Schizophrenia Bulletin Advance Access published online on April 3, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbp015
Toward a Model of Cognitive Insight in First-Episode Psychosis: Verbal Memory and Hippocampal Structure
2 Brain Imaging Group, Douglas Mental Health University Institute, Quebec, Canada
3 Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Quebec, Canada
4 Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Quebec, Canada
5 Department of Psychiatry, McGill University, Quebec, Canada
1 To whom correspondence should be addressed; Brain Imaging Group, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Verdun, Quebec H4H 1R3, Canada; tel: 514-761-6131 ext. 4393, fax: 514-888-4064, e-mail: martin.lepage{at}mcgill.ca.
Our previous work has linked verbal learning and memory with cognitive insight, but not clinical insight, in individuals with a first-episode psychosis (FEP). The current study reassessed the neurocognitive basis of cognitive and clinical insight and explored their neural basis in 61 FEP patients. Cognitive insight was measured with the Beck Cognitive Insight Scale (BCIS) and clinical insight with the Scale to assess Unawareness of Mental Disorder (SUMD). Global measures for 7 domains of cognition were examined. Hippocampi were manually segmented in to 3 parts: the body, head, and tail. Verbal learning and memory significantly correlated with the BCIS composite index. Composite index scores were significantly associated with total left hippocampal (HC) volume; partial correlations, however, revealed that this relationship was attributable largely to verbal memory performance. The BCIS self-certainty subscale significantly and inversely correlated with bilateral HC volumes, and these associations were independent of verbal learning and memory performance. The BCIS self-reflectiveness subscale significantly correlated with verbal learning and memory but not with HC volume. No significant correlations emerged between the SUMD and verbal memory or HC volume. These results strengthen our previous assertion that in individuals with an FEP cognitive insight may rely on memory whereby current experiences are appraised based on previous ones. The HC may be a viable location among others for the brain system that underlies aspects of cognitive insight in individuals with an FEP.
Keywords: awareness of illness / cognition / magnetic resonance imaging / neuroimaging / first-episode schizophrenia / overconfidence