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Disrupted Dorsal Mid-Insula Activation During Interoception Across Psychiatric Disorders.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Nord, Camilla L 
Lawson, Rebecca P 

Abstract

OBJECTIVE: Maintenance of bodily homeostasis relies on interoceptive mechanisms in the brain to predict and regulate bodily state. While altered neural activation during interoception in specific psychiatric disorders has been reported in many studies, it is unclear whether a common neural locus underpins transdiagnostic interoceptive differences. METHODS: The authors conducted a meta-analysis of neuroimaging studies comparing patients with psychiatric disorders with healthy control subjects to identify brain regions exhibiting convergent disrupted activation during interoception. Bibliographic, neuroimaging, and preprint databases through May 2020 were searched. A total of 306 foci from 33 studies were extracted, which included 610 control subjects and 626 patients with schizophrenia, bipolar or unipolar depression, posttraumatic stress disorder, anxiety, eating disorders, or substance use disorders. Data were pooled using a random-effects model implemented by the activation likelihood estimation algorithm. The preregistered primary outcome was the neuroanatomical location of the convergence of peak voxel coordinates. RESULTS: Convergent disrupted activation specific to the left dorsal mid-insula was found (Z=4.47, peak coordinates: -36, -2, 14; volume: 928 mm3). Studies directly contributing to the cluster included patients with bipolar disorder, anxiety, major depression, anorexia, and schizophrenia, assessed with task probes including pain, hunger, and interoceptive attention. A series of conjunction analyses against extant meta-analytic data sets revealed that this mid-insula cluster was anatomically distinct from brain regions involved in affective processing and from regions altered by psychological or pharmacological interventions for affective disorders. CONCLUSIONS: These results reveal transdiagnostic, domain-general differences in interoceptive processing in the left dorsal mid-insula. Disrupted mid-insular activation may represent a neural marker of psychopathology and a putative target for novel interventions.

Description

Keywords

Affect, Cognitive Neuroscience, Emotion, Homeostasis, Insula, Interoception, Neuroimaging, Transdiagnostic, Adolescent, Adult, Biomarkers, Cerebral Cortex, Humans, Interoception, Magnetic Resonance Imaging, Mental Disorders, Neuroimmunomodulation, Young Adult

Journal Title

Am J Psychiatry

Conference Name

Journal ISSN

0002-953X
1535-7228

Volume Title

178

Publisher

American Psychiatric Association Publishing

Rights

All rights reserved
Sponsorship
MRC (unknown)
Wellcome Trust (206691/Z/17/Z)
Medical Research Council (MC_UU_00005/4)
MRC (MC_UU_00030/12)