Self-Awareness of Psychopathology and Brain Volume in Patients With First Episode Psychosis.

Jeong-Youn Kim,Aeran Kwon,Hyeonjin Jeon,Seung-Hwan Lee,Min Jin Jin,Young-Chul Chung

doi:10.3389/fpsyt.2019.00839

Abstract

Memory impairment, excessive rumination, and increased interpersonal sensitivity are major characteristics of high psychosis risk or first episode psychosis (FEP). Herein, we investigated the relationship between brain volume and self-awareness of psychopathology in patients with FEP. All participants (FEP: 34 and HCs: 34) completed clinical assessments and the following self-reported psychopathology evaluations: prospective and retrospective memory questionnaire (PRMQ), ruminative response scale (RRS), and interpersonal sensitivity measure (IPSM). Structural magnetic resonance imaging was then conducted. The PRMQ, RRS, and IPSM scores were significantly higher in the FEP group than in the healthy controls (HCs). The volumes of the amygdala, hippocampus, and superior temporal gyrus (STG) were significantly lower in the FEP group than in the HCs. There was a significant group-dependent moderation effect between self-awareness of psychopathology (PRMQ, RRS, and IPSM scores) and right STG (rSTG) volume. In the FEP group, self-awareness of psychopathology was positively associated with rSTG volume, while in the HCs, this correlation was negative. Our results indicate that self-awareness of psychopathology impacts rSTG volume in the opposite direction between patients with FEP and HCs. In patients with FEP, awareness of impairment may induce increases in rSTG brain volume. However, HCs showed decreased rSTG volume when they were aware of impairment.

Highlights

First episode psychosis (FEP) is defined as the first time a person outwardly shows symptoms of psychosis
The patients with first episode psychosis (FEP) did not differ in age and sex from the healthy controls (HCs), the number of years of education differed significantly between the two groups (p < 0.001), so we controlled for years of education as a covariate in the statistical analysis
Significant group-dependent moderation effects were found between self-awareness of psychopathology (PRMQ, ruminative response scale (RRS), and interpersonal sensitivity measure (IPSM) scores) and right STG (rSTG) volume

Summary

Introduction

First episode psychosis (FEP) is defined as the first time a person outwardly shows symptoms of psychosis. Self-awareness of psychopathology is one dimension of clinical insight [3]. Lack of self-awareness of illness is associated with poor psychosocial function [4], poor clinical outcomes [5], and poorer treatment adherence [6], while in healthy controls, greater selfawareness of illness may lead them to adopt the identity of a “psychiatric patient” to themselves. Self-Awareness of Psychopathology and Brain Volume in FEP [7], which may be associated with poorer social functioning [8] and lower self-esteem [9]. Previous studies have found that patients with full-blown schizophrenia lack self-awareness of illness [4, 10]. About 46% of FEP patients showed poor insight [11] and insight impairment is associated with multiple cognitive deficits [12]

Methods

Results

Conclusion