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Published Online: 22 June 2021

Disrupted Dorsal Mid-Insula Activation During Interoception Across Psychiatric Disorders

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.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 761 - 770
PubMed: 34154372

History

Received: 11 September 2020
Revision received: 7 December 2020
Revision received: 6 January 2021
Revision received: 20 January 2021
Accepted: 22 January 2021
Published online: 22 June 2021
Published in print: August 01, 2021

Keywords

  1. Interoception
  2. Transdiagnostic
  3. Insula
  4. Neuroimaging
  5. Homeostasis
  6. Affect
  7. Cognitive Neuroscience
  8. Emotion

Authors

Details

Camilla L. Nord, Ph.D. [email protected]
Medical Research Council Cognition and Brain Sciences Unit (Nord, Lawson, Dalgleish) and Department of Psychology (Lawson), University of Cambridge, Cambridge, U.K.; and Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, U.K. (Dalgleish).
Rebecca P. Lawson, Ph.D.
Medical Research Council Cognition and Brain Sciences Unit (Nord, Lawson, Dalgleish) and Department of Psychology (Lawson), University of Cambridge, Cambridge, U.K.; and Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, U.K. (Dalgleish).
Tim Dalgleish, Ph.D.
Medical Research Council Cognition and Brain Sciences Unit (Nord, Lawson, Dalgleish) and Department of Psychology (Lawson), University of Cambridge, Cambridge, U.K.; and Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, U.K. (Dalgleish).

Notes

Send correspondence to Dr. Nord ([email protected]).

Competing Interests

Drs. Nord and Dalgleish are supported by the U.K. Medical Research Council (grant SUAG/043 G101400) and the National Institute for Health Research Cambridge Biomedical Research Center. Dr. Nord is supported by an AXA Research Fund Fellowship (grant G102329). Dr. Lawson is supported by an Autistica Future Leaders Award (number 7265) and a Royal Society Wellcome Trust Henry Dale Fellowship (number 206691)

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