Failures of metacognition and lack of insight in neuropsychiatric disorders
Failures of metacognition and lack of insight in neuropsychiatric disorders
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DOI：
10.1098/rstb.2012.0002
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发表时间：
2012-05-19
影响因子：
6.3
通讯作者：
Gilleen, James
中科院分区：
文献类型：
--
作者：
David, Anthony S.;Bedford, Nicholas;Gilleen, James
缺乏洞察力或对疾病的无知是许多精神疾病的标志，特别是精神分裂症（SCZ）和其他精神病，可以被视为元认知的失败。随着标准评估工具的发展和广泛使用，以及洞察力及其丧失的临床和神经心理学相关性的绘制，心理健康领域在这一领域的研究蓬勃发展。越来越多的人认识到这个概念的多面性和洞察力的不同“对象”，例如对一个人生病的一般意识，对个体症状、障碍和表现的更具体的元认知意识。这反过来又导致了这样一种观点，即洞察力可能表现出模块性，并且可能在不同的领域和疾病中表现出差异，这得到了直接比较SCZ，阿尔茨海默病和脑损伤患者记忆缺陷和疾病意识的元认知的工作的支持。本文的重点将放在精神病学，特别是精神病的各种元认知失败。我们探索基于自我反思的认知模型及其可能的社会和神经基础，包括来自结构和功能MRI的数据。内侧额叶皮层似乎在健康和疾病的自我评价中起着重要作用。
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.