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Brain structural correlates of metacognition in first-episode psychosis

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posted on 2023-06-09, 19:28 authored by Erkan Alkan, Geoff Davies, Kathryn GreenwoodKathryn Greenwood, Simon L H Evans
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 two metacognitive measures (the Beck Cognitive Insight Scale (BCIS)) and a perceptual metacognitive accuracy task and structural 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 the neural bases of metacognition might differ in FEP: hippocampal (rather than frontal) integrity seems to be critical. Further, 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.

History

Publication status

  • Published

File Version

  • Accepted version

Journal

Schizophrenia Bulletin

ISSN

0586-7614

Publisher

Oxford University Press

Volume

45

Page range

1-10

Department affiliated with

  • Psychology Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2019-10-28

First Open Access (FOA) Date

2020-11-29

First Compliant Deposit (FCD) Date

2019-10-25

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