Stronger default mode network connectivity is associated with poorer clinical insight in youth at ultra high-risk for psychotic disorders

Sarah V. Clark*, Vijay A. Mittal, Jessica A. Bernard, Aral Ahmadi, Tricia Z. King, Jessica A. Turner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Impaired clinical insight (CI) is a common symptom of psychotic disorders and a promising treatment target. However, to date, our understanding of how variability in CI is tied to underlying brain dysfunction in the clinical high-risk period is limited. Developing a stronger conception of this link will be a vital first step for efforts to determine if CI can serve as a useful prognostic indicator. The current study investigated whether variability in CI is related to major brain networks in adolescents and young adults at ultra high-risk (UHR) of developing psychosis. Thirty-five UHR youth were administered structured clinical interviews as well as an assessment for CI and underwent resting-state magnetic resonance imaging scans. Functional connectivity was calculated in the default mode network (DMN) and fronto-parietal network (FPN), two major networks that are dysfunctional in psychosis and are hypothesized to affect insight. Greater DMN connectivity between the posterior cingulate/precuneus and ventromedial prefrontal cortex (DMN) was related to poorer CI (R2 = 0.399). There were no significant relationships between insight and the FPN. This is the first study to relate a major brain network to clinical insight before the onset of psychosis. Findings are consistent with evidence if a hyperconnected DMN in schizophrenia and UHR, and similar to a previous study of insight and connectivity in schizophrenia. Results suggest that a strongly connected DMN may be related to poor self-awareness of subthreshold psychotic symptoms in UHR adolescents and young adults.

Original languageEnglish (US)
Pages (from-to)244-250
Number of pages7
JournalSchizophrenia Research
StatePublished - Mar 2018


  • Default mode network
  • Insight
  • Prodrome
  • Ultra high-risk

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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