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Insular

What is the insular?

The insular cortex is located deep within the lateral fissure, between the frontal and temporal lobes. The insular has connections with the thalamus, amygdala and cortex, with suggested functions including the integration of sensory, affective and cognitive components of a painful stimulus to create the sensation of pain; homeostatic regulation; as well as motor control such as speech articulation; it has also been linked with internal awareness.

What is the evidence for insular alterations?

Structural changes

Moderate to high quality evidence found reductions in insular grey matter volume in both chronic and first-episode schizophrenia (treated or antipsychotic naïve), as well as in people at high risk (clinical or genetic), compared to controls. Moderate quality evidence found reductions in left insular grey matter volume were associated with increased severity of auditory hallucinations. Moderate to low quality evidence found similar grey matter volume reductions in the right insular of people with schizophrenia and in people with an autistic spectrum disorder.

Moderate quality evidence found people at genetic high risk (relatives) showed increased left insular grey matter volume compared to people with chronic schizophrenia, with no differences between relatives and people with first-episode schizophrenia. People at clinical high risk (those with subclinical symptoms) showed increased left insular volume compared to people with first-episode schizophrenia. People at clinical high risk showed increased insular volume when compared to people at genetic high risk. People at high-risk (clinical or genetic) compared to controls. People at clinical or genetic high-risk who developed a psychotic episode showed decreases in the right insula compared to those who did not develop psychosis.

Functional changes

Moderate to low quality evidence found increased activation in the insular of people with schizophrenia during auditory hallucinations. Compared to controls, there was increased activation in the right insular during executive function tasks, increased activation in the insular during emotionally neutral tasks, and decreased activation in the insular during working memory tasks. There was decreased activation in the right insular of people with schizophrenia during theory of mind tasks when compared to people with an autism spectrum disorder.

Moderate to low quality evidence found increased activation in the bilateral insular of people with schizophrenia after cognitive remediation.

October 2020

Last updated at: 3:59 am, 31st October 2020
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Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.