Altered neural basis of self-reflective processing in schizophrenia: An fMRI study

•Impaired self-awareness is related to core symptoms and functioning in schizophrenia.•This fMRI study explored its neural basis using original self/other evaluation tasks.•Schizophrenia patients had fronto-parietal hyperactivation during self-reflection.•Schizophrenia patients exhibited no normal self > other contrast in limbic activation.•Fronto-parietal and limbic abnormalities may underlie the core features of schizophrenia. Impaired self-awareness has often been described in schizophrenia. Recent neuroimaging studies examining the self-reflection processes in schizophrenia have produced inconsistent results. We examined the self-reflective neural network using self- and other-evaluation tasks in schizophrenia. Fifteen schizophrenia patients and fifteen age- and sex-matched healthy subjects underwent functional magnetic resonance imaging. Subjects were required to decide whether the sentence described their own personal trait (self-evaluation) and that of their close friends (other-evaluation). Unlike normal control subjects, the schizophrenia patients did not have greater activation of the left posterior cingulate gyrus and hippocampus during self-evaluation than during other-evaluation. On the other hand, the schizophrenia patients had higher activation of the right superior frontal and right supramarginal gyri during self-evaluation than control subjects. Only the patient group exhibited hyperactivation in the left hippocampus and right external capsule associated with the other-evaluation task. These findings provide evidence for an altered neural basis of self-reflective processing, which may underlie the self-awareness deficits in schizophrenia.