前叶和后扣带皮层（PCC）在洞察任务期间表现出比一般元认知任务更强的激活。在一般元认知任务期间，大脑激活没有显着的组间差异。尽管 BOLD 测量与临床洞察力测量无关，但从任务选择性楔前叶/PCC 区域提取时，ASL 测量的脑血流量 (CBF) 值确实相关：较高的 CBF 与较高的临床洞察力评分相关。这些结果表明，后内侧皮层区域对临床洞察力具有选择性。而前下楔前叶和后扣带回皮层（PCC）在洞察任务期间比在一般元认知任务期间表现出更强的激活。在一般元认知任务期间，大脑激活没有显着的组间差异。尽管 BOLD 测量与临床洞察力测量无关，但从任务选择性楔前叶/PCC 区域提取时，ASL 测量的脑血流量 (CBF) 值确实相关：较高的 CBF 与较高的临床洞察力评分相关。这些结果表明，后内侧皮层区域对临床洞察力具有选择性。而前下楔前叶和后扣带回皮层（PCC）在洞察任务期间比在一般元认知任务期间表现出更强的激活。在一般元认知任务期间，大脑激活没有显着的组间差异。尽管 BOLD 测量与临床洞察力测量无关，但从任务选择性楔前叶/PCC 区域提取时，ASL 测量的脑血流量 (CBF) 值确实相关：较高的 CBF 与较高的临床洞察力评分相关。这些结果表明，后内侧皮层区域对临床洞察力具有选择性。尽管 BOLD 测量与临床洞察力测量无关，但从任务选择性楔前叶/PCC 区域提取时，ASL 测量的脑血流量 (CBF) 值确实相关：较高的 CBF 与较高的临床洞察力评分相关。这些结果表明，后内侧皮层区域对临床洞察力具有选择性。尽管 BOLD 测量与临床洞察力测量无关，但从任务选择性楔前叶/PCC 区域提取时，ASL 测量的脑血流量 (CBF) 值确实相关：较高的 CBF 与较高的临床洞察力评分相关。这些结果表明，后内侧皮层区域对临床洞察力具有选择性。