Abstract
Individuals in the early phases of psychotic illness have disturbed metacognitive capacity, which has been linked to a number of poor outcomes. Little is known, however, about the neural systems associated with metacognition in this population. The purpose of this study was to elucidate the neuroanatomical correlates of metacognition. We anticipated that higher levels of metacognition may be dependent upon gray matter density (GMD) of regions within the prefrontal cortex. Examining whole-brain structure in 25 individuals with early phase psychosis, we found positive correlations between increased medial prefrontal cortex and ventral striatum GMD and higher metacognition. These findings represent an important step in understanding the path through which the biological correlates of psychotic illness may culminate into poor metacognition and, ultimately, disrupted functioning. Such a path will serve to validate and promote metacognition as a viable treatment target in early phase psychosis.
Highlights
Schizophrenia is a chronic and disabling psychiatric disorder [1], affecting greater than 20 million individuals worldwide [2]
By including the Positive and Negative Syndrome Scale (PANSS) negative symptom cluster as a regressor, we demonstrated that the relationships of mPFC and ventral striatum (VS) with metacognition were not better accounted for by the association between total metacognition and negative symptoms (Table 4)
We propose a model that draws from this work and offers a possible path from aberrant brain structure to the dysfunction associated with EPP
Summary
Schizophrenia is a chronic and disabling psychiatric disorder [1], affecting greater than 20 million individuals worldwide [2]. It is associated with compromised daily functioning, as well as severe symptoms such as hallucinations, delusions, disordered thinking and odd behavior. Metacognitive dysfunction has gained increasing recognition for its importance to clinical course and outcome in schizophrenia and related psychotic illnesses. Metacognition broadly refers to the process of thinking about cognitive states, it can be thought of as a spectrum of mental activities ranging from discrete (recognition of thoughts, feelings, and basic judgment) to more synthetic capacities. Because the neural correlates of synthetic metacognition have yet to be investigated, the present study focuses on this form of metacognition that, importantly, represents the ability to form and utilize integrated, complex mental representations of the self, others, and events in order to respond to life challenges [4,5]
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