Brain Structural Correlates of Metacognition in First-Episode Psychosis

被引:20
|
作者
Alkan, Erkan [1 ]
Davies, Geoff [1 ,2 ,3 ]
Greenwood, Kathryn [2 ,4 ]
Evans, Simon L. H. [1 ]
机构
[1] Univ Surrey, Fac Hlth & Med Sci, Guildford GU2 7XH, Surrey, England
[2] Univ Sussex, Sch Psychol, Brighton, E Sussex, England
[3] Surrey & Borders Partnership NHS Fdn Trust, Surrey, England
[4] Sussex Partnership NHS Fdn Trust, Worthing, England
关键词
metacognition; cognitive insight; psychosis; structural MRI; hippocampus; 1ST EPISODE PSYCHOSIS; COGNITIVE INSIGHT; CORTICAL THICKNESS; SPECTRUM DISORDERS; VERBAL MEMORY; SURFACE-AREA; SCHIZOPHRENIA; SELF; VOLUME; NEUROCOGNITION;
D O I
10.1093/schbul/sbz116
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Metacognition is impaired in schizophrenia and is an important predictor of functional outcome, but the underlying neuropathology is not clear. Studies have implicated frontal regions and there is also some evidence that the hippocampus might play a pivotal role, but findings are inconsistent. We set out to more comprehensively investigate the neural underpinnings of insight in first-episode psychosis (FEP) using 2 metacognitive measures (the Beck Cognitive Insight Scale [BCIS]) and a perceptual metacognitive accuracy task alongside structural magnetic resonance imaging (MRI). We measured cortical thickness in insula and frontal regions, hippocampal (including subfield) volumes, hippocampal microstructure (using neurite orientation dispersion and density imaging [NODDI]), and fractional anisotropy in fornix. Relative to controls, FEP showed poorer metacognitive accuracy, thinner cortex in frontal regions and lower fornix integrity. In healthy controls (but not FEP), metacognitive accuracy correlated with cortical thickness in frontal cortex and insula. Conversely, in FEP (but not controls), metacognitive accuracy correlated with hippocampal volume and microstructural indices. Subicular hippocampal subregions were particularly implicated. No structural correlates of BCIS were found. These findings suggest that the neural bases of metacognition might differ in FEP: hippocampal (rather than frontal) integrity seems to be critical. Further, the use of objectively measured metacognitive indices seems to be a more powerful method for understanding the neurocircuitry of metacognition in FEP, which has the potential to inform therapeutic strategies and improve outcome in these patients.
引用
收藏
页码:552 / 561
页数:10
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