Failures of metacognition and lack of insight in neuropsychiatric disorders

Philosophical Transactions of the Royal Society B: Biological Sciences - Tập 367 Số 1594 - Trang 1379-1390 - 2012
Anthony S. David1, Nicholas Bedford1, Ben Wiffen1, James Gilleen1
1Section of Cognitive Neuropsychology, Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK

Tóm tắt

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.

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Philosophical Transactions of the Royal Society B: Biological Sciences

Tập 367 Số 1594

1379-1390

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