Clinical insight in first-episode psychosis: Clinical, neurocognitive and metacognitive predictors

Pousa, Esther; Brébion, Gildas; López-Carrilero, Raquel; Ruiz, Albert; Grasa, Eva; Barajas, Ana; Pelaéz, Trini; Alfonso-Gutiérrrez-Zotes,; Lorente, Elena; Barrigón, María Luisa; Ruiz-Delgado, Isabel; González-Higueras, Fermín; Cid, Jordi; Pérez‐Solà, Víctor; Ochoa, Susana

doi:10.1016/j.schres.2022.08.007

Cited by 6 publications

(3 citation statements)

References 55 publications

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“…Considering the consistent underlying pathophysiology, our patient's symptom progression from various cenesthetic hallucinations to nihilistic delusions regarding self may support this theory. Moreover, abnormal reasoning may be linked to metacognitive deficits, which have been widely recognized in schizophrenia and contribute to the development of delusions 15 . The lack of insight and metacognition of her symptoms was clearly observed in our patient throughout her entire clinical course beyond her present course and might have provoked her current delusions.…”

Section: Discussionmentioning

confidence: 50%

“…Moreover, abnormal reasoning may be linked to metacognitive deficits, which have been widely recognized in schizophrenia and contribute to the development of delusions. 15 The lack of insight and metacognition of her symptoms was clearly observed in our patient throughout her entire clinical course beyond her present course and might have provoked her current delusions.…”

Section: Discussionmentioning

confidence: 55%

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You are already dead: Case report of nihilistic delusions regarding others as one representation of Cotard's syndrome

et al. 2023

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Background: While the symptom of "I am already dead" is a hallmark of Cotard's syndrome, also known as nihilistic delusions, the symptom of "you are already dead" has been neglected.Case presentation: A woman aged in her 60s diagnosed with schizophrenia was admitted to our hospital for psychotic symptoms, including delusions of reference, delusions of guilt, auditory hallucinations, cenesthetic hallucinations, agitation, depression, suicidal ideation, and catatonia. During hospitalization, her cenesthetic hallucinations progressed to include nihilistic delusions. She described cenesthetic hallucinations along with various delusional descriptions, including the belief that various objects, such as spoons, irons, nails, rulers, bins, and coins, were inside her body and that her body was being burned or in danger of exploding. She also claimed an altered sense of her own body, that her body was larger than normal or reversed. Moreover, she reported nihilistic delusions that her face and body did not exist, that her heart was not functioning, and that she was going to die soon or was already dead. She occasionally refused to eat because of the feeling of being dead. Notably, during a severe episode, she claimed that a doctor in front of her was dead. Clozapine was effective in improving her symptoms. Ultimately, the patient regained her sense of being alive and acknowledged that the doctor was alive. Conclusion:We report the case of a patient presenting with nihilistic delusions regarding both self and others, along with prior cenesthetic hallucinations. Aberrant interoceptive processing could be a potential link between these two forms of nihilistic delusions.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 55%

You are already dead: Case report of nihilistic delusions regarding others as one representation of Cotard's syndrome

et al. 2023

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“…Executive functions contribute to illness insight 70 . This may explain why poor illness insight and delusions, whose definition requires the former 71 , mediated the association between DLPFC volume and aggression. The IPL is centrally involved in theory of mind, or the ability to infer mental states in oneself and others 72 .…”

Section: Discussionmentioning

confidence: 99%

Structural brain abnormalities and aggressive behaviour in schizophrenia: Mega-analysis of data from 2095 patients and 2861 healthy controls via the ENIGMA consortium

Lamsma,

Raine,

Kia

et al. 2024

Preprint

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Background Schizophrenia is associated with an increased risk of aggressive behaviour, which may partly be explained by illness-related changes in brain structure. However, previous studies have been limited by group-level analyses, small and selective samples of inpatients and long time lags between exposure and outcome. Methods This cross-sectional study pooled data from 20 sites participating in the international ENIGMA-Schizophrenia Working Group. Sites acquired T1-weighted and diffusion-weighted magnetic resonance imaging scans in a total of 2095 patients with schizophrenia and 2861 healthy controls. Measures of grey matter volume and white matter microstructural integrity were extracted from the scans using harmonised protocols. For each measure, normative modelling was used to calculate how much patients deviated (in z-scores) from healthy controls at the individual level. Ordinal regression models were used to estimate the associations of these deviations with concurrent aggressive behaviour (as odds ratios [ORs] with 99% confidence intervals [CIs]). Mediation analyses were performed for positive symptoms (i.e., delusions, hallucinations and disorganised thinking), impulse control and illness insight. Aggression and potential mediators were assessed with the Positive and Negative Syndrome Scale, Scale for the Assessment of Positive Symptoms or Brief Psychiatric Rating Scale. Results Aggressive behaviour was significantly associated with reductions in total cortical volume (OR [99% CI] = 0.88 [0.78, 0.98], p = .003) and global white matter integrity (OR [99% CI] = 0.72 [0.59, 0.88], p = 3.50 x 10-5) and additional reductions in dorsolateral prefrontal cortex volume (OR [99% CI] = 0.85 [0.74, 0.97], p =.002), inferior parietal lobule volume (OR [99% CI] = 0.76 [0.66, 0.87], p = 2.20 x 10-7) and internal capsule integrity (OR [99% CI] = 0.76 [0.63, 0.92], p = 2.90 x 10-4). Except for inferior parietal lobule volume, these associations were largely mediated by increased severity of positive symptoms and reduced impulse control. Conclusions This study provides evidence that the co-occurrence of positive symptoms, poor impulse control and aggressive behaviour in schizophrenia has a neurobiological basis, which may inform the development of therapeutic interventions.

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Neuropsychological profiles in first-episodes psychosis and their relationship with clinical, metacognition and social cognition variables

Espinosa,

Bagaeva,

López-Carrilero

et al. 2024

Eur Arch Psychiatry Clin Neurosci

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Clinical insight in first-episode psychosis: Clinical, neurocognitive and metacognitive predictors

Cited by 6 publications

References 55 publications

You are already dead: Case report of nihilistic delusions regarding others as one representation of Cotard's syndrome

You are already dead: Case report of nihilistic delusions regarding others as one representation of Cotard's syndrome

Structural brain abnormalities and aggressive behaviour in schizophrenia: Mega-analysis of data from 2095 patients and 2861 healthy controls via the ENIGMA consortium

Neuropsychological profiles in first-episodes psychosis and their relationship with clinical, metacognition and social cognition variables

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