Section of Cognitive Neuropsychology, Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Philos Trans R Soc Lond B Biol Sci. 2012 May 19;367(1594):1379-90. doi: 10.1098/rstb.2012.0002.
Lack of insight or unawareness of illness are the hallmarks of many psychiatric disorders, especially schizophrenia (SCZ) and other psychoses and could be conceived of as a failure in metacognition. Research in this area in the mental health field h as burgeoned with the development and widespread use of standard assessment instruments and the mapping out of the clinical and neuropsychological correlates of insight and its loss. There has been a growing appreciation of the multi-faceted nature of the concept and of the different 'objects' of insight, such as the general awareness that one is ill, to more specific metacognitive awareness of individual symptoms, impairments and performance. This in turn has led to the notion that insight may show modularity and may fractionate across different domains and disorders, supported by work that directly compares metacognition of memory deficits and illness awareness in patients with SCZ, Alzheimer's disease and brain injury. The focus of this paper will be on the varieties of metacognitive failure in psychiatry, particularly the psychoses. We explore cognitive models based on self-reflectiveness and their possible social and neurological bases, including data from structural and functional MRI. The medial frontal cortex appears to play an important role in self-appraisal in health and disease.
缺乏洞察力或对疾病的无意识是许多精神障碍的特征，尤其是精神分裂症（SCZ）和其他精神病，可被视为元认知失败。随着标准评估工具的开发和广泛应用，以及洞察力及其丧失的临床和神经心理学相关性的描绘，精神卫生领域的这一研究领域得到了蓬勃发展。人们越来越认识到这一概念的多面性，以及洞察力的不同“对象”，例如普遍意识到自己患病，到对个人症状、障碍和表现的更具体的元认知意识。这反过来又导致了这样一种观点，即洞察力可能表现出模块性，并可能在不同的领域和障碍中进行划分，这一观点得到了直接比较 SCZ、阿尔茨海默病和脑损伤患者记忆缺陷和疾病意识的元认知的工作的支持。本文的重点将是精神病学中各种元认知失败，特别是精神病。我们探索基于自我反思的认知模型及其可能的社会和神经基础，包括来自结构和功能 MRI 的数据。内侧前额叶皮层似乎在健康和疾病中的自我评估中发挥重要作用。
