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Brain Structural Correlates of Metacognition in First-Episode Psychosis

Alkan, Erkan, Davies, Geoff, Greenwood, Kathryn and Evans, Simon L. H. (2019) Brain Structural Correlates of Metacognition in First-Episode Psychosis Schizophrenia Bulletin.

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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.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Psychology
Authors :
Greenwood, Kathryn
Evans, Simon L.
Date : 28 November 2019
Funders : Dr. Mortimer and Theresa Sackler Foundation
DOI : 10.1093/schbul/sbz116
Copyright Disclaimer : © The Author(s) 2019. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email:
Uncontrolled Keywords : Metacognition; Cognitive insight Psychosis; Structural MRI; Hippocampus
Depositing User : Diane Maxfield
Date Deposited : 13 Dec 2019 11:21
Last Modified : 13 Dec 2019 11:57

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