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Reggente N. VR for Cognition and Memory. Curr Top Behav Neurosci 2023; 65:189-232. [PMID: 37440126 DOI: 10.1007/7854_2023_425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
This chapter will provide a review of research into human cognition through the lens of VR-based paradigms for studying memory. Emphasis is placed on why VR increases the ecological validity of memory research and the implications of such enhancements.
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Affiliation(s)
- Nicco Reggente
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA.
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2
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Pijnenborg GHM, Larabi DI, Xu P, Hasson-Ohayon I, de Vos AE, Ćurčić-Blake B, Aleman A, Van der Meer L. Brain areas associated with clinical and cognitive insight in psychotic disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 116:301-336. [PMID: 32569706 DOI: 10.1016/j.neubiorev.2020.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023]
Abstract
In the past years, ample interest in brain abnormalities related to clinical and cognitive insight in psychosis has contributed several neuroimaging studies to the literature. In the current study, published findings on the neural substrates of clinical and cognitive insight in psychosis are integrated by performing a systematic review and meta-analysis. Coordinate-based meta-analyses were performed with the parametric coordinate-based meta-analysis approach, non-coordinate based meta-analyses were conducted with the metafor package in R. Papers that could not be included in the meta-analyses were systematically reviewed. Thirty-seven studies were retrieved, of which 21 studies were included in meta-analyses. Poorer clinical insight was related to smaller whole brain gray and white matter volume and gray matter volume of the frontal gyri. Cognitive insight was predominantly positively associated with structure and function of the hippocampus and ventrolateral prefrontal cortex. Impaired clinical insight is not associated with abnormalities of isolated brain regions, but with spatially diffuse global and frontal abnormalities suggesting it might rely on a range of cognitive and self-evaluative processes. Cognitive insight is associated with specific areas and appears to rely more on retrieving and integrating self-related information.
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Affiliation(s)
- G H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands; Department of Clinical and Developmental Neuropsychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
| | - D I Larabi
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - P Xu
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China; Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen 518054, China; Great Bay Neuroscience and Technology Research Institute (Hong Kong), Kwun Tong, Hong Kong
| | - I Hasson-Ohayon
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - A E de Vos
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands
| | - B Ćurčić-Blake
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands
| | - A Aleman
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands; Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China
| | - L Van der Meer
- Department of Rehabilitation, Lentis Mental Health Care, PO box 128, 9470 KA, Zuidlaren, the Netherlands; Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
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3
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Larabi DI, Renken RJ, Cabral J, Marsman JBC, Aleman A, Ćurčić-Blake B. Trait self-reflectiveness relates to time-varying dynamics of resting state functional connectivity and underlying structural connectomes: Role of the default mode network. Neuroimage 2020; 219:116896. [PMID: 32470573 DOI: 10.1016/j.neuroimage.2020.116896] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cognitive insight is defined as the ability to reflect upon oneself (i.e. self-reflectiveness), and to not be overly confident of one's own (incorrect) beliefs (i.e. self-certainty). These abilities are impaired in several disorders, while they are essential for the evaluation and regulation of one's behavior. We hypothesized that cognitive insight is a dynamic process, and therefore examined how it relates to temporal dynamics of resting state functional connectivity (FC) and underlying structural network characteristics in 58 healthy individuals. METHODS Cognitive insight was measured with the Beck Cognitive Insight Scale. FC characteristics were calculated after obtaining four FC states with leading eigenvector dynamics analysis. Gray matter (GM) and DTI connectomes were based on GM similarity and probabilistic tractography. Structural graph characteristics, such as path length, clustering coefficient, and small-world coefficient, were calculated with the Brain Connectivity Toolbox. FC and structural graph characteristics were correlated with cognitive insight. RESULTS Individuals with lower cognitive insight switched more and spent less time in a globally synchronized state. Additionally, individuals with lower self-reflectiveness spent more time in, had a higher probability of, and had a higher chance of switching to a state entailing default mode network (DMN) areas. With lower self-reflectiveness, DTI-connectomes were segregated less (i.e. lower global clustering coefficient) with lower embeddedness of the left angular gyrus specifically (i.e. lower local clustering coefficient). CONCLUSIONS Our results suggest less stable functional and structural networks in individuals with poorer cognitive insight, specifically self-reflectiveness. An overly present DMN appears to play a key role in poorer self-reflectiveness.
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Affiliation(s)
- Daouia I Larabi
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Remco J Renken
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - Joana Cabral
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Jan-Bernard C Marsman
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands; University of Groningen, Department of Psychology, Groningen, the Netherlands
| | - Branislava Ćurčić-Blake
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
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4
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Muñoz-Neira C, Tedde A, Coulthard E, Thai NJ, Pennington C. Neural correlates of altered insight in frontotemporal dementia: a systematic review. Neuroimage Clin 2019; 24:102066. [PMID: 31795052 PMCID: PMC6889795 DOI: 10.1016/j.nicl.2019.102066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/14/2019] [Accepted: 11/03/2019] [Indexed: 12/12/2022]
Abstract
Altered insight into disease or specific symptoms is a prominent clinical feature of frontotemporal dementia (FTD). Understanding the neural bases of insight is crucial to help improve FTD diagnosis, classification and management. A systematic review to explore the neural correlates of altered insight in FTD and associated syndromes was conducted. Insight was fractionated to examine whether altered insight into different neuropsychological/behavioural objects is underpinned by different or compatible neural correlates. 6 databases (Medline, Embase, PsycINFO, Web of Science, BIOSIS and ProQuest Dissertations & Theses Global) were interrogated between 1980 and August 2019. 15 relevant papers were found out of 660 titles screened. The studies included suggest that different objects of altered insight are associated with distinctive brain areas in FTD. For example, disease unawareness appears to predominantly correlate with right frontal involvement. In contrast, altered insight into social cognition potentially involves, in addition to frontal areas, the temporal gyrus, insula, parahippocampus and amygdala. Impaired insight into memory problems appears to be related to the frontal lobes, postcentral gyrus, parietal cortex and posterior cingulate. These results reflect to a certain extent those observed in other neurodegenerative conditions like Alzheimer's disease (AD) and also other brain disorders. Nevertheless, they should be cautiously interpreted due to variability in the methodological aspects used to reach those conclusions. Future work should triangulate different insight assessment approaches and brain imaging techniques to increase the understanding of this highly relevant clinical phenomenon in dementia.
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Affiliation(s)
- Carlos Muñoz-Neira
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK.
| | - Andrea Tedde
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Sassari, Italy
| | - Elizabeth Coulthard
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK
| | - N Jade Thai
- Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK
| | - Catherine Pennington
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Centre for Dementia Prevention, University of Edinburgh, UK
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5
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Bréchet L, Mange R, Herbelin B, Theillaud Q, Gauthier B, Serino A, Blanke O. First-person view of one's body in immersive virtual reality: Influence on episodic memory. PLoS One 2019; 14:e0197763. [PMID: 30845269 PMCID: PMC6405051 DOI: 10.1371/journal.pone.0197763] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 02/14/2019] [Indexed: 01/29/2023] Open
Abstract
Episodic memories (EMs) are recollections of contextually rich and personally relevant past events. EM has been linked to the sense of self, allowing one to mentally travel back in subjective time and re-experience past events. However, the sense of self has recently been linked to online multisensory processing and bodily self-consciousness (BSC). It is currently unknown whether EM depends on BSC mechanisms. Here, we used a new immersive virtual reality (VR) system that maintained the perceptual richness of life episodes and fully controlled the experimental stimuli during encoding and retrieval, including the participant’s body. Our data reveal a classical EM finding, which shows that memory for complex real-life like scenes decays over time. However, here we also report a novel finding that delayed retrieval performance can be enhanced when participants view their body as part of the virtual scene during encoding. This body effect was not observed when no virtual body or a moving control object was shown, thereby linking the sense of self, and BSC in particular, to EMs. The present VR methodology and the present behavioral findings will enable to study key aspects of EM in healthy participants and may be especially beneficial for the restoration of self-relevant memories in future experiments.
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Affiliation(s)
- Lucie Bréchet
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
- Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
| | - Robin Mange
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
- Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
| | - Bruno Herbelin
- Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
| | - Quentin Theillaud
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
- Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
| | - Baptiste Gauthier
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
- Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
| | - Andrea Serino
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
- Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
- Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Campus Biotech, Geneva, Switzerland
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
- * E-mail:
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6
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Reggente N, Essoe JKY, Aghajan ZM, Tavakoli AV, McGuire JF, Suthana NA, Rissman J. Enhancing the Ecological Validity of fMRI Memory Research Using Virtual Reality. Front Neurosci 2018; 12:408. [PMID: 29962932 PMCID: PMC6013717 DOI: 10.3389/fnins.2018.00408] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/25/2018] [Indexed: 12/23/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is a powerful research tool to understand the neural underpinnings of human memory. However, as memory is known to be context-dependent, differences in contexts between naturalistic settings and the MRI scanner environment may potentially confound neuroimaging findings. Virtual reality (VR) provides a unique opportunity to mitigate this issue by allowing memories to be formed and/or retrieved within immersive, navigable, visuospatial contexts. This can enhance the ecological validity of task paradigms, while still ensuring that researchers maintain experimental control over critical aspects of the learning and testing experience. This mini-review surveys the growing body of fMRI studies that have incorporated VR to address critical questions about human memory. These studies have adopted a variety of approaches, including presenting research participants with VR experiences in the scanner, asking participants to retrieve information that they had previously acquired in a VR environment, or identifying neural correlates of behavioral metrics obtained through VR-based tasks performed outside the scanner. Although most such studies to date have focused on spatial or navigational memory, we also discuss the promise of VR in aiding other areas of memory research and facilitating research into clinical disorders.
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Affiliation(s)
- Nicco Reggente
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Joey K-Y Essoe
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Zahra M Aghajan
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Amir V Tavakoli
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins Children's Center, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Nanthia A Suthana
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jesse Rissman
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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7
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A longitudinal study of cognitive insight and cortical thickness in first-episode psychosis. Schizophr Res 2018; 193:251-260. [PMID: 28669589 DOI: 10.1016/j.schres.2017.06.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 11/23/2022]
Abstract
Among individuals with psychosis, those with poor cognitive insight (lower Self-Reflectiveness, higher Self-Certainty) show volumetric reductions in cortical structure. We evaluated whether changes in cognitive insight are associated with progressive changes in cortical structure in first-episode psychosis (FEP) and control subjects. Beck Cognitive Insight Scale ratings and magnetic resonance imaging scans were acquired at baseline for 130 FEP and 52 controls, 59 FEP and 28 controls at 1-year, and 53 FEP and 20 controls at 2-years. Cortical thickness was computed across scans and analyzed with linear mixed models. At baseline, groups did not differ on Self-Reflectiveness or Self-Certainty. At baseline, higher Self-Reflectiveness significantly correlated with thinner right occipital cortex in FEP, and higher Self-Certainty was significantly negatively correlated with cortical thickness in left posterior cingulate in controls. Longitudinal analysis showed that Self-Reflectiveness and Self-Certainty did not change over time in either group. Interestingly, the lack of change in cognitive insight aligned with longitudinal cortical thickness results, where no interaction effects were seen with cortical thickness between time and either Self-Reflectiveness or Self-Certainty. Exploratory analyses with a reduced threshold found that in FEP, across all time-points, higher Self-Certainty associated with thinner cortex in left posterior cingulate/precuneus. Results suggest that the posterior cingulate may be a common neural correlate for Self-Certainty in FEP and non-clinical subjects.
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8
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Pu S, Nakagome K, Itakura M, Ohtachi H, Iwata M, Nagata I, Kaneko K. Right Frontotemporal Cortex Mediates the Relationship between Cognitive Insight and Subjective Quality of Life in Patients with Schizophrenia. Front Psychiatry 2018; 9:16. [PMID: 29456514 PMCID: PMC5801421 DOI: 10.3389/fpsyt.2018.00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/17/2018] [Indexed: 11/19/2022] Open
Abstract
Although prior studies identified a relationship between cognitive insight and subjective quality of life (QOL) in patients with schizophrenia, the brain regions mediating this relationship remain unknown. Recent studies have shown that the ventrolateral prefrontal cortex may be particularly important for cognitive insight in individuals with schizophrenia. Here, we examined whether frontotemporal function mediates the relationship between cognitive insight and QOL in 64 participants, including 32 patients with schizophrenia and 32 healthy controls. Cognitive insight was measured using the Beck Cognitive Insight Scale (BCIS), while participants' subjective QOL was assessed using the Medical Outcomes Study 36-item Short-form Health Survey. Frontotemporal function was evaluated during a verbal fluency task using multichannel near-infrared spectroscopy. Consistent with previous findings, we found that frontotemporal function was impaired in patients with schizophrenia. Interestingly, our data also revealed that the right ventrolateral PFC and the right anterior part of the temporal cortex significantly mediated the relationship between the self-reflectiveness (SR) subscale of the BCIS and subjective QOL. These findings suggest that cognitive insight, particularly SR, is associated with subjective QOL in patients with schizophrenia via right frontotemporal function. The findings of this study provide important insight into a QOL model of schizophrenia, which may guide the development of cost-effective interventions that target frontotemporal function in patients with schizophrenia.
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Affiliation(s)
- Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | - Masashi Itakura
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroaki Ohtachi
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaaki Iwata
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Izumi Nagata
- National Hospital Organization, Tottori Medical Center, Tottori-shi, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
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9
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Cognitive insight: A systematic review. Clin Psychol Rev 2017; 55:12-24. [DOI: 10.1016/j.cpr.2017.04.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 03/12/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
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10
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Caletti E, Marotta G, Del Vecchio G, Paoli RA, Cigliobianco M, Prunas C, Zugno E, Bottinelli F, Brambilla P, Altamura AC. The metabolic basis of cognitive insight in psychosis: A positron emission tomography study. PLoS One 2017; 12:e0175803. [PMID: 28414766 PMCID: PMC5393874 DOI: 10.1371/journal.pone.0175803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 03/31/2017] [Indexed: 01/23/2023] Open
Abstract
The purpose of this study was to investigate the relationship between cognitive insight and cerebral metabolism in patients suffering from psychosis. The Beck Cognitive Insight Scale (BCIS) was administered to 63 patients with psychosis undergoing Positron Emission Tomography investigation. The sample was divided into two groups considering the BCIS score. Data were analyzed using Statistical Parametric Mapping. RESULTS patients with low insight, compared to those with high insight, showed decreased metabolism in the right fusiform gyrus, left precuneus, superior temporal gyrus and insula bilaterally, as well as increased metabolism in the left orbito-frontal gyrus (all p<0.005). Our results suggest that reduced posterior (occipito-temporo-insulo-parietal) and increased anterior (orbitofrontal) cerebral metabolism may sustain low cognitive insight in psychosis.
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Affiliation(s)
- Elisabetta Caletti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Marotta
- Section of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Riccardo A. Paoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Cigliobianco
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cecilia Prunas
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Zugno
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Bottinelli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, Texas, United States of America
| | - A. Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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11
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Orfei MD, Piras F, Banaj N, Di Lorenzo G, Siracusano A, Caltagirone C, Bandinelli PL, Ducci G, Spalletta G. Unrealistic self-overconfidence in schizophrenia is associated with left presubiculum atrophy and impaired episodic memory. Cortex 2016; 86:132-139. [PMID: 27951456 DOI: 10.1016/j.cortex.2016.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/14/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
The study aimed at investigating the role of the hippocampal subfields in cognitive insight and the clinical and neuropsychological underpinnings of the related two sub-dimensions, Self-Reflectiveness (SR), i.e., openness to external feedback, and Self-Certainty (SC), i.e., unrealistic overconfidence in one's opinions. In order to do this, 45 patients with a diagnosis of schizophrenia and 45 age- and gender-matched healthy control subjects (HC) were administered the Beck Cognitive Insight Scale (BCIS), along with neuropsychological, clinical and psychopathological assessment, and underwent an MRI investigation. Hippocampal segmentation was carried out. Regression analyses were performed for BCIS indexes, volumetric parameters of hippocampal subfields and clinical and neuropsychological variables. Results highlighted that in the schizophrenia group, higher levels of SC were related to reduced volume of the left presubiculum, and worse episodic memory. No significant relationship emerged for the SR index. There was no significant relationship between any of the BCIS indexes and volumetric data of the hippocampal subfields in the HC group. Our data support the hypothesis that unrealistic self-overconfidence in schizophrenia is related to the hippocampal presubiculum atrophy, which is involved in episodic memory and cognitive control and is supposed to be underpinned by difficulty in integrating new memories and thus in generating new hypotheses about the self.
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Affiliation(s)
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Museo storico della fisica e Centro studi e ricerche Enrico Fermi, Rome, Italy.
| | - Nerisa Banaj
- Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico "Tor Vergata", Rome, Italy.
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico "Tor Vergata", Rome, Italy.
| | - Carlo Caltagirone
- Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | | | | | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
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12
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Palmer EC, Gilleen J, David AS. The relationship between cognitive insight and depression in psychosis and schizophrenia: a review and meta-analysis. Schizophr Res 2015; 166:261-8. [PMID: 26095015 DOI: 10.1016/j.schres.2015.05.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 05/05/2015] [Accepted: 05/19/2015] [Indexed: 11/27/2022]
Abstract
Lack of insight is a commonly observed problem in patients with psychosis and schizophrenia. Clinical insight in patients has been associated with low mood. Cognitive insight is a recently defined concept, relating to the ability to self-reflect and the degree to which patients are over-confident regarding their interpretations of illness-related experiences, and is related to clinical insight. We therefore sought to investigate whether there is a positive relationship between cognitive insight and mood. A literature search identified 17 relevant papers published between 2004 and 2014. Our analysis indicated that there was a small but significant positive correlation between the composite index (CI) of the Beck Cognitive Insight Scale (BCIS) and depression scores, but this was driven by a significant positive relationship between depression and the BCIS self-reflection (SR) sub-scale, where low mood was related to higher SR scores. There was no significant relationship between the self-certainty sub-scale and depression. Post-hoc analysis indicated that different depression scales did not significantly affect the relationship with SR. Our results support the idea that cognitive insight is significantly related to mood in schizophrenia, and the effect size is similar to that between clinical insight and mood. Potential applications of this knowledge into treatment and rehabilitation are discussed and a model of cognitive insight is proposed.
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Affiliation(s)
- Emma C Palmer
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London Department of Psychiatry, University of Oxford, United Kingdom.
| | - James Gilleen
- Psychosis Studies, IoPPN, King's College London, United Kingdom
| | - Anthony S David
- Section of Cognitive Neuropsychiatry, IoPPN, King's College London, United Kingdom
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Buchy L, Hawco C, Joober R, Malla A, Lepage M. Cognitive insight in first-episode schizophrenia: further evidence for a role of the ventrolateral prefrontal cortex. Schizophr Res 2015; 166:65-8. [PMID: 26004692 DOI: 10.1016/j.schres.2015.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/01/2015] [Accepted: 05/04/2015] [Indexed: 01/31/2023]
Abstract
In people with psychoses, Self-Reflectiveness may rely on the right ventrolateral prefrontal cortex (VLPFC). We used functional magnetic resonance imaging (fMRI) and a novel virtual reality paradigm to evaluate the role of the VLPFC for Self-Reflectiveness in 25 first-episode of schizophrenia (FES) participants and 24 controls. Participants first viewed 20 characters each paired with a unique object/location, and later completed source memory judgements during fMRI scanning. Self-Reflectiveness, measured with the Beck Cognitive Insight Scale, was significantly and positively correlated to activation in bilateral VLPFC in FES, but not in controls, providing further evidence that the VLPFC supports Self-Reflectiveness in FES.
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Affiliation(s)
- Lisa Buchy
- Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Colin Hawco
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Ontario, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada; Department of Psychiatry, McGill University, Montreal, Canada; Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada.
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Raffard S, Bortolon C, Macgregor A, Norton J, Boulenger JP, El Haj M, Capdevielle D. Cognitive insight in schizophrenia patients and their biological parents: a pilot study. Schizophr Res 2014; 159:471-7. [PMID: 25242359 DOI: 10.1016/j.schres.2014.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/04/2014] [Accepted: 08/30/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical insight in schizophrenia patients is partly associated with familial environment but has been poorly studied to date. We aimed to explore (1) the relationship between parents' cognitive insight and their offspring's; (2) the relationship between parents' cognitive insight and their clinical insight into the disease of their offspring; and (3) the clinical and cognitive determinants of cognitive insight in parents. METHODS Cognitive insight was assessed in 37 patient-biological parent pairs/dyads with the Beck Cognitive Insight Scale (BCIS). Other measures included the Scale to assess Unawareness of Mental Disorder and cognitive assessments. RESULTS We found no significant association between parents' cognitive insight and their offspring's. Conversely, a positive association between parents' cognitive insight and parents' insight into their offspring's symptoms was found. Better awareness of their offspring's specific symptoms was associated with lower levels of overconfidence in one's beliefs and with BCIS total score. BCIS Self-Certainty and BCIS total score were associated with better executive functioning and verbal comprehension. CONCLUSIONS Better insight into their offspring's symptoms is associated with cognitive insight in biological parents of schizophrenia patients. Our results support the integration of cognitive intervention targeting parents' cognitive flexibility in family psychoeducational programs and provide an important first step towards developing a more refined understanding of the factors involved in insight into symptoms of illness in parents of schizophrenia patients.
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Affiliation(s)
- Stéphane Raffard
- Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France; University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France.
| | - Catherine Bortolon
- Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France; University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France
| | - Alexandra Macgregor
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France
| | - Joanna Norton
- Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France
| | - Jean-Philippe Boulenger
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France
| | - Mohamad El Haj
- Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France; INSERM U-1061, Montpellier, France; University Montpellier 1, Montpellier, France
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