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Agurto C, Cecchi G, King S, Eyigoz EK, Parvaz MA, Alia-Klein N, Goldstein RZ. Speak and you shall predict: speech at initial cocaine abstinence as a biomarker of long-term drug use behavior. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.18.549548. [PMID: 37503140 PMCID: PMC10370100 DOI: 10.1101/2023.07.18.549548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Importance Valid biomarkers that can predict longitudinal clinical outcomes at low cost are a holy grail in psychiatric research, promising to ultimately be used to optimize and tailor intervention and prevention efforts. Objective To determine if baseline linguistic markers in natural speech, as compared to non-speech clinical and demographic measures, can predict drug use severity measures at future sessions in initially abstinent individuals with cocaine use disorder (iCUD). Design A longitudinal cohort study (August 2017 - March 2020), where baseline measures were used to predict outcomes collected at three-month intervals for up to one year of follow-up. Participants Eighty-eight initially abstinent iCUD were studied at baseline; 57 (46 male, age 50.7+/-7.9 years) came back for at least another session. Main Outcomes and Measures Outcomes were self-reported symptoms of withdrawal, craving, abstinence duration and frequency of cocaine use in the past 90 days at each study session. The predictors were derived from 5-min recordings of vocal descriptions of the positive consequences of abstinence and the negative consequences of using cocaine; the baseline cocaine and other common drug use measures, demographic and neuropsychological variables were used for comparison. Results Models using the non-speech variables showed the best predictive performance at three(r>0.45, P<2×10-3) and six months follow-up (r>0.37, P<3×10-2). At 12 months, the natural language processing-based model showed significant correlations with withdrawal (r=0.43, P=3×10-2), craving (r=0.72, P=5×10-5), days of abstinence (r=0.76, P=1×10-5), and cocaine use in the past 90 days (r=0.61, P=2×10-3), significantly outperforming the other models for abstinence prediction. Conclusions and Relevance At short time intervals, maximal predictive power was obtained with models that used baseline drug use (in addition to demographic and neuropsychological) measures, potentially reflecting a slow rate of change in these measures, which could be estimated by linear functions. In contrast, short speech samples predicted longer-term changes in drug use, implying deeper penetrance by potentially capturing non-linear dynamics over longer intervals. Results suggest that, compared to the common outcome measures used in clinical trials, speech-based measures could be leveraged as better predictors of longitudinal drug use outcomes in initially abstinent iCUD, as potentially generalizable to other substance use disorders and related comorbidity.
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Affiliation(s)
- Carla Agurto
- IBM Research, 1101 Kitchawan Rd, Yorktown Heights, NY, 10598
| | | | - Sarah King
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029
| | - Elif K. Eyigoz
- IBM Research, 1101 Kitchawan Rd, Yorktown Heights, NY, 10598
| | - Muhammad A. Parvaz
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029
- Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029
| | - Nelly Alia-Klein
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029
| | - Rita Z. Goldstein
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029
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Mohamed H, Bertram R, Hubbeling D. Lack of insight and lack of decision-making capacity are not the same as anosognosia. Australas Psychiatry 2022; 30:136-137. [PMID: 34339609 DOI: 10.1177/10398562211032237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gagliardi G, Vannini P. Episodic Memory Impairment Mediates the Loss of Awareness in Mild Cognitive Impairment. Front Aging Neurosci 2022; 13:802501. [PMID: 35126092 PMCID: PMC8814670 DOI: 10.3389/fnagi.2021.802501] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Loss of awareness is a common symptom in Alzheimer's Disease (AD) and responsible for a significant loss of functional abilities. The mechanisms underlying loss of awareness in AD is unknown, although previous findings have implicated dysfunction of primary executive functioning (EF) or episodic memory (EM) to be the cause. Therefore, our main study objective was to explore the involvement of EF and EM dysfunction in amyloid-related loss of awareness across the clinical spectrum of AD. METHODS A total of 895 participants (362 clinically normal [CN], 422 people with mild cognitive impairment [MCI] and 111 with dementia) from the Alzheimer's Disease Neuroimaging Initiative were used for the analyses. A sub-analysis was performed in 202 participants who progressed in their clinical diagnosis from CN to MCI or MCI to dementia as well as dementia patients. Mediation models were used in each clinical group with awareness (assessed with the Everyday Cognitive function questionnaire) as a dependent variable to determine whether EF and/or EM would mediate the effect of amyloid on awareness. We also ran these analyses with subjective and informant complaints as dependent variables. Direct correlations between all variables were also performed. RESULTS We found evidence for a decline in awareness across the groups, with increased awareness observed in the CN group and decreased awareness observed in the MCI and dementia groups. Our results showed that EM, and not EF, partially mediated the relationship between amyloid and awareness such that greater amyloid and lower EM performance was associated with lower awareness. When analyzing each group separately, this finding was only observed in the MCI group and in the group containing progressors and dementia patients. When repeating the analyses for subjective and informant complaints separately, the results were replicated only for the informant's complaints. DISCUSSION Our results demonstrate that decline in EM and, to a lesser degree, EF, mediate the effect of amyloid on awareness. In line with previous studies demonstrating the development of anosognosia in the prodromal stage, our findings suggest that decreased awareness is the result of an inability for the participant to update his/her insight into his/her cognitive performance (i.e., demonstrating a petrified self).
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Affiliation(s)
- Geoffroy Gagliardi
- Neurology, Brigham and Women's Hospital, Boston, MA, United States
- Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Cambridge, MA, United States
| | - Patrizia Vannini
- Neurology, Brigham and Women's Hospital, Boston, MA, United States
- Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Cambridge, MA, United States
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4
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Martins BNFL, Palmier NR, Prado-Ribeiro AC, de Goes MF, Lopes MA, Brandão TB, Rivera C, Migliorati CA, Epstein JB, Santos-Silva AR. Awareness of the risk of radiation-related caries in patients with head and neck cancer: A survey of physicians, dentists, and patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:398-408. [PMID: 34353769 DOI: 10.1016/j.oooo.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Radiation-related caries (RRC) is one of the most aggressive complications of radiotherapy (RT) in survivors of head and neck cancer (HNC). Lack of RRC awareness may contribute to the occurrence of this oral cavity complication. RRC may be considered a "forgotten oral complication" by patients with HNC, oncologists, and dentists. The present study aimed to assess the level of awareness of RRC among physicians, dentists, and patients. STUDY DESIGN Physicians (group 1, G1), dentists (group 2, G2), and patients with HNC undergoing RT (group 3, G3) answered questionnaires concerning their awareness of RRC. Physicians (G1) were divided into group 1A (oncological experience) and group 1B (general physicians/other specialties). Dentists (G2) were divided into group 2A (oncological experience) and group 2B (general dentists/other specialties). Personalized questionnaires were designed for each group. RESULTS Recruitment was as follows: physicians (n = 124): 1A (n = 64), 1B (n = 60); dentists: (n = 280), 2A (n = 160), 2B (n = 120). In addition, 58 patients answered the questionnaire. In terms of RRC awareness, 46.77% of physicians, 81.78% of dentists, and 24.13% of patients had some knowledge of the problem. CONCLUSION Patient awareness of RRC was poor. The heterogeneity of answers among physicians and dentists suggests an opportunity to improve patient education and prevention of this serious oral complication of RT.
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Affiliation(s)
| | - Natália Rangel Palmier
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, Piracicaba, SP, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP), Dental Oncology Service, São Paulo, SP, Brazil.
| | - Ana Carolina Prado-Ribeiro
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, Piracicaba, SP, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP), Dental Oncology Service, São Paulo, SP, Brazil
| | - Mario Fernando de Goes
- University of Campinas (UNICAMP), Oral Rehabilitation Department, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - Marcio Ajudarte Lopes
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - Thais Bianca Brandão
- Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP), Dental Oncology Service, São Paulo, SP, Brazil
| | - Cesar Rivera
- Department of Basic Biomedical Sciences, Universidad de Talca, Talca, Chile
| | | | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Health System, Los Angeles, CA, USA; City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Alan Roger Santos-Silva
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, Piracicaba, SP, Brazil.
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Thirioux B, Harika-Germaneau G, Langbour N, Jaafari N. The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms. Front Psychiatry 2020; 10:966. [PMID: 32116810 PMCID: PMC7020772 DOI: 10.3389/fpsyt.2019.00966] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 12/06/2019] [Indexed: 01/12/2023] Open
Abstract
Lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions. Insight is the capacity to recognize (psychical insight) and accept one's mental illness (emotional insight). Insight growth necessitates developing an objective perspective on one's subjective pathological experiences. Therefore, insight has been posited to require undamaged self-reflexion and cognitive perspective-taking capacities. These enable patients to look objectively at themselves from the imagined perspective of someone else. Preserved theory-of-mind performances have been reported to positively impact insight in psychosis. However, some patients with schizophrenia or obsessive-compulsive disorders, although recognizing their mental disease, are still not convinced of this and do not accept it. Hence, perspective-taking explains psychical insight (recognition) but not emotional insight (acceptance). Here, we propose a new conceptual model. We hypothesize that insight growth relies upon the association of intact self-reflexion and empathic capacities. Empathy (feeling into someone else) integrates heterocentered visuo-spatial perspective (feeling into), embodiment, affective (feeling into) and cognitive processes, leading to internally experience the other's thought. We posit that this subjective experience enables to better understand the other's thought about oneself and to affectively adhere to this. We propose that the process of objectification, resulting from empathic heterocentered, embodiment, and cognitive processes, generates an objective viewpoint on oneself. It enables to recognize one's mental illness and positively impacts psychical insight. The process of subjectification, resulting from empathic affective processes, enables to accept one's illness and positively impacts emotional insight. That is, affectively experiencing the thought of another person about oneself reinforces the adhesion of the emotional system to the objective recognition of the disease. Applying our model to different psychiatric disorders, we predict that the negative effect of impaired self-reflexion and empathic capacities on insight is a transnosographic state and that endophenotypical differences modulate this common state, determining a psychiatric disease as specific.
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Affiliation(s)
- Bérangère Thirioux
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Ghina Harika-Germaneau
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nicolas Langbour
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, CHU de Poitiers, INSERM U 1084, Experimental and Clinical Neuroscience Laboratory, Groupement de Recherche CNRS 3557, Poitiers, France
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6
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Wibawa P, Zombor R, Dragovic M, Hayhow B, Lee J, Panegyres PK, Rock D, Starkstein SE. Anosognosia Is Associated With Greater Caregiver Burden and Poorer Executive Function in Huntington Disease. J Geriatr Psychiatry Neurol 2020; 33:52-58. [PMID: 31213121 DOI: 10.1177/0891988719856697] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anosognosia, or unawareness of one's deficits, is estimated to occur in 25% to 50% of Huntington disease (HD). The relationship between anosognosia and increased caregiver burden found in other dementias has not been determined in HD. METHODS Patient-caregiver dyads presenting to a statewide HD clinic were assessed using the Anosognosia Scale and grouped into "anosognosia" and "no anosognosia." Caregiver burden, measured by Zarit Burden Interview (ZBI) and Caregiver Burden Inventory (CBI), demographic data, and Unified Huntington's Disease Rating Scale, including Mini-Mental State Examination, Stroop, Trail Making, Verbal Fluency, and Symbol Digit Modalities Tests, were compared between groups. RESULTS Of the 38 patients recruited, 10 (26.3%) met criteria for anosognosia. Patients with anosognosia elicited higher caregiver burden ratings on both the ZBI (mean difference 16.4 [12.1], P < .001) and CBI (16.7 [15.0], P < .005) while also demonstrating poorer executive function. Except for CAG burden score, between-group characteristics did not differ significantly. Stroop Interference predicted both anosognosia and caregiver burden. CONCLUSIONS In HD, anosognosia is associated with greater caregiver burden and executive deficits. Its occurrence should prompt further patient assessment and increased caregiver support.
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Affiliation(s)
- P Wibawa
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia.,Clinical Research Centre, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - R Zombor
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - M Dragovic
- Clinical Research Centre, North Metropolitan Health Service-Mental Health, Perth, Australia.,The University of Western Australia, School of Psychiatry and Clinical Neurosciences, Perth, Australia
| | - B Hayhow
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia.,The University of Western Australia, School of Psychiatry and Clinical Neurosciences, Perth, Australia.,School of Medicine, University of Notre Dame, Fremantle, Australia
| | - J Lee
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - P K Panegyres
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - D Rock
- The University of Western Australia, School of Psychiatry and Clinical Neurosciences, Perth, Australia.,WA Primary Health Alliance, Perth, Australia
| | - S E Starkstein
- The University of Western Australia, School of Psychiatry and Clinical Neurosciences, Perth, Australia.,Department of Health, Fremantle Hospital, Perth, Australia
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8
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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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9
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Kim J, Plitman E, Nakajima S, Alshehri Y, Iwata Y, Chung JK, Caravaggio F, Menon M, Blumberger DM, Pollock BG, Remington G, De Luca V, Graff-Guerrero A, Gerretsen P. Modulation of brain activity with transcranial direct current stimulation: Targeting regions implicated in impaired illness awareness in schizophrenia. Eur Psychiatry 2019; 61:63-71. [DOI: 10.1016/j.eurpsy.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/15/2019] [Accepted: 06/21/2019] [Indexed: 01/29/2023] Open
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Mondragón JD, Maurits NM, De Deyn PP. Functional Neural Correlates of Anosognosia in Mild Cognitive Impairment and Alzheimer's Disease: a Systematic Review. Neuropsychol Rev 2019; 29:139-165. [PMID: 31161466 PMCID: PMC6560017 DOI: 10.1007/s11065-019-09410-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/08/2019] [Indexed: 12/11/2022]
Abstract
Functional neuroimaging techniques (i.e. single photon emission computed tomography, positron emission tomography, and functional magnetic resonance imaging) have been used to assess the neural correlates of anosognosia in mild cognitive impairment (MCI) and Alzheimer's disease (AD). A systematic review of this literature was performed, following the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement, on PubMed, EMBASE, and PsycINFO databases. Twenty-five articles met all inclusion criteria. Specifically, four brain connectivity and 21 brain perfusion, metabolism, and activation articles. Anosognosia is associated in MCI with frontal lobe and cortical midline regional dysfunction (reduced perfusion and activation), and with reduced parietotemporal metabolism. Reduced within and between network connectivity is observed in the default mode network regions of AD patients with anosognosia compared to AD patients without anosognosia and controls. During initial stages of cognitive decline in anosognosia, reduced indirect neural activity (i.e. perfusion, metabolism, and activation) is associated with the cortical midline regions, followed by the parietotemporal structures in later stages and culminating in frontotemporal dysfunction. Although the current evidence suggests differences in activation between AD or MCI patients with anosognosia and healthy controls, more evidence is needed exploring the differences between MCI and AD patients with and without anosognosia using resting state and task related paradigms.
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Affiliation(s)
- Jaime D Mondragón
- Department of Neurology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands.
- Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Natasha M Maurits
- Department of Neurology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
| | - Peter P De Deyn
- Department of Neurology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
- Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute Born-Bunge, Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp, Belgium
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Abstract
Cognitive impairments in substance use disorders have been extensively researched, especially since the advent of cognitive and computational neuroscience and neuroimaging methods in the last 20 years. Conceptually, altered cognitive function can be viewed as a hallmark feature of substance use disorders, with documented alterations in the well-known "executive" domains of attention, inhibition/regulation, working memory, and decision-making. Poor cognitive (sometimes referred to as "top-down") regulation of downstream motivational processes-whether appetitive (reward, incentive salience) or aversive (stress, negative affect)-is recognized as a fundamental impairment in addiction and a potentially important target for intervention. As addressed in this special issue, cognitive impairment is a transdiagnostic domain; thus, advances in the characterization and treatment of cognitive dysfunction in substance use disorders could have benefit across multiple psychiatric disorders. Toward this general goal, we summarize current findings in the abovementioned cognitive domains of substance use disorders, while suggesting a potentially useful expansion to include processes that both precede (precognition) and supersede (social cognition) what is usually thought of as strictly cognition. These additional two areas have received relatively less attention but phenomenologically and otherwise are important features of substance use disorders. The review concludes with suggestions for research and potential therapeutic targeting of both the familiar and this more comprehensive version of cognitive domains related to substance use disorders.
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Buchmann I, Jung R, Liepert J, Randerath J. Assessing Anosognosia in Apraxia of Common Tool-Use With the VATA-NAT. Front Hum Neurosci 2018; 12:119. [PMID: 29636672 PMCID: PMC5880953 DOI: 10.3389/fnhum.2018.00119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
In neurological patients, a lack of insight into their impairments can lead to possibly dangerous situations and non-compliance in rehabilitation therapy with worse rehabilitation outcomes as a result. This so called anosognosia is a multifaceted syndrome that can occur after brain damage affecting different neurological or cognitive functions. To our knowledge no study has investigated anosognosia for apraxia of common tool-use (CTU) so far. CTU-apraxia is a disorder frequently occurring after stroke that affects the use of familiar objects. Here, we introduce a new questionnaire to diagnose anosognosia for CTU-apraxia, the Visual Analogue Test assessing Anosognosia for Naturalistic Action Tasks (VATA-NAT). This assessment is adapted from a series of VATA-questionnaires that evaluate insight into motor (VATA-M) or language (VATA-L) impairment and take known challenges such as aphasia into account. Fifty one subacute stroke patients with left (LBD) or right (RBD) brain damage were investigated including patients with and without CTU-apraxia. Patients were assessed with the VATA-L, -M and -NAT before and after applying a diagnostics session for each function. Interrater reliability, composite reliability as well as convergent and divergent validity were evaluated for the VATA-NAT. Seven percent of the LBD patients with CTU-apraxia demonstrated anosognosia. After tool-use diagnostics this number increased to 20 percent. For the VATA-NAT, psychometric data revealed high interrater-reliability (τ ≥ 0.828), composite reliability (CR ≥ 0.809) and convergent validity (τ = -0.626). When assessing patients with severe aphasia, the possible influence of language comprehension difficulties needs to be taken into account for interpretation. Overall, close monitoring of anosognosia over the course of rehabilitation is recommended. With the VATA-NAT we hereby provide a novel assessment for anosognosia in patients with CTU-apraxia. For diagnosing anosognosia we recommend to combine this new tool with the existing VATA-M and -L subtests, particularly in patients who demonstrate severe functional deficits.
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Affiliation(s)
- Ilka Buchmann
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
| | - Rebecca Jung
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Joachim Liepert
- Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany.,Kliniken Schmieder, Allensbach, Germany
| | - Jennifer Randerath
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
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13
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Gerretsen P, Kim J, Shah P, Quilty L, Balakumar T, Caravaggio F, Plitman E, Chung JK, Iwata Y, Pollock BG, Dash S, Sockalingam S, Graff-Guerrero A. BASIS: The blood pressure awareness and insight scale. J Clin Hypertens (Greenwich) 2018. [PMID: 29524293 DOI: 10.1111/jch.13248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Impaired illness awareness or not accepting that one has hypertension (HTN) may be an important predictor of treatment adherence and optimal blood pressure control. The purpose of this study was to perform a systematic review of available instruments to evaluate HTN awareness, and subsequently present a novel scale that measures the core domains of subjective illness awareness in HTN. Based on the absence of any validated HTN specific measure identified through our review, the Blood Pressure Awareness and Insight Scale (BASIS) was developed (www.illnessawarenessscales.com). An online survey platform was used to collect data on 100 participants. BASIS showed good concurrent (r(98) = .65, P < 0.001) and discriminant validity, internal consistency (Cronbach's α = .75), and 1-month test-retest reliability (ICC = 0.77). BASIS is a comprehensive, easy-to-use instrument specifically designed to measure subjective HTN awareness. BASIS may be used in research studies and clinical practice to assess the impact of HTN awareness on treatment adherence and clinical outcomes.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Lena Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Thushanthi Balakumar
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eric Plitman
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jun Ku Chung
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Satya Dash
- Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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14
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Towards a cognitive neuroscience of self-awareness. Neurosci Biobehav Rev 2017; 83:765-773. [DOI: 10.1016/j.neubiorev.2016.04.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/19/2016] [Accepted: 04/07/2016] [Indexed: 11/17/2022]
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15
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Factors Related to Different Objects of Awareness in Alzheimer Disease. Alzheimer Dis Assoc Disord 2017; 31:335-342. [DOI: 10.1097/wad.0000000000000210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Gerretsen P, Pothier DD, Falls C, Armstrong M, Balakumar T, Uchida H, Mamo DC, Pollock BG, Graff-Guerrero A. Vestibular stimulation improves insight into illness in schizophrenia spectrum disorders. Psychiatry Res 2017; 251:333-341. [PMID: 28237912 PMCID: PMC5720160 DOI: 10.1016/j.psychres.2017.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/04/2017] [Accepted: 02/08/2017] [Indexed: 11/16/2022]
Abstract
Impaired insight into illness (IMP-INS) is common among individuals with schizophrenia spectrum disorders (SSD), contributing to medication nonadherence and poor clinical outcomes. Caloric vestibular simulation (CVS) is typically used to assess peripheral vestibular system function. Left cold CVS is also a transiently effective treatment for IMP-INS and hemineglect secondary to right brain hemisphere stroke, and possibly for IMP-INS and mood stabilization in patients with SSD. Participants with SSD and moderate-to-severe IMP-INS participated in an exploratory double blind, crossover, randomized controlled study of the effects of CVS on IMP-INS. Participants sequentially received all experimental conditions-left cold (4°C), right cold, and body temperature/sham CVS-in a random order. Repeated measures ANOVA were performed to compare changes in IMP-INS, mood and positive symptom severity pre and 30min post CVS. A significant interaction was found between CVS condition, time, and body temperature nystagmus peak slow phase velocity (PSPV) for IMP-INS, indicating that single session left cold CVS transiently improved IMP-INS while right cold CVS may have worsened IMP-INS, particularly in participants with greater vestibular reactivity (i.e. higher PSPV) to body temperature CVS. The procedure's effectiveness is attributed to stimulation of underactive right hemisphere circuits via vestibular nuclei projections to the contralateral hemisphere.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Mental Health Research Institute, Research Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - David D Pothier
- Department of Otolaryngology - Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, Toronto, Ontario, Canada
| | - Carolyn Falls
- Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, Toronto, Ontario, Canada
| | - Maxine Armstrong
- Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, Toronto, Ontario, Canada
| | - Thushanthi Balakumar
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Hiroyuki Uchida
- Geriatric Mental Health Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - David C Mamo
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Faculties of Medicine and Health Science, University of Malta, Msida, Malta
| | - Bruce G Pollock
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Mental Health Research Institute, Research Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Mental Health Research Institute, Research Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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17
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Jacus JP. Awareness, apathy, and depression in Alzheimer's disease and mild cognitive impairment. Brain Behav 2017; 7:e00661. [PMID: 28413709 PMCID: PMC5390841 DOI: 10.1002/brb3.661] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/17/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Results from studies on awareness disorders in Alzheimer's disease (AD) are controversial because the methodologies, the "objects" of awareness, and the patients' pathologic stage all vary. Our study aimed to compare scores and correlates of awareness according to the stage of the disease and the assessment method. METHODS We compared 20 mild AD patients to 20 mild cognitive impairment (MCI) patients, using the Patient Competency Rating Scale (PCRS; patient vs. caregiver report) and the Self-Consciousness Scale (rating scale). All patients underwent cognitive, psycho-affective and behavioral assessments (global cognition, executive functions, episodic memory, anxiety-depression, and apathy measures). RESULTS Groups were matched for age, education, and gender. They were comparable on the depression, anxiety, apathy and awareness scales (ps > .05), and differed for all cognitive variables (p < .05). Using the median split approach, greater apathy and lower depression were associated with poorer awareness on the Self-Consciousness Scale (respectively: odds ratio [OR] = 4.8, p = .03; OR = 4.84, p = .04), and the PCRS (only apathy: OR = 9.3, p = .003). Greater apathy plus lower depression were associated with poorer awareness in both scales (PCRS: OR = 40.5, p = .005; Self-consciousness scale: OR = 28, p = .012). CONCLUSION These results evidence comparable awareness between AD and MCI patients. The correlates were more affective and behavioral than cognitive, independently from assessment method.
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Affiliation(s)
- Jean-Pierre Jacus
- Consultations Mémoire Centre Hospitalier du val d'Ariège Foix Cedex France.,Laboratoire Epsylon, EA 4556 Université Paul-Valery Montpellier France
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18
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Mihaljcic T, Haines TP, Ponsford JL, Stolwyk RJ. Investigating the relationship between reduced self-awareness of falls risk, rehabilitation engagement and falls in older adults. Arch Gerontol Geriatr 2016; 69:38-44. [PMID: 27886565 DOI: 10.1016/j.archger.2016.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/24/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
The present study aimed to investigate whether self-awareness of falls risk is associated with rehabilitation engagement, motivation for rehabilitation, and number of falls after hospital discharge. The sample comprised 91 older adults (Mage=77.97, SD=8.04) undergoing inpatient rehabilitation. The Self-Awareness of Falls Risk Measure (SAFRM) was used to measure different aspects of self-awareness. The treating physiotherapist and occupational therapist rated the patient's engagement in rehabilitation and the patient reported his/her motivation for treatment. Falls information was collected from the patient and significant other once a month for three months following hospital discharge. Significant correlations were found between physiotherapist-rated engagement and intellectual (rs=-0.22, p<0.05) and anticipatory awareness (rs=-0.24, p<0.05). Occupational therapist-rated engagement and patient-reported motivation for rehabilitation was correlated with emergent awareness (rs=-0.38 and -0.31, p<0.05, respectively) and overall self-awareness (rs=-0.31 and -0.26, p<0.05, respectively). Regression analyses indicated that overall self-awareness provided a unique contribution to occupational therapist-rated engagement when controlling for age, gender, cognition and functional ability. Falls were reported by 29.9% of participants, however, self-awareness did not differ significantly between fallers and non-fallers. The findings suggest that self-awareness of falls risk is associated with rehabilitation engagement and motivation. Therefore, improving patient self-awareness of falls risk may increase engagement in therapy leading to better patient outcomes.
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Affiliation(s)
- Tijana Mihaljcic
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Terry P Haines
- Department of Physiotherapy, Monash University, McMahons Road, Frankston, VIC 3199, Australia; Allied Health Research Unit, Monash Health, Warrigal Road, Cheltenham, VIC 3192, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia; Monash-Epworth Rehabilitation Research Centre, Suite 1.7, 173 Lennox Street, VIC 3121, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
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Abstract
In spite of the increasing number of studies on insight in psychiatry and also in neurology and psychology, its nature is still elusive. It encompasses at least three fundamental characteristics: the awareness of suffering from an illness, an understanding of the cause and source of this suffering, and an acknowledgment of the need for treatment. As such, insight is fundamental for patients' management, prognosis, and treatment. Not surprisingly, the majority of available data, which have been gathered on schizophrenia, show a relationship between low insight and poorer outcomes. For mood disorders, however, insight is associated with less positive results. For other psychiatric disorders, insight has rarely been investigated. In neurology, the impaired ability to recognize the presence of sensory, perceptual, motor, affective, or cognitive functioning-referred to as anosognosia-has been related to damage of specific brain regions. This article provides a comprehensive review of insight in different psychiatric and neurological disorders, with a special focus on brain areas and neurotransmitters that serve as the substrate for this complex phenomenon.
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Epping EA, Kim JI, Craufurd D, Brashers-Krug TM, Anderson KE, McCusker E, Luther J, Long JD, Paulsen JS. Longitudinal Psychiatric Symptoms in Prodromal Huntington's Disease: A Decade of Data. Am J Psychiatry 2016; 173:184-92. [PMID: 26472629 PMCID: PMC5465431 DOI: 10.1176/appi.ajp.2015.14121551] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Psychiatric symptoms are a significant aspect of Huntington's disease, an inherited neurodegenerative illness. The presentation of these symptoms is highly variable, and their course does not fully correlate with motor or cognitive disease progression. The authors sought to better understand the development and longitudinal course of psychiatric manifestations in individuals who carry the Huntington's disease mutation, starting from the prodromal period prior to motor diagnosis. METHOD Longitudinal measures for up to 10 years of psychiatric symptoms from the Symptom Checklist-90-Revised were obtained from 1,305 participants (1,007 carrying the Huntington's disease mutation and 298 without [classified as controls]) and 1,235 companions enrolled in the Neurobiological Predictors of Huntington's Disease (PREDICT-HD) study. Participants with the mutation were stratified into three groups according to probability of motor diagnosis within 5 years. Using linear mixed-effects regression models, differences in psychiatric symptoms at baseline and over time between the mutation-positive groups and the controls were compared, as well as between ratings by mutation-positive participants and their companions. RESULTS Nineteen of 24 psychiatric measures (12 participant ratings and 12 companion ratings) were significantly higher at baseline and showed significant increases longitudinally in the individuals with the Huntington's disease mutation compared with controls. The differences were greatest in comparisons of symptom reports from companions compared with self-reports, especially in participants who were closest to motor diagnosis. CONCLUSIONS The results indicate that psychiatric manifestations develop more often than previously thought in the Huntington's disease prodrome. Symptoms also increase with progression of disease severity. Greater symptom ratings by companions than by mutation-positive participants suggest decreasing awareness in those affected.
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Affiliation(s)
- Eric A. Epping
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Ji-In Kim
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - David Craufurd
- Institute of Human Development, The University of Manchester, Manchester, England, UK
| | - Thomas M. Brashers-Krug
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Karen E. Anderson
- Huntington Disease Care, Education, and Research Center, MedStar Georgetown University Hospital, Washington, DC, USA,Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC, USA,Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Elizabeth McCusker
- Department of Neurology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Jolene Luther
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Jeffrey D. Long
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Jane S. Paulsen
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,Department of Psychology, The University of Iowa, Iowa City, IA, USA,Correspondence to Jane S. Paulsen, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Psychiatry Research, 1–305 Medical Education Building, Iowa City, IA USA 52242-1000. Tele: 319-353-4551; Fax: 319-353-3003;
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21
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Agyapong VIO. Factors predicting the presence of impaired clinical insight in liaison psychiatric patients assessed in the Emergency Room. Int J Psychiatry Clin Pract 2016; 20:32-9. [PMID: 26472047 DOI: 10.3109/13651501.2015.1107910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES There are limited studies on the factors that can predict the presence of impaired clinical insight specifically in an Emergency Room (ER) psychiatric patient population. The objective of this study is to examine the factors that can predict the likelihood that a patient presenting to the ER will have impaired clinical insight. METHODS Nineteen independent demographic and clinical factors contained on data assessment tools for 337 patients assessed by the crisis team in the ER over 6 months were compiled and analysed using SPSS Version 20 with univariate analyses and logistic regression. RESULTS Patients who were unemployed or had a history of self-harm or had psychotic symptoms on mental state examination were about two, three and six times, respectively, more likely to have impaired clinical insight compared with those who were employed, had no history of self-harm or had no psychotic symptoms on mental state examination, controlling for other factors in the logistic regression model. CONCLUSION Patients who are unemployed, have a history of self-harm or have psychotic symptoms following as psychiatric assessment in the ER may benefit from an insight-oriented psychotherapy.
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Affiliation(s)
- Vincent I O Agyapong
- a Department of Psychiatry , University of Alberta , Edmonton , AB , Canada ;,b Department of Psychiatry , Northern Lights Regional Health Centre , Fort McMurray , AB , Canada
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22
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Spalletta G, Piras F, Piras F, Sancesario G, Iorio M, Fratangeli C, Cacciari C, Caltagirone C, Orfei MD. Neuroanatomical correlates of awareness of illness in patients with amnestic mild cognitive impairment who will or will not convert to Alzheimer's disease. Cortex 2015; 61:183-95. [PMID: 25481475 DOI: 10.1016/j.cortex.2014.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/07/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Awareness of cognitive deficits may be reduced in mild cognitive impairment (MCI). This may have a detrimental effect on illness course and may be a predictor of subsequent conversion to AD. Although neuropsychological correlates have been widely investigated, no evidence of a neuroanatomical basis of the phenomenon has been reported yet. This study was aimed at investigating the neuroanatomical correlates of deficit awareness in amnestic MCI to determine whether they constitute risk factors for conversion to AD. METHOD A sample of 36 first-diagnosis amnestic MCI patients were followed for five years. At the first diagnostic visit they were administered an extensive diagnostic and clinical procedure and the Memory Insight Questionnaire (MIQ), measuring a total index and four sub-indices, to investigate awareness of deficits in dementia; they also underwent a high resolution T1-weighted Magnetic Resonance Imaging (MRI) investigation. Grey matter brain volumes were analysed on a voxel-by-voxel basis using Statistical Parametric Mapping 8. Data of 10 converter patients (CONV) and those of 26 non converter patients (NOCONV) were analysed using multiple regression models. RESULTS At baseline, self-awareness of memory deficits was poorer in CONV compared to NOCONV. Furthermore, reduced awareness of cognitive deficits in CONV correlated with reduced grey matter volume of the anterior cingulate (memory deficit awareness), right pars triangularis of the inferior frontal cortex (memory deficit awareness) and cerebellar vermis (total awareness), whereas in NOCONV it correlated with reduced grey matter volume of left superior (total awareness) and middle (language deficit awareness) temporal areas. Further, at baseline self-awareness of memory deficits were poorer in CONV than in NOCONV. CONCLUSIONS Defective awareness of cognitive deficits is underpinned by different mechanisms in CONV and NOCONV amnestic MCI patients. Our data support the hypothesis that poor awareness of cognitive deficit is a predictor of subsequent conversion to AD.
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Affiliation(s)
| | | | | | | | | | | | | | - Carlo Caltagirone
- IRCCS Santa Lucia Foundation, Rome, Italy; Tor Vergata University, Rome, Italy
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Gerretsen P, Menon M, Mamo DC, Fervaha G, Remington G, Pollock BG, Graff-Guerrero A. Impaired insight into illness and cognitive insight in schizophrenia spectrum disorders: resting state functional connectivity. Schizophr Res 2014; 160:43-50. [PMID: 25458571 PMCID: PMC4429527 DOI: 10.1016/j.schres.2014.10.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Impaired insight into illness (clinical insight) in schizophrenia has negative effects on treatment adherence and clinical outcomes. Schizophrenia is described as a disorder of disrupted brain connectivity. In line with this concept, resting state networks (RSNs) appear differentially affected in persons with schizophrenia. Therefore, impaired clinical, or the related construct of cognitive insight (which posits that impaired clinical insight is a function of metacognitive deficits), may reflect alterations in RSN functional connectivity (fc). Based on our previous research, which showed that impaired insight into illness was associated with increased left hemisphere volume relative to right, we hypothesized that impaired clinical insight would be associated with increased connectivity in the DMN with specific left hemisphere brain regions. METHODS Resting state MRI scans were acquired for participants with schizophrenia or schizoaffective disorder (n=20). Seed-to-voxel and ROI-to-ROI fc analyses were performed using the CONN-fMRI fc toolbox v13 for established RSNs. Clinical and cognitive insight were measured with the Schedule for the Assessment of Insight-Expanded Version and Beck Cognitive Insight Scale, respectively, and included as the regressors in fc analyses. RESULTS As hypothesized, impaired clinical insight was associated with increased connectivity in the default mode network (DMN) with the left angular gyrus, and also in the self-referential network (SRN) with the left insula. Cognitive insight was associated with increased connectivity in the dorsal attention network (DAN) with the right inferior frontal cortex (IFC) and left anterior cingulate cortex (ACC). CONCLUSION Increased connectivity in DMN and SRN with the left angular gyrus and insula, respectively, may represent neural correlates of impaired clinical insight in schizophrenia spectrum disorders, and is consistent with the literature attributing impaired insight to left hemisphere dominance. Increased connectivity in the DAN with the IFC and ACC in relation to cognitive insight may facilitate enhanced mental flexibility in this sample.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada,Geriatric Mental Health Program, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of Toronto, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mahesh Menon
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of British Columbia, Canada
| | - David C. Mamo
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of Toronto, Canada,Department of Psychiatry, Faculties of Medicine and Health Science, University of Malta, Msida, Malta
| | - Gagan Fervaha
- Schizophrenia Program, Centre for Addiction & Mental Health, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Schizophrenia Program, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G. Pollock
- Geriatric Mental Health Program, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Canada; Department of Psychiatry, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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24
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Assessing anosognosias after stroke: A review of the methods used and developed over the past 35 years. Cortex 2014; 61:43-63. [DOI: 10.1016/j.cortex.2014.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/03/2014] [Accepted: 04/18/2014] [Indexed: 11/19/2022]
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Gerretsen P, Plitman E, Rajji TK, Graff-Guerrero A. The effects of aging on insight into illness in schizophrenia: a review. Int J Geriatr Psychiatry 2014; 29:1145-61. [PMID: 25055980 PMCID: PMC4472640 DOI: 10.1002/gps.4154] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/03/2014] [Accepted: 05/05/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Impaired insight into illness is a prevalent feature of schizophrenia, which negatively influences treatment adherence and clinical outcomes. Little is known about the effects of aging on insight impairment. We aimed to review the available research literature on the effects of aging on insight into illness in schizophrenia, in relation to positive, negative, and cognitive symptoms. Ultimately, we propose a trajectory of insight in schizophrenia across the lifespan. METHOD A systematic Medline® literature search was conducted, searching for English language studies describing the relationship of insight into illness in schizophrenia with aging. RESULTS We identified 62 studies. Insight impairment is associated with illness severity, premorbid intellectual function (i.e. IQ), executive function, and memory. Insight impairment improves modestly during midlife, worsening again in late life. It tends to fluctuate with each episode of psychosis, likely in relation to worsening positive symptoms that improve with antipsychotic treatment. The relationship between insight impairment and cognitive dysfunction appears to attenuate with age, while the relationship with lower premorbid intellectual function is preserved. The association between impaired insight and negative symptoms is unclear. CONCLUSIONS The available literature suggests that the course of insight impairment follows a U-shaped curve, where insight impairment is severe during the first episode of psychosis, modestly improves over midlife, and declines again in late life. Future studies are required to investigate the trajectory of insight into illness and its core domains across the lifespan from prodromal phase to late life.
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Affiliation(s)
- Philip Gerretsen
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Eric Plitman
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Tarek K. Rajji
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Ariel Graff-Guerrero
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
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Gambina G, Bonazzi A, Valbusa V, Condoleo MT, Bortolami O, Broggio E, Sala F, Moretto G, Moro V. Awareness of cognitive deficits and clinical competence in mild to moderate Alzheimer's disease: their relevance in clinical practice. Neurol Sci 2014; 35:385-90. [PMID: 23959532 DOI: 10.1007/s10072-013-1523-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/07/2013] [Indexed: 11/26/2022]
Abstract
Awareness of cognitive deficits and clinical competence were investigated in 79 mild to moderate Alzheimer's disease patients. Awareness was assessed by the anosognosia questionnaire for dementia, and clinical competence by specific neuropsychological tests such as trail making test-A, Babcock story recall test, semantic and phonemic verbal fluency. The findings show that 66 % of the patients were aware of memory deficits, while the 34 % were unaware. Deficit in awareness correlated with lower scores on the Mini Mental State Examination test that, in the score range from 24.51 to 30 and from 19.50 to 24.50, appeared to be a significant predictor of level of awareness. None of the AD patients had fully preserved clinical competence, only 7 patients (9 %) had partially preserved clinical competence and 72 patients (91 %) had completely lost clinical competence. All the patients with partially preserved clinical competence (9 %) were aware of their memory deficit. The study indicates that neuropsychological tests used for the assessment of executive functions are not suitable for investigating clinical competence. Therefore, additional and specific tools for the evaluation of clinical competence are necessary. Indeed, these might allow clinicians to identify AD patients who, despite their deficits in selected functions, retain their autonomy of choice as well as recognize those patients who should proceed to the nomination of a legal representative.
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Gerretsen P, Menon M, Chakravarty MM, Lerch JP, Mamo DC, Remington G, Pollock BG, Graff-Guerrero A. Illness denial in schizophrenia spectrum disorders: a function of left hemisphere dominance. Hum Brain Mapp 2014; 36:213-25. [PMID: 25209949 DOI: 10.1002/hbm.22624] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/12/2014] [Accepted: 08/21/2014] [Indexed: 01/09/2023] Open
Abstract
Impaired illness awareness or anosognosia is a common, but poorly understood feature of schizophrenia that contributes to medication nonadherence and poor treatment outcomes. Here we present a functional imaging study to measure brain activity at the moment of illness denial. To accomplish this, participants with schizophrenia (n = 18) with varying degrees of illness awareness were confronted with their illness beliefs while undergoing functional MRI. To link structure with function, we explored the relationships among impaired illness awareness and brain activity during the illness denial task with cortical thickness. Impaired illness awareness was associated with increased brain activity in the left temporoparieto-occipital junction (TPO) and left medial prefrontal cortex (mPFC) at the moment of illness denial. Brain activity in the left mPFC appeared to be a function of participants' degree of self-reflectiveness, while the activity in the left TPO was associated with cortical thinning in this region and more specific to illness denial. Participants with impaired illness awareness had slower response times to illness related stimuli than those with good illness awareness. Increased left hemisphere brain activity in association with illness denial is consistent with the literature in other neuropsychiatric conditions attributing anosognosia or impaired illness awareness to left hemisphere dominance. The TPO and mPFC may represent putative targets for noninvasive treatment interventions, such as transcranial magnetic or direct current stimulation.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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The neuropsychology of self-reflection in psychiatric illness. J Psychiatr Res 2014; 54:55-63. [PMID: 24685311 PMCID: PMC4022422 DOI: 10.1016/j.jpsychires.2014.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/10/2014] [Accepted: 03/07/2014] [Indexed: 01/02/2023]
Abstract
The development of robust neuropsychological measures of social and affective function-which link critical dimensions of mental health to their underlying neural circuitry-could be a key step in achieving a more pathophysiologically-based approach to psychiatric medicine. In this article, we summarize research indicating that self-reflection (the inward attention to personal thoughts, memories, feelings, and actions) may be a useful model for developing such a paradigm, as there is evidence that self-reflection is (1) measurable with self-report scales and performance-based tests, (2) linked to the activity of a specific neural circuit, and (3) dimensionally related to mental health and various forms of psychopathology.
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Spalletta G, Piras F, Piras F, Caltagirone C, Orfei MD. The structural neuroanatomy of metacognitive insight in schizophrenia and its psychopathological and neuropsychological correlates. Hum Brain Mapp 2014; 35:4729-40. [PMID: 24700789 DOI: 10.1002/hbm.22507] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/17/2014] [Accepted: 02/25/2014] [Indexed: 12/21/2022] Open
Abstract
Lack of insight into illness is a multidimensional phenomenon that has relevant implications on clinical course and therapy compliance. Here, we focused on metacognitive insight in schizophrenia, that is, the ability to monitor one's changes in state of mind and sensations, with the aim of investigating its neuroanatomical, psychopathological, and neuropsychological correlates. Fifty-seven consecutive patients with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnosis of schizophrenia were administered the Insight Scale, and comprehensive psychopathological and neuropsychological batteries. They underwent a high-resolution T1-weighted magnetic resonance imaging investigation. Gray matter (GM) and white matter (WM) volumes were analyzed on a voxel-by-voxel basis using Statistical Parametric Mapping 8. Reduced metacognitive insight was related to reduced GM volumes in the left ventrolateral prefrontal cortex, right dorsolateral prefrontal cortex and insula, and bilateral premotor area and putamen. Further, it was related to reduced WM volumes of the right superior longitudinal fasciculum, left corona radiata, left forceps minor, and bilateral cingulum. Increased metacognitive insight was related to increased depression severity and attentional control impairment, while the latter was related to increased GM volumes in brain areas linked to metacognitive insight. Results of this study suggest that prefrontal GM and WM bundles, all implied in cognitive control and self-reflection, may be the neuroanatomical correlates of metacognitive insight in schizophrenia. Further, higher metacognitive insight is hypothesized to be a risk factor for depression which may subsequently impair attention. This line of research may provide the basis for the development of cognitive interventions aimed at improving self-monitoring and compliance to treatment.
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Affiliation(s)
- Gianfranco Spalletta
- Department of Clinical and Behavioural Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
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Jacus JP, Dupont MP, Herades Y, Pelix C, Large H, Baud M. [Awareness disorders in Alzheimer's disease and in mild cognitive impairment]. Encephale 2014; 40:180-7. [PMID: 24630532 DOI: 10.1016/j.encep.2013.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 10/07/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Awareness disorders in Alzheimer's disease still remains unclear despite much research regarding this phenomenon. Papers report various and contrasted results with varying frequency from one study to another. Hence, the interest in awareness in Alzheimer's disease remains limited. Nevertheless, this symptom is closely associated with caregivers' burden and increases the patient's dependency, since the patient is unable to avoid dangers, requiring some care services or institutionalization The purpose of this current review is to recall the main neuro-anatomical and theoretical basis of awareness disorders, and to highlight the recent findings in Alzheimer's disease and in its pre-clinical stages. METHOD With this in mind, we have conducted a non-exhaustive search using the pubmed online database to collect the most important reviews and the most recent findings regarding awareness disorders in Mild Cognitive Impairment (MCI) and/or in Alzheimer's disease. LITERATURE FINDINGS In Alzheimer's disease, the links between awareness disorders and other variables, such as severity of dementia or depression, change from one study to the other and do not permit one to understand whether unawareness is an intrinsic or extrinsic reaction to the pathological process itself. Recent results suggest executive, cognitive and behavioral correlates more than psychopathological correlates, although the latter cannot be excluded. In Mild Cognitive Impairment, studies show varied results. Some studies report that patients suffering from Mild Cognitive Impairment can be compared to healthy control subjects and both groups have better awareness than patients with Alzheimer's disease. However, other studies show contrary results and awareness disorders might be a predictor of conversion from Mild Cognitive Impairment to dementia, as with apathy, in which the ability to cope with difficulties represents one of the main features. DISCUSSION These controversial results are due to the heterogeneity of Alzheimer patients and in particular of MCI patients, but also to various conceptions of awareness disorders in Alzheimer's disease; none of them, however, taking into account all its diversity and complexity. Thus, neurological approaches underline neuropsychological dysfunctions linked to right frontal and/or hemispheric damage but are based on brain injury or strokes, which are events that differ greatly from a neurodegenerative disease involving progressive cognitive, emotional and social disturbances. Psychiatric approaches have taken into account the various aspects of insight, which before were often forbidden and reduced to a categorical point of view, and so could contribute to a better understanding of awareness disorders in Alzheimer's disease. However, these aspects have been conceptualized for psychiatric patients, suffering from positive symptoms, where compliance in treatment is the central key. Insight in neurological diseases is more focused on negative symptoms and generally concerns a basic perception of impairments in mainly cognitive domains. Moreover, modeling has often opposed neurological and psychological mechanisms, so awareness disorders are out of scope of a primary and secondary symptomatology. Although some authors have proposed to take into account these two mechanisms (unawareness and denial), clinical practice has shown that it was impossible to distinguish them both. Finally, some social cognitive approaches are able to demonstrate that there is no correlation between severity of dementia and awareness disorders. Nevertheless, the Self-concept, underlying this point of view, does not permit distinguishing neuropsychological from psycho-social factors. Moreover, only one evaluation tool based on Self-modeling in Alzheimer's disease exists, and to conceptualize Self in a specific pathology does not permit the comparison of this pathology to others or to healthy control subjects. So, the authors present the multidimensional model proposed by Clare et al., and some perspectives to stimulate future research, and perform potential meta-analyses.
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Affiliation(s)
- J-P Jacus
- Consultation mémoire, centre hospitalier du Val-d'Ariège, 09017 Foix cedex, France.
| | - M-P Dupont
- Unité cognitivo-comportementale, consultation mémoire, centre hospitalier Ariège-Couserans, 09200 Saint-Girons, France
| | - Y Herades
- Consultation mémoire, centre hospitalier du Val-d'Ariège, 09017 Foix cedex, France; Centre hospitalier du Val-d'Ariège, 09017 Foix cedex, France
| | - C Pelix
- Consultation mémoire, centre hospitalier du Val-d'Ariège, 09017 Foix cedex, France
| | - H Large
- Unité mobile de gériatrie, consultation mémoire, centre hospitalier Ariège-Couserans, 09200 Saint-Girons, France
| | - M Baud
- Unité cognitivo-comportementale, centre hospitalier Ariège-Couserans, 09200 Saint-Girons, France
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Sollberger M, Rosen HJ, Shany-Ur T, Ullah J, Stanley CM, Laluz V, Weiner MW, Wilson SM, Miller BL, Rankin KP. Neural substrates of socioemotional self-awareness in neurodegenerative disease. Brain Behav 2014; 4:201-14. [PMID: 24683513 PMCID: PMC3967536 DOI: 10.1002/brb3.211] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/30/2013] [Accepted: 12/15/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neuroimaging studies examining neural substrates of impaired self-awareness in patients with neurodegenerative diseases have shown divergent results depending on the modality (cognitive, emotional, behavioral) of awareness. Evidence is accumulating to suggest that self-awareness arises from a combination of modality-specific and large-scale supramodal neural networks. METHODS We investigated the structural substrates of patients' tendency to overestimate or underestimate their own capacity to demonstrate empathic concern for others. Subjects' level of empathic concern was measured using the Interpersonal Reactivity Index, and subject-informant discrepancy scores were used to predict regional atrophy pattern, using voxel-based morphometry analysis. Of the 102 subjects, 83 were patients with neurodegenerative diseases such as behavioral variant frontotemporal dementia (bvFTD) or semantic variant primary progressive aphasia (svPPA); the other 19 were healthy older adults. RESULTS bvFTD and svPPA patients typically overestimated their level of empathic concern compared to controls, and overestimating one's empathic concern predicted damage to predominantly right-hemispheric anterior infero-lateral temporal regions, whereas underestimating one's empathic concern showed no neuroanatomical basis. CONCLUSIONS These findings suggest that overestimation and underestimation of one's capacity for empathic concern cannot be interpreted as varying degrees of the same phenomenon, but may arise from different pathophysiological processes. Damage to anterior infero-lateral temporal regions has been associated with semantic self-knowledge, emotion processing, and social perspective taking; neuropsychological functions partly associated with empathic concern itself. These findings support the hypothesis that-at least in the socioemotional domain-neural substrates of self-awareness are partly modality-specific.
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Affiliation(s)
- Marc Sollberger
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California ; Department of Neurology, University Hospital Basel, Switzerland ; Memory Clinic, University Center for Medicine of Aging, Felix-Platter Hospital Basel, Switzerland
| | - Howard J Rosen
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Tal Shany-Ur
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Jerin Ullah
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Christine M Stanley
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Victor Laluz
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Michael W Weiner
- Department of Radiology, University of California San Francisco, California ; Magnetic Resonance Imaging Unit, San Francisco Veterans Affairs Hospital San Francisco, California
| | - Stephen M Wilson
- Department of Speech, Language and Hearing Sciences Tucson, Arizona
| | - Bruce L Miller
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
| | - Katherine P Rankin
- Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California
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Moeller SJ, Konova AB, Parvaz MA, Tomasi D, Lane RD, Fort C, Goldstein RZ. Functional, structural, and emotional correlates of impaired insight in cocaine addiction. JAMA Psychiatry 2014; 71:61-70. [PMID: 24258223 PMCID: PMC4193926 DOI: 10.1001/jamapsychiatry.2013.2833] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Individuals with cocaine use disorder (CUD) have difficulty monitoring ongoing behavior, possibly stemming from dysfunction of brain regions mediating insight and self-awareness. OBJECTIVE To investigate the neural correlates of impaired insight in addiction using a combined functional magnetic resonance imaging and voxel-based morphometry approach. DESIGN, SETTING, AND PARTICIPANTS This multimodal imaging study was performed at the Clinical Research Center at Brookhaven National Laboratory. The study included 33 CUD cases and 20 healthy controls. MAIN OUTCOMES AND MEASURES Functional magnetic resonance imaging, voxel-based morphometry, Levels of Emotional Awareness Scale, and drug use variables. RESULTS Compared with the other 2 study groups, the impaired insight CUD group had lower error-induced rostral anterior cingulate cortex (rACC) activity as associated with more frequent cocaine use, less gray matter within the rACC, and lower Levels of Emotional Awareness Scale scores. CONCLUSIONS AND RELEVANCE These results point to rACC functional and structural abnormalities and diminished emotional awareness in a subpopulation of CUD cases characterized by impaired insight. Because the rACC has been implicated in appraising the affective and motivational significance of errors and other types of self-referential processing, functional and structural abnormalities in this region could result in lessened concern (frequently ascribed to minimization and denial) about behavioral outcomes that could potentially culminate in increased drug use. Treatments that target this CUD subgroup could focus on enhancing the salience of errors (eg, lapses).
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Affiliation(s)
- Scott J. Moeller
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Anna B. Konova
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Department of Psychology, Stony Brook University, Stony Brook, NY 11794
| | - Muhammad A. Parvaz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Dardo Tomasi
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892
| | - Richard D. Lane
- Department of Psychiatry, University of Arizona, Tuscon, AZ 85724
| | - Carolyn Fort
- Department of Psychiatry, University of Arizona, Tuscon, AZ 85724
| | - Rita Z. Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Correspondence and requests for materials should be addressed to: Rita Z. Goldstein, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574; tel. (212) 659-8838; fax (212) 996-8931;
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Gerretsen P, Mulsant BH, Liu AY, Granholm E, Menon M, Graff-Guerrero A, Pollock BG, Mamo DC, Rajji TK. Insight into illness in late-life schizophrenia: a function of illness severity and premorbid intellectual function. Schizophr Res 2013; 150:217-22. [PMID: 23972588 DOI: 10.1016/j.schres.2013.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Abstract
Impaired insight into illness is a common but poorly understood phenomenon in schizophrenia. Several studies in midlife adults with schizophrenia have reported an association between impaired insight and illness severity, executive dysfunction, premorbid intellectual function, and to a lesser degree attention. Aging is associated with a decline in attention and executive function. Thus, the relationship between cognition and insight is expected to differ between younger and older adults with schizophrenia. This study assessed this relationship among 50 patients with schizophrenia 60 years and older. Insight was explained by illness severity (16.2% of the variance) and premorbid intellectual function (23.9% of the variance), but not by attention or executive function. Our findings suggest that the predictors of insight in schizophrenia differ early and later in life. In particular, insight's association with attention and executive function observed in younger patients is attenuated by age-related changes in cognition. In contrast, premorbid intellectual function continues to be a strong predictor of insight in late life, which highlights the need to better understand and enhance cognitive function early in the course of schizophrenia.
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Affiliation(s)
- Philip Gerretsen
- University of Toronto and Centre for Addiction and Mental Health, Toronto, ON, Canada
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Gerretsen P, Chakravarty MM, Mamo D, Menon M, Pollock BG, Rajji TK, Graff‐Guerrero A. Frontotemporoparietal asymmetry and lack of illness awareness in schizophrenia. Hum Brain Mapp 2013; 34:1035-43. [PMID: 22213454 PMCID: PMC6870294 DOI: 10.1002/hbm.21490] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Lack of illness awareness or anosognosia occurs in both schizophrenia and right hemisphere lesions due to stroke, dementia, and traumatic brain injury. In the latter conditions, anosognosia is thought to arise from unilateral hemispheric dysfunction or interhemispheric disequilibrium, which provides an anatomical model for exploring illness unawareness in other neuropsychiatric disorders, such as schizophrenia. METHODS Both voxel-based morphometry using Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra (DARTEL) and a deformation-based morphology analysis of hemispheric asymmetry were performed on 52 treated schizophrenia subjects, exploring the relationship between illness awareness and gray matter volume. Analyses included age, gender, and total intracranial volume as covariates. RESULTS Hemispheric asymmetry analyses revealed illness unawareness was significantly associated with right < left hemisphere volumes in the anteroinferior temporal lobe (t = 4.83, P = 0.051) using DARTEL, and the dorsolateral prefrontal cortex (t = 5.80, P = 0.003) and parietal lobe (t = 4.3, P = 0.050) using the deformation-based approach. Trend level associations were identified in the right medial prefrontal cortex (t = 4.49, P = 0.127) using DARTEL. Lack of illness awareness was also strongly associated with reduced total white matter volume (r = 0.401, P < 0.01) and illness severity (r = 0.559, P < 0.01). CONCLUSION These results suggest a relationship between anosognosia and hemispheric asymmetry in schizophrenia, supporting previous volume-based MRI studies in schizophrenia that found a relationship between illness unawareness and reduced right hemisphere gray matter volume. Functional imaging studies are required to examine the neural mechanisms contributing to these structural observations.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - M. Mallar Chakravarty
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
- Mouse Imaging Centre (MICe), The Hospital for Sick Children, Toronto, Ontario, Canada
- Kimel Family Translational Imaging‐Genetics Research Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health
| | - David Mamo
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Mahesh Menon
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bruce G. Pollock
- Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K. Rajji
- Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff‐Guerrero
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Antoine P, Nandrino JL, Billiet C. Awareness of deficits in Alzheimer's disease patients: analysis of performance prediction discrepancies. Psychiatry Clin Neurosci 2013; 67:237-44. [PMID: 23683154 DOI: 10.1111/pcn.12050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 08/31/2012] [Accepted: 01/09/2013] [Indexed: 11/27/2022]
Abstract
AIM Unawareness has been operationalized in terms of a discrepancy between the patient's self-reports and three main categories of standards: judgment of a relative, clinical assessment, and objective test performance. The purpose of this study was to develop a new measure of deficit unawareness based on multidimensional, isomorphic, simple tasks and to examine the relationship between this measure and neuropsychological tests. METHODS : Analysis was conducted on cognitive performance prediction discrepancies in a sample of Alzheimer's disease (AD) patients and a matched comparison group. RESULTS Patients rated their cognitive functioning more highly than their performance, but their overall self-reports were lower than the overall self-reports of the comparison group. AD patients performed significantly lower than their predicted scores in all Dementia Rating Scale (DRS) domains, in contrast to comparison participants, who did not consistently perform significantly lower across domains. All unawareness scores were moderately inter-correlated, except for memory, and all unawareness scores with the exception of memory were correlated with overall neuropsychological functioning. CONCLUSION A methodological and conceptual difficulty has been identified, and this raises the issue of the generalizability of studies with a focus on memory unawareness. The method proposed seems a good tool to assess the relationships between unawareness and several different aspects of cognitive functioning, in particular executive functioning.
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Affiliation(s)
- Pascal Antoine
- URECA, University of Lille Nord de France, Villeneuve d'Ascq, France.
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Starkstein SE, Tranel D. Neurological and psychiatric aspects of emotion. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:53-74. [PMID: 22608615 DOI: 10.1016/b978-0-444-52002-9.00004-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Neurological and psychiatric aspects of emotions have been the focus of intense research for the past 30 years. Studies in both acute (e.g., stroke, traumatic brain injury (TBI)) and chronic (e.g., dementia, Parkinson's disease) neurological disorders demonstrated a high frequency of both depression and apathy. Studies in stroke and TBI reported a significant association between lesion location and depression. Both depression and apathy are significant predictors of poor recovery among patients with brain injuries, and of steeper cognitive and functional decline among patients with neurodegenerative disorders. Poor insight and judgment are frequently found among patients with brain injury or degeneration. There is increasing evidence that damage to specific brain regions, such as the ventromedial prefrontal cortex, is associated with inappropriate emotional reactions in social contexts and diminished anxiety and concern for the future. In severe cases, behavioural changes may also include poor decision-making in the social realm, deficits in goal-directed behavior, and lack of insight into these changes. Future studies will validate specific diagnostic criteria for the various cognitive, emotional, and behavioral problems reported among patients with neurological disorders, which may result in more specific and effective treatments.
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Affiliation(s)
- Sergio E Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
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Moeller SJ, Hajcak G, Parvaz MA, Dunning JP, Volkow ND, Goldstein RZ. Psychophysiological prediction of choice: relevance to insight and drug addiction. ACTA ACUST UNITED AC 2012; 135:3481-94. [PMID: 23148349 DOI: 10.1093/brain/aws252] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
An important goal of addiction research and treatment is to predict behavioural responses to drug-related stimuli. This goal is especially important for patients with impaired insight, which can interfere with therapeutic interventions and potentially invalidate self-report questionnaires. This research tested (i) whether event-related potentials, specifically the late positive potential, predict choice to view cocaine images in cocaine addiction; and (ii) whether such behaviour prediction differs by insight (operationalized in this study as self-awareness of image choice). Fifty-nine cocaine abusers and 32 healthy controls provided data for the following laboratory components that were completed in a fixed-sequence (to establish prediction): (i) event-related potential recordings while passively viewing pleasant, unpleasant, neutral and cocaine images, during which early (400-1000 ms) and late (1000-2000 ms) window late positive potentials were collected; (ii) self-reported arousal ratings for each picture; and (iii) two previously validated tasks: one to assess choice for viewing these same images, and the other to group cocaine abusers by insight. Results showed that pleasant-related late positive potentials and arousal ratings predicted pleasant choice (the choice to view pleasant pictures) in all subjects, validating the method. In the cocaine abusers, the predictive ability of the late positive potentials and arousal ratings depended on insight. Cocaine-related late positive potentials better predicted cocaine image choice in cocaine abusers with impaired insight. Another emotion-relevant event-related potential component (the early posterior negativity) did not show these results, indicating specificity of the late positive potential. In contrast, arousal ratings better predicted respective cocaine image choice (and actual cocaine use severity) in cocaine abusers with intact insight. Taken together, the late positive potential could serve as a biomarker to help predict drug-related choice--and possibly associated behaviours (e.g. drug seeking in natural settings, relapse after treatment)--when insight (and self-report) is compromised.
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Affiliation(s)
- Scott J Moeller
- Medical Research, Brookhaven National Laboratory, Upton, NY 11973-5000, USA
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Orfei MD, Piras F, Macci E, Caltagirone C, Spalletta G. The neuroanatomical correlates of cognitive insight in schizophrenia. Soc Cogn Affect Neurosci 2012. [PMID: 22287264 DOI: 10.1093/scannss016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Insight has been mostly studied from a clinical perspective. Recently, attention moved to cognitive insight or the ability to monitor and correct one's erroneous convictions. Here, we investigated the neuroanatomical correlates of cognitive insight. We administered the Beck cognitive insight scale to 45 outpatients with a schizophrenia diagnosis and 45 age- and gender-matched healthy control subjects who underwent a MRI investigation, including high-resolution volumetric and diffusion tensor imaging sequences. Gray and white matter volume, mean diffusivity and fractional anisotropy were used as dependent variables and were analyzed on a voxel-by-voxel basis with reference to the cognitive insight indexes. Self-reflectiveness was positively related to gray matter volume of the right ventro-lateral prefrontal cortex (VLPFC). No statistically significant results emerged from the DTI analyses, and no significant relationships were found for self-certainty and global cognitive insight. Reduced self-reflectiveness is related to a reduced volume of the VLPFC, an area involved in generating and maintaining in working memory different hypotheses about the self. This line of research focusing on the metacognitive features of insight in schizophrenia can provide relevant information to identify patients who are most vulnerable to lack of insight and develop effective cognitive therapeutic strategies.
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Affiliation(s)
- Maria Donata Orfei
- IRCCS Santa Lucia Foundation, Laboratory of Clinical and Behavioural Neurology Via Ardeatina, 306. 00179 Rome, Italy
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Orfei MD, Piras F, Macci E, Caltagirone C, Spalletta G. The neuroanatomical correlates of cognitive insight in schizophrenia. Soc Cogn Affect Neurosci 2012; 8:418-23. [PMID: 22287264 DOI: 10.1093/scan/nss016] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Insight has been mostly studied from a clinical perspective. Recently, attention moved to cognitive insight or the ability to monitor and correct one's erroneous convictions. Here, we investigated the neuroanatomical correlates of cognitive insight. We administered the Beck cognitive insight scale to 45 outpatients with a schizophrenia diagnosis and 45 age- and gender-matched healthy control subjects who underwent a MRI investigation, including high-resolution volumetric and diffusion tensor imaging sequences. Gray and white matter volume, mean diffusivity and fractional anisotropy were used as dependent variables and were analyzed on a voxel-by-voxel basis with reference to the cognitive insight indexes. Self-reflectiveness was positively related to gray matter volume of the right ventro-lateral prefrontal cortex (VLPFC). No statistically significant results emerged from the DTI analyses, and no significant relationships were found for self-certainty and global cognitive insight. Reduced self-reflectiveness is related to a reduced volume of the VLPFC, an area involved in generating and maintaining in working memory different hypotheses about the self. This line of research focusing on the metacognitive features of insight in schizophrenia can provide relevant information to identify patients who are most vulnerable to lack of insight and develop effective cognitive therapeutic strategies.
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Affiliation(s)
- Maria Donata Orfei
- IRCCS Santa Lucia Foundation, Laboratory of Clinical and Behavioural Neurology Via Ardeatina, 306. 00179 Rome, Italy
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Minnerop M, Weber B, Schoene-Bake JC, Roeske S, Mirbach S, Anspach C, Schneider-Gold C, Betz RC, Helmstaedter C, Tittgemeyer M, Klockgether T, Kornblum C. The brain in myotonic dystrophy 1 and 2: evidence for a predominant white matter disease. ACTA ACUST UNITED AC 2011; 134:3530-46. [PMID: 22131273 PMCID: PMC3235566 DOI: 10.1093/brain/awr299] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Myotonic dystrophy types 1 and 2 are progressive multisystemic disorders with potential brain involvement. We compared 22 myotonic dystrophy type 1 and 22 myotonic dystrophy type 2 clinically and neuropsychologically well-characterized patients and a corresponding healthy control group using structural brain magnetic resonance imaging at 3 T (T1/T2/diffusion-weighted). Voxel-based morphometry and diffusion tensor imaging with tract-based spatial statistics were applied for voxel-wise analysis of cerebral grey and white matter affection (Pcorrected < 0.05). We further examined the association of structural brain changes with clinical and neuropsychological data. White matter lesions rated visually were more prevalent and severe in myotonic dystrophy type 1 compared with controls, with frontal white matter most prominently affected in both disorders, and temporal lesions restricted to myotonic dystrophy type 1. Voxel-based morphometry analyses demonstrated extensive white matter involvement in all cerebral lobes, brainstem and corpus callosum in myotonic dystrophy types 1 and 2, while grey matter decrease (cortical areas, thalamus, putamen) was restricted to myotonic dystrophy type 1. Accordingly, we found more prominent white matter affection in myotonic dystrophy type 1 than myotonic dystrophy type 2 by diffusion tensor imaging. Association fibres throughout the whole brain, limbic system fibre tracts, the callosal body and projection fibres (e.g. internal/external capsules) were affected in myotonic dystrophy types 1 and 2. Central motor pathways were exclusively impaired in myotonic dystrophy type 1. We found mild executive and attentional deficits in our patients when neuropsychological tests were corrected for manual motor dysfunctioning. Regression analyses revealed associations of white matter affection with several clinical parameters in both disease entities, but not with neuropsychological performance. We showed that depressed mood and fatigue were more prominent in patients with myotonic dystrophy type 1 with less white matter affection (early disease stages), contrary to patients with myotonic dystrophy type 2. Thus, depression in myotonic dystrophies might be a reactive adjustment disorder rather than a direct consequence of structural brain damage. Associations of white matter affection with age/disease duration as well as patterns of cerebral water diffusion parameters pointed towards an ongoing process of myelin destruction and/or axonal loss in our cross-sectional study design. Our data suggest that both myotonic dystrophy types 1 and 2 are serious white matter diseases with prominent callosal body and limbic system affection. White matter changes dominated the extent of grey matter changes, which might argue against Wallerian degeneration as the major cause of white matter affection in myotonic dystrophies.
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Affiliation(s)
- Martina Minnerop
- Department of Neurology, University Hospital of Bonn, 53105 Bonn, Germany
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Parvaz MA, Alia-Klein N, Woicik PA, Volkow ND, Goldstein RZ. Neuroimaging for drug addiction and related behaviors. Rev Neurosci 2011; 22:609-24. [PMID: 22117165 PMCID: PMC3462350 DOI: 10.1515/rns.2011.055] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this review, we highlight the role of neuroimaging techniques in studying the emotional and cognitive-behavioral components of the addiction syndrome by focusing on the neural substrates subserving them. The phenomenology of drug addiction can be characterized by a recurrent pattern of subjective experiences that includes drug intoxication, craving, bingeing, and withdrawal with the cycle culminating in a persistent preoccupation with obtaining, consuming, and recovering from the drug. In the past two decades, imaging studies of drug addiction have demonstrated deficits in brain circuits related to reward and impulsivity. The current review focuses on studies employing positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and electroencephalography (EEG) to investigate these behaviors in drug-addicted human populations. We begin with a brief account of drug addiction followed by a technical account of each of these imaging modalities. We then discuss how these techniques have uniquely contributed to a deeper understanding of addictive behaviors.
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Affiliation(s)
- Muhammad A. Parvaz
- Medical Department, Brookhaven National Laboratory, 30 Bell Ave., Bldg. 490, Upton, NY 11973-5000, USA
| | - Nelly Alia-Klein
- Medical Department, Brookhaven National Laboratory, 30 Bell Ave., Bldg. 490, Upton, NY 11973-5000, USA
| | - Patricia A. Woicik
- Medical Department, Brookhaven National Laboratory, 30 Bell Ave., Bldg. 490, Upton, NY 11973-5000, USA
| | - Nora D. Volkow
- National Institute of Drug Abuse, Bethesda, MD 20892, USA
| | - Rita Z. Goldstein
- Medical Department, Brookhaven National Laboratory, 30 Bell Ave., Bldg. 490, Upton, NY 11973-5000, USA
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Phenomenology and neural correlates of implicit and emergent motor awareness in patients with anosognosia for hemiplegia. Behav Brain Res 2011; 225:259-69. [DOI: 10.1016/j.bbr.2011.07.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/04/2011] [Accepted: 07/05/2011] [Indexed: 11/18/2022]
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Griffen JA, Rapport LJ, Bryer RC, Bieliauskas LA, Burt C. Awareness of Deficits and On-Road Driving Performance. Clin Neuropsychol 2011; 25:1158-78. [DOI: 10.1080/13854046.2011.609841] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gerretsen P, Diaz P, Mamo D, Kavanagh D, Menon M, Pollock BG, Graff-Guerrero A. Transient insight induction with electroconvulsive therapy in a patient with refractory schizophrenia: a case report and systematic literature review. J ECT 2011; 27:247-50. [PMID: 20966768 DOI: 10.1097/yct.0b013e3181f816f6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anosognosia or lack of illness awareness is a clinical manifestation of both schizophrenia and right hemispheric lesions associated with stroke, neurodegeneration, or traumatic brain injury. It is thought to result from right hemispheric dysfunction or interhemispheric disequilibrium, which provides a neuroanatomical model for illness unawareness in schizophrenia. Lack of insight contributes to medication nonadherence and poor treatment outcomes and is often refractory to pharmacological and psychological interventions. We present the first report of transient illness awareness (<8 hours) after individual bilateral electroconvulsive therapy treatments in the case of a 39-year-old man with antipsychotic refractory schizophrenia. Electroencephalography demonstrated frontal slow wave activity with shifting frontotemporal predominance, which was concurrent with the patient's transient level of insight. A systematic review of the literature on electroconvulsive therapy-induced illness awareness in schizophrenia and psychotic disorders produced zero relevant results. Future research should focus on the prospective role of focal interventions, such as transcranial magnetic stimulation, in the development of a neurophysiological model for anosognosia reversal in schizophrenia that may, in turn, contribute to novel therapeutic developments targeting lack of illness awareness.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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Zamboni G, Wilcock G. Lack of awareness of symptoms in people with dementia: the structural and functional basis. Int J Geriatr Psychiatry 2011; 26:783-92. [PMID: 21744382 DOI: 10.1002/gps.2620] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 07/20/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review studies investigating the brain correlates of unawareness of cognitive and behavioural symptoms in people with dementia. DESIGN A detailed search of the literature was conducted to include all the peer-reviewed studies published in English aimed at identifying the structural or functional brain correspondents of unawareness in dementia patients. Their results were interpreted in relation to the methodological differences in terms of type of dementia studied, the protocol adopted to measure lack of awareness, the imaging techniques employed, the experimental designs and statistical analyses performed. RESULTS Eighteen studies undertaken to explore the functional and structural correlates of unawareness of cognitive symptoms in dementia were identified. Although their results showed a disparate range of brain correlates, they were mainly localized in frontal and temporo-parietal regions. CONCLUSIONS Although the anatomical correlates of unawareness of disease in dementia have not yet been exhaustively explored, understanding the correlates of unawareness may also contribute to understand the brain correlates of self-awareness and self-reflection. We discuss the current knowledge base and consider potential future directions for research.
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Affiliation(s)
- G Zamboni
- OPTIMA Project, Nuffield Department of Clinical Medicine, University of Oxford, UK; FMRIB Centre, University of Oxford, UK.
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Can insight be predicted in first-episode psychosis patients? A longitudinal and hierarchical analysis of predictors in a drug-naïve sample. Schizophr Res 2011; 130:148-56. [PMID: 21632216 DOI: 10.1016/j.schres.2011.04.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/20/2011] [Accepted: 04/30/2011] [Indexed: 11/23/2022]
Abstract
Poor insight is a ubiquitous phenomenon in psychosis with great repercussions on clinical practise and the outcomes of patients. Poor insight comprises "state" and "trait" components. This paper targeted predictors of global insight and insight dimensions at baseline in the drug-naïve status of first-episode psychosis patients and during a 6-month follow up after episode remission. Seventy-seven consecutive and previously unmedicated patients with first-episode schizophrenia-spectrum disorders (FESSD) completed baseline and 6-month insight, premorbid, symptomatological and neuropsychological assessments. Insight measures served as dependent variables for a set of hierarchical multiple regression models. Premorbid personality abnormalities and duration of untreated psychosis (DUP) significantly predicted 'state' and 'trait' insight global scores. Duration of untreated psychosis (DUP) significantly predicted 'state' insight, measured as refusal of treatment at baseline. Moreover, premorbid personality abnormalities and DUP with minor contributions of demographic variables, cognitive functioning and psychopathological dimensions predicted 'trait insight', defined as insight after remission of the psychosis episode 'Insight improver' FESSD patients showed better late adolescent premorbid adjustment, lower personality disturbances (sociopathic, schizoid and schizotypy dimensions), shorter DUP, and lower positive, negative and disorganisation symptoms and better cognitive performance on the Trail Making B test at the 6-month follow-up assessment. Premorbid personality abnormalities and DUP were predictors of 'state' and 'trait' insight, both at global scores and dimension levels. Moreover, insight improvement in patients with FESSD was related to premorbid abnormalities (in both adjustment and personality), shorter DUP, fewer positive and negative symptoms and better performance in cognitive tests at the 6-month follow up.
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Anosognosia in mild cognitive impairment and mild Alzheimer's disease: frequency and neuropsychological correlates. Am J Geriatr Psychiatry 2010; 18:1133-40. [PMID: 20808100 DOI: 10.1097/jgp.0b013e3181dd1c50] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate severity of anosognosia and to identify its neuropsychological correlates in preclinical and clinical Alzheimer's Disease (AD). METHODS The Clinical Insight Rating Scale, the Anosognosia Questionnaire for Dementia (AQ-D), and the Mental Deterioration Battery were used to assess anosognosia and cognitive performances in mild AD (N = 38), amnesic mild cognitive impairment (a-MCI; N = 35), and multiple domain MCI (md-MCI; N = 38). RESULTS Patients with mild AD were more anosognosic than both MCI groups, which, however, did not differ from one other. A categorical diagnosis of anosognosia was made in 42% of patients with mild AD, 3% of md-MCI, but in no subjects with a-MCI. Reduced verbal episodic memory raw score was associated with decreased awareness of cognitive difficulties (AQ-D total and intellectual functioning scores) only in MCI. In mild AD, anosognosia was linked only to increased age and reduced basic activities of daily living performances. CONCLUSIONS The diagnosis of anosognosia is frequent in patients with mild AD but not in those with MCI. In the latter case, the authors cannot speak of true anosognosia but only of decreased awareness of illness. Furthermore, reduced awareness of cognitive difficulties is linked with verbal memory performances in patients with MCI but not in those with AD, suggesting for the latter the involvement of factors other than neuropsychological. Thus, neuropsychiatric dimensions commonly present in patients with AD should be investigated along with anosognosia.
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Winblad S, Jensen C, Månsson JE, Samuelsson L, Lindberg C. Depression in Myotonic Dystrophy type 1: clinical and neuronal correlates. Behav Brain Funct 2010; 6:25. [PMID: 20482818 PMCID: PMC2881877 DOI: 10.1186/1744-9081-6-25] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 05/19/2010] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study was designed to investigate the prevalence and correlates of depression in Myotonic dystrophy type 1 (DM1). METHODS Thirty-one patients with DM1 and 47 subjects in a clinical contrast group, consisting of other neuromuscular disorders, including Spinal muscular atrophy, Limb girdle muscle atrophy and Facioscapulohumeral dystrophy, completed Beck Depression Inventory (BDI). We aimed to establish whether different factors associated with DM1 correlated with ratings in the BDI. RESULTS Signs of a clinical depression were prevalent in 32% of the patients with DM1, which was comparable with ratings in the clinical contrast group. The depressive condition was mild to moderate in both groups. In DM1, a longer duration of clinical symptoms was associated with lower scores on the BDI and higher educational levels were correlated with higher scores on depression. We also found a negative association with brain white matter lesions. CONCLUSIONS Findings indicate significantly more DM1 patients than normative collectives showing signs of a clinical depression. The depressive condition is however mild to moderate and data indicate that the need for intervention is at hand preferentially early during the disease process.
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Affiliation(s)
- Stefan Winblad
- Neuromuscular Centre, Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden.
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The relationship between mood state, interpersonal attitudes and psychological distress in stroke patients. Int J Rehabil Res 2010; 33:43-8. [PMID: 19738483 DOI: 10.1097/mrr.0b013e32832e98ca] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study investigated whether increasing positive mood improved interpersonal attitudes and relieved depression in depressed stroke patients despite levels of cognitive and emotional dysfunction. Depressed stroke (n = 30) and rheumatic/orthopaedic controls (n = 30) were compared on the effect of verbal and nonverbal positive and neutral mood induction on mood state, interpersonal attitudes, psychological distress and related cognitive and emotional processing deficits. Compared with the neutral mood induction condition, the positive mood induction significantly improved mood state, interpersonal attitudes and psychological distress, irrespective of cognitive and emotional processing deficits. The nonverbal material was effective for all patients but was more marked for the left hemisphere stroke group. There was no obvious influence of humour appreciation despite reduced understanding in the right hemisphere stroke group. Although the effect is likely to be short-lived, these results support the trial of positive mood induction within therapy programmes to relieve depression.
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Moeller SJ, Maloney T, Parvaz MA, Alia-Klein N, Woicik PA, Telang F, Wang GJ, Volkow ND, Goldstein RZ. Impaired insight in cocaine addiction: laboratory evidence and effects on cocaine-seeking behaviour. ACTA ACUST UNITED AC 2010; 133:1484-93. [PMID: 20395264 DOI: 10.1093/brain/awq066] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuropsychiatric disorders are often characterized by impaired insight into behaviour. Such an insight deficit has been suggested, but never directly tested, in drug addiction. Here we tested for the first time this impaired insight hypothesis in drug addiction, and examined its potential association with drug-seeking behaviour. We also tested potential modulation of these effects by cocaine urine status, an individual difference known to impact underlying cognitive functions and prognosis. Sixteen cocaine addicted individuals testing positive for cocaine in urine, 26 cocaine addicted individuals testing negative for cocaine in urine, and 23 healthy controls completed a probabilistic choice task that assessed objective preference for viewing four types of pictures (pleasant, unpleasant, neutral and cocaine). This choice task concluded by asking subjects to report their most selected picture type; correspondence between subjects' self-reports with their objective choice behaviour provided our index of behavioural insight. Results showed that the urine positive cocaine subjects exhibited impaired insight into their own choice behaviour compared with healthy controls; this same study group also selected the most cocaine pictures (and fewest pleasant pictures) for viewing. Importantly, however, it was the urine negative cocaine subjects whose behaviour was most influenced by insight, such that impaired insight in this subgroup only was associated with higher cocaine-related choice on the task and more severe actual cocaine use. These findings suggest that interventions to enhance insight may decrease drug-seeking behaviour, especially in urine negative cocaine subjects, potentially to improve their longer-term clinical outcomes.
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Affiliation(s)
- Scott J Moeller
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
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