Relationship of Metacognition and Insight to Neural Synchronization and Cognitive Function in Early Phase Psychosis

Abstract

<jats:p> Metacognition is the process of thinking about one’s own mental states. It involves a range of faculties that allow an individual to integrate information and form understanding of self and others, and use this understanding to respond to life challenges. Clinical insight is the awareness of one’s mental illness, its consequences, and the need for treatment. Persons with psychotic disorders show impaired metacognition and insight, but the neurobiological bases for these impairments are not well characterized. We hypothesized that metacognition and insight may depend on capacity of neural circuits to synchronize at gamma frequencies, as well as the integrity of underlying cognitive processes. In order to test these hypotheses, 17 adults with early phase psychosis were evaluated. Metacognition was assessed with the Metacognition Assessment Scale–Abbreviated, and insight was assessed with the Scale of Unawareness of Illness–Abbreviated. The auditory steady state response (ASSR) to gamma range stimulation (40 Hz) was used as an index of neural synchronization. Cognitive function was assessed using the Brief Assessment of Cognition in Schizophrenia. Increases in ASSR power were associated with poorer metacognition and insight. Higher cognitive performance was associated with higher levels of metacognitive function and insight. These findings suggest that altered neural synchronization and constituent cognitive processes affect both metacognition and insight in early phase psychosis and may offer targets for both pharmacological and psychotherapeutic interventions. </jats:p>

40-Hz auditory steady-state responses and the complex information processing: An exploratory study in healthy young males

“…Third, the gamma-range ASSRs were shown to correlate with the degree of cognitive decline in Alzheimer’s disease and Mild Cognitive Impairment patients [45]. In SZ patients ASSRs correlated with working memory [27,32,46], attention [29], reasoning and problem-solving abilities [47], metacognition and insight [48]. The above-mentioned findings suggest that gamma-range ASSRs (and 40-Hz ASSR in particular) may reflect the neurobiological mechanisms underlying some cognitive processes.…”

“…Thus, the relationship between cognitive functioning and networks underlying the generation of 40-Hz ASSR needs to be investigated further in controlled uniform groups to foster its usage as an individual biological marker for disturbed functioning in neuropsychiatric disorders [49,53]. Additionally, previous ASSR studies assessed the response over the central frontal locations only [27,29,32,48–50]. However, 40Hz ASSRs were reported to be somewhat larger over the right hemisphere [54,55]—either due to a generally higher right side activation with auditory stimulation [56] or due to the anatomic features of the left temporal regions causing left signal cancellation/distortions [57].…”

Activation of group II metabotropic receptors attenuates cortical E-I imbalance in a 15q13.3 microdeletion mouse model

“…The 40-Hz auditory steady-state responses (ASSRs) represents a promising biomarker for monitoring high frequency network synchrony in schizophrenia patients [57][58][59] and in subjects at ultra-high risk for developing schizophrenia 60 . Importantly, ASSR has also been correlated with a range of cognitive functions such as working memory, attention, reasoning and problem solving [60][61][62][63][64][65] and may reflect neuronal network mechanisms of cognitive processing.…”

Gamma-Range Auditory Steady-State Responses and Cognitive Performance: A Systematic Review

“…Most of the studies examined multiple cognitive domains and used neuropsychological batteries: BACS [44,59,69,70], WAIS [75], ADAS-cog subscale [55], MATRICS MCCB [76], or different subtests from various batteries like WAIS [73,74] and PEBL [71]. Three of the studies evaluated only global cognitive functioning [59,61,69]. In contrast, some studies targeted at specific functions, e.g., short-term and working memory, applying digit span [72] or phonological awareness measured by a Spoonerism task [62].…”

“…The main ASSR outcome measures were power and phase synchronization/consistency; two studies provided signal-to-noise ratio evalua-tions [60,62], and one study provided individual gamma peak frequencies [58]. Most studies focused on the evaluation of the response during the entire stimulation duration [43,55,59,[62][63][64][65][66][67]69,72,75]. Rass et al, Sun et al, and Gaskins et al did not include the early response (0-100 ms) part [60,73,74,76].…”