Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA.
Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA.
Sci Rep. 2022 Dec 16;12(1):21752. doi: 10.1038/s41598-022-25532-4.
Insight impairment contributes significantly to morbidity in psychiatric disorders. The neurologic concept of anosognosia, reflecting deficits in metacognitive awareness of illness, is increasingly understood as relevant to psychopathology, but has been little explored in psychiatric disorders other than schizophrenia. We explored anosognosia as an aspect of insight impairment in n = 71 individuals with DSM-5 hoarding disorder. We used a standardized clutter severity measure to assess whether individuals with hoarding disorder underreport home clutter levels relative to independent examiners. We then explored whether underreporting, as a proxy for anosognosia, is predicted by clinical or neurocognitive behavioral measures. We found that individuals with hoarding disorder underreport their clutter, and that underreporting is predicted by objective severity of clutter. In an n = 53 subset of participants, we found that underreporting is predicted by altered performance on tests of cognitive control and inhibition, specifically Go/No-Go and Stroop tests. The relation of underreporting to objective clutter, the cardinal symptom of hoarding disorder, suggests that anosognosia may reflect core pathophysiology of the disorder. The neurocognitive predictors of clutter underreporting suggest that anosognosia in hoarding disorder shares a neural basis with metacognitive awareness deficits in other neuropsychiatric disorders and that executive anosognosia may be a transdiagnostic manifestation of psychopathology.
认知障碍严重影响精神障碍患者的发病率。神经病学中的病感失认概念反映了对疾病的元认知意识缺陷，它越来越被认为与精神病理学有关，但在除精神分裂症以外的精神障碍中研究甚少。我们探讨了认知障碍的一个方面，即 71 名 DSM-5 囤积障碍患者的洞察力障碍。我们使用标准化的杂乱严重程度测量来评估囤积障碍患者是否相对于独立检查者低估了家庭杂乱程度。然后，我们探讨了这种低估（作为病感失认的替代指标）是否可以由临床或神经认知行为测量来预测。我们发现，囤积障碍患者低估了他们的杂乱程度，而低估程度可以由杂乱的客观严重程度来预测。在 n=53 名参与者的亚组中，我们发现，在认知控制和抑制测试（尤其是 Go/No-Go 和 Stroop 测试）中的表现改变可以预测低估。低估与客观杂乱（囤积障碍的主要症状）之间的关系表明，病感失认可能反映了该疾病的核心病理生理学。杂乱低估的神经认知预测因素表明，囤积障碍中的病感失认与其他神经精神障碍中元认知意识缺陷具有共同的神经基础，而执行病感失认可能是精神病理学的一种跨诊断表现。
