Brain Structural Correlates of Metacognition in First-Episode Psychosis

Abstract Metacognition is impaired in schizophrenia and is an important predictor of functional outcome, but the underlying neuropathology is not clear. Studies have implicated frontal regions and there is also some evidence that the hippocampus might play a pivotal role, but findings are inconsistent. We set out to more comprehensively investigate the neural underpinnings of insight in first-episode psychosis (FEP) using 2 metacognitive measures (the Beck Cognitive Insight Scale [BCIS]) and a perceptual metacognitive accuracy task alongside structural magnetic resonance imaging (MRI). We measured cortical thickness in insula and frontal regions, hippocampal (including subfield) volumes, hippocampal microstructure (using neurite orientation dispersion and density imaging [NODDI]), and fractional anisotropy in fornix. Relative to controls, FEP showed poorer metacognitive accuracy, thinner cortex in frontal regions and lower fornix integrity. In healthy controls (but not FEP), metacognitive accuracy correlated with cortical thickness in frontal cortex and insula. Conversely, in FEP (but not controls), metacognitive accuracy correlated with hippocampal volume and microstructural indices. Subicular hippocampal subregions were particularly implicated. No structural correlates of BCIS were found. These findings suggest that the neural bases of metacognition might differ in FEP: hippocampal (rather than frontal) integrity seems to be critical. Further, the use of objectively measured metacognitive indices seems to be a more powerful method for understanding the neurocircuitry of metacognition in FEP, which has the potential to inform therapeutic strategies and improve outcome in these patients.

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Cognitive insight is associated with cortical thickness in first-episode psychosis

Schizophrenia Research ◽

10.1016/j.schres.2016.02.026 ◽

2016 ◽

Vol 172 (1-3) ◽

pp. 16-22 ◽

Cited By ~ 17

Author(s):

Lisa Buchy ◽

Mariapaola Barbato ◽

Frank P. MacMaster ◽

Signe Bray ◽

Darren Clark ◽

...

Keyword(s):

Cortical Thickness ◽

First Episode Psychosis ◽

First Episode ◽

Cognitive Insight ◽

Episode Psychosis

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A longitudinal study of cognitive insight and cortical thickness in first-episode psychosis

Schizophrenia Research ◽

10.1016/j.schres.2017.06.048 ◽

2018 ◽

Vol 193 ◽

pp. 251-260 ◽

Cited By ~ 8

Author(s):

Lisa Buchy ◽

Carolina Makowski ◽

Ashok Malla ◽

Ridha Joober ◽

Martin Lepage

Keyword(s):

Longitudinal Study ◽

Cortical Thickness ◽

First Episode Psychosis ◽

First Episode ◽

Cognitive Insight ◽

Episode Psychosis

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Cortical thickness and surface area correlates with cognitive dysfunction among first-episode psychosis patients

Psychological Medicine ◽

10.1017/s0033291716000684 ◽

2016 ◽

Vol 46 (10) ◽

pp. 2145-2155 ◽

Cited By ~ 8

Author(s):

L. Haring ◽

A. Müürsepp ◽

R. Mõttus ◽

P. Ilves ◽

K. Koch ◽

...

Keyword(s):

Structure Function ◽

Surface Area ◽

Cortical Thickness ◽

Brain Structure ◽

Brain Mri ◽

Brain Regions ◽

First Episode Psychosis ◽

First Episode ◽

Neurocognitive Performance ◽

Episode Psychosis

BackgroundIn studies using magnetic resonance imaging (MRI), some have reported specific brain structure–function relationships among first-episode psychosis (FEP) patients, but findings are inconsistent. We aimed to localize the brain regions where cortical thickness (CTh) and surface area (cortical area; CA) relate to neurocognition, by performing an MRI on participants and measuring their neurocognitive performance using the Cambridge Neuropsychological Test Automated Battery (CANTAB), in order to investigate any significant differences between FEP patients and control subjects (CS).MethodExploration of potential correlations between specific cognitive functions and brain structure was performed using CANTAB computer-based neurocognitive testing and a vertex-by-vertex whole-brain MRI analysis of 63 FEP patients and 30 CS.ResultsSignificant correlations were found between cortical parameters in the frontal, temporal, cingular and occipital brain regions and performance in set-shifting, working memory manipulation, strategy usage and sustained attention tests. These correlations were significantly dissimilar between FEP patients and CS.ConclusionsSignificant correlations between CTh and CA with neurocognitive performance were localized in brain areas known to be involved in cognition. The results also suggested a disrupted structure–function relationship in FEP patients compared with CS.

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Specificity proteins 1 and 4, hippocampal volume and first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.152140 ◽

2016 ◽

Vol 208 (6) ◽

pp. 591-592 ◽

Cited By ~ 1

Author(s):

Montserrat Fusté ◽

Iria Meléndez-Pérez ◽

Victoria Villalta-Gil ◽

Raquel Pinacho ◽

Núria Villalmanzo ◽

...

Keyword(s):

Mononuclear Cells ◽

Hippocampal Volume ◽

First Episode Psychosis ◽

Magnetic Resonance Images ◽

First Episode ◽

Peripheral Blood Mononuclear ◽

Specificity Protein 1 ◽

Episode Psychosis ◽

Morphometry Analysis ◽

Specificity Protein

SummaryWe assessed specificity protein 1 (SP1) and 4 (SP4) transcription factor levels in peripheral blood mononuclear cells and conducted a voxel-based morphometry analysis on brain structural magnetic resonance images from 11 patients with first-episode psychosis and 14 healthy controls. We found lower SP1 and SP4 levels in patients, which correlated positively with right hippocampal volume. These results extend previous evidence showing that such transcription factors may constitute a molecular pathway to the development of psychosis.

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FRONTAL CORTICAL THICKNESS IS ASSOCIATED WITH CLINICAL IMPROVEMENT OF NEGATIVE SYMPTOMS IN MALE ADOLESCENTS WITH EARLY-ONSET FIRST-EPISODE PSYCHOSIS

Schizophrenia Research ◽

10.1016/j.schres.2010.02.333 ◽

2010 ◽

Vol 117 (2-3) ◽

pp. 227-228

Author(s):

Margarita Amador ◽

Joost Janssen ◽

Santiago Reig ◽

Mara Parellada ◽

Dolores Moreno ◽

...

Keyword(s):

Clinical Improvement ◽

Cortical Thickness ◽

Early Onset ◽

Negative Symptoms ◽

First Episode Psychosis ◽

First Episode ◽

Male Adolescents ◽

Episode Psychosis

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Using Machine Learning and Structural Neuroimaging to Detect First Episode Psychosis: Reconsidering the Evidence

Schizophrenia Bulletin ◽

10.1093/schbul/sby189 ◽

2019 ◽

Vol 46 (1) ◽

pp. 17-26 ◽

Cited By ~ 20

Author(s):

Sandra Vieira ◽

Qi-yong Gong ◽

Walter H L Pinaya ◽

Cristina Scarpazza ◽

Stefania Tognin ◽

...

Keyword(s):

Machine Learning ◽

Cortical Thickness ◽

Gray Matter Volume ◽

Diagnostic Value ◽

First Episode Psychosis ◽

Current Evidence ◽

First Episode ◽

Structural Neuroimaging ◽

Individual Level ◽

Episode Psychosis

Abstract Despite the high level of interest in the use of machine learning (ML) and neuroimaging to detect psychosis at the individual level, the reliability of the findings is unclear due to potential methodological issues that may have inflated the existing literature. This study aimed to elucidate the extent to which the application of ML to neuroanatomical data allows detection of first episode psychosis (FEP), while putting in place methodological precautions to avoid overoptimistic results. We tested both traditional ML and an emerging approach known as deep learning (DL) using 3 feature sets of interest: (1) surface-based regional volumes and cortical thickness, (2) voxel-based gray matter volume (GMV) and (3) voxel-based cortical thickness (VBCT). To assess the reliability of the findings, we repeated all analyses in 5 independent datasets, totaling 956 participants (514 FEP and 444 within-site matched controls). The performance was assessed via nested cross-validation (CV) and cross-site CV. Accuracies ranged from 50% to 70% for surfaced-based features; from 50% to 63% for GMV; and from 51% to 68% for VBCT. The best accuracies (70%) were achieved when DL was applied to surface-based features; however, these models generalized poorly to other sites. Findings from this study suggest that, when methodological precautions are adopted to avoid overoptimistic results, detection of individuals in the early stages of psychosis is more challenging than originally thought. In light of this, we argue that the current evidence for the diagnostic value of ML and structural neuroimaging should be reconsidered toward a more cautious interpretation.

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