Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA.
Clin EEG Neurosci. 2020 Jul;51(4):259-266. doi: 10.1177/1550059419857971. Epub 2019 Jun 26.
Metacognition is the process of thinking about one's own mental states. It involves a range of faculties that allow an individual to integrate information and form understanding of self and others, and use this understanding to respond to life challenges. Clinical insight is the awareness of one's mental illness, its consequences, and the need for treatment. Persons with psychotic disorders show impaired metacognition and insight, but the neurobiological bases for these impairments are not well characterized. We hypothesized that metacognition and insight may depend on capacity of neural circuits to synchronize at gamma frequencies, as well as the integrity of underlying cognitive processes. In order to test these hypotheses, 17 adults with early phase psychosis were evaluated. Metacognition was assessed with the Metacognition Assessment Scale-Abbreviated, and insight was assessed with the Scale of Unawareness of Illness-Abbreviated. The auditory steady state response (ASSR) to gamma range stimulation (40 Hz) was used as an index of neural synchronization. Cognitive function was assessed using the Brief Assessment of Cognition in Schizophrenia. Increases in ASSR power were associated with poorer metacognition and insight. Higher cognitive performance was associated with higher levels of metacognitive function and insight. These findings suggest that altered neural synchronization and constituent cognitive processes affect both metacognition and insight in early phase psychosis and may offer targets for both pharmacological and psychotherapeutic interventions.
元认知是对自身心理状态的思考过程。它涉及一系列能力，使个体能够整合信息，形成对自我和他人的理解，并利用这种理解应对生活挑战。临床洞察力是指对自己的精神疾病、其后果以及治疗需求的认识。患有精神病的人表现出元认知和洞察力受损，但这些损伤的神经生物学基础尚不清楚。我们假设元认知和洞察力可能取决于神经回路以伽马频率同步的能力，以及基础认知过程的完整性。为了检验这些假设，我们评估了 17 名处于早期阶段的精神病患者。使用元认知评估量表-缩写版评估元认知，使用疾病不察觉量表-缩写版评估洞察力。伽马范围刺激（40Hz）的听觉稳态反应（ASSR）被用作神经同步的指标。使用简明精神分裂症认知评估量表评估认知功能。ASSR 功率的增加与较差的元认知和洞察力有关。较高的认知表现与较高的元认知功能和洞察力水平相关。这些发现表明，改变的神经同步和组成认知过程会影响早期精神病的元认知和洞察力，并可能为药物和心理治疗干预提供目标。
