Brain Structural Correlates of Metacognition in First-Episode Psychosis

Abstract

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.

Confidence in visual motion discrimination is preserved in individuals with schizophrenia

“…Recent studies have reported lower visual metacognitive per formance in people with a first episode of psychosis relative to agematched controls. 34,41 In the present study, we tested people with a chronic disorder and found no deterioration of metacog nition relative to controls, but we did find a negative relation ship between metacognitive efficiency and illness duration (Appendix 1, Table S2). This finding suggests that metacogni tive performance in patients may evolve nonlinearly over time, with prevalent deficits at the early and late stages of schizo phrenia.…”

Brain structural correlates of functional capacity in first-episode psychosis

“…FEP participants were required to have a primary diagnosis of FEP, while controls had no history of psychiatric illness. Additional measures were included within the test session and results from these have been reported elsewhere 3 , 49 – 52 . In particular, please refer to Rae et al 52 for analyses of microstructural white matter abnormalities in this sample based on NODDI.…”

FreeSurfer‐based segmentation of hippocampal subfields: A review of methods and applications, with a novel quality control procedure for ENIGMA studies and other collaborative efforts

“…Schizophrenia (Zheng et al, 2019), first episode and chronic disease (Kawano et al, 2015;McHugo et al, 2018), symptom correlates (Han et al, 2016;Kühn et al, 2012), first episode psychosis (Baglivo et al, 2018;Buchy et al, 2016;Li et al, 2018), response to electroconvulsive therapy (Jiang, Xu, et al, 2019), conversion of high risk patients (Provenzano et al, 2020), young relatives at risk (Francis et al, 2013;, progression patterns , genetic and cognitive correlates of schizophrenia (Nakahara et al, 2019) Metacognition and insight deficits (Alkan, Davies, Greenwood, & Evans, 2019;Hýža, Kuhn, Češková, Ustohal, & Kašpárek, 2016;Orfei et al, 2017) PTSD and early life adversity PTSD (Averill et al, 2017;Bøen et al, 2014;Hayes et al, 2017;L. Chen et al, 2016), childhood maltreatment (Chalavi et al, 2015;Teicher, Anderson, & Polcari, 2012), verbal abuse (Lee et al, 2018), childhood trauma in schizophrenia and healthy controls (du Plessis et al, 2019), in bipolar disorders and healthy controls and in adolescence (Malhi et al, 2019) Other neuropsychiatric conditions…”