Does the salience network play a cardinal role in psychosis? An emerging hypothesis of insular dysfunction

Does the salience network play a cardinal role in psychosis? An emerging hypothesis of insular dysfunction

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J Psychiatry Neurosci 2012;37(1):17-27

Lena Palaniyappan, MBBS, MMedSci; Peter F. Liddle, BMBCh, PhD

Division of Psychiatry, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom

Abstract

The insular cortex is one of the brain regions that show consistent abnormalities in both structural and functional neuroimaging studies of schizophrenia. In healthy individuals, the insula has been implicated in a myriad of physiologic functions. The anterior cingulate cortex (ACC) and insula together constitute the salience network, an intrinsic large-scale network showing strong functional connectivity. Considering the insula as a functional unit along with the ACC provides an integrated understanding of the role of the insula in information processing. In this review, we bring together evidence from imaging studies to understand the role of the salience network in schizophrenia and propose a model of insular dysfunction in psychosis.


Submitted Dec. 8, 2010; Revised Feb. 21, 2011; Accepted Apr. 15, 2011.

Competing interests: L. Palaniyappan declares having received the Eli Lilly Young Investigator Travel Award to participate in the 9th Bipolar Conference, Pittsburgh, Pa. P.F. Liddle declares having received lecture honoraria from Bristol Meyers Squibb.

Contributors: L. Palaniyappan and P.F. Liddle both contributed to study design, wrote and reviewed the article and approved its publication.

DOI: 10.1503/jpn.100176

Correspondence to: Dr. L. Palaniyappan, Division of Psychiatry, A Floor, South Block, Queen’s Medical Centre, Nottingham, NG7 2UH UK; lena.palaniyappan@nottingham.ac.uk