Insight and Awareness Flashcards
What is anosagnosia?
Lack of awareness of a neurological deficit or psychiatric condition
Who was the first documented case of anosognosia?
Ursula M
Unaware of visual loss (Anton’s Syndrome)
How does a lesion resulting in hemianopia WITH anosognosia differ from one WITHOU?
Much larger, reaching into parietal lobe
(Attached ‘awareness’ system)
What is the spectrum of insight?
Objective deficits (e.g., hemiplegia) to subjective experiences (e.g., delusions)
Insight is modular or a general system?
Modular
I.e. may have insight into some functions but not others (many different insight systems as opposed to just one)
(At least in neurology)
How is insight into memory impairment in Alzheimer’s?
▪️ Will often overestimate ability
▪️ As will informants to some extent
▪️ Not very good at learning and adjusting awareness
How is insight into memory impairment in schizophrenia?
Tend to be very accurate at predicting ability = insight into impairment
What can we infer from intact insight into memory deficits in schizophrenia?
Insight is modular - they can still have insight into other deficits even if they don’t have insight into their delusions and hallucinations
What factors relate to greater insight/awareness and what does this tell us about insight?
▪️ Better executive functioning
▪️ Better working memory
▪️ Lower mood
(suggests although modular, there are some general factors too)
How does depression relate to insight and why?
Individuals with greater insight and awareness tend to have lower mood
▪️ Greater awareness of problems?
▪️ Depressive realism?
How does carer burden relate to insight and awareness?
Greater carer burden associated with lower awareness
Harder to care for people who lack insight?
What are the three components of insight?
▪️ Awareness of illness (“I am sick”)
▪️ Compliance/adherence to treatment (“This tablet will help”)
▪️ Ability to re-label symptoms (“The voices aren’t real”)
All overlap, can have one without the other
Very good insight = all three
What are the hypothesised constituents of insight?
▪️ Psychopathology
▪️ Neurobiological?
▪️ General intellect
▪️ Executive function
▪️ Personality
▪️ Culture
▪️ Family/peer attitudes
▪️ Unknown
How does cognition relate to insight?
More severe insight deficits associated with lower general cognition (including IQ)
Well replicated BUT small/modest effect size?
What is the Cognitive Model of Insight?
▪️ Cognitive system is constantly processing perceptions, memories etc
▪️ Executive function controls how we process
▪️ All of this is monitored by appraisal system (metacognition)
Is insight a lack of knowledge?
No!
If give mentally ill individual vignette describing someone with similar symptoms, they can say that the person is mentally ill but they cannot recognise that they are like them (cannot apply knowledge to themselves?)
What is the overall conclusions of insight and brain structure and volume?
Quite inconsistent
Some find it in temporal lobes, some in frontal lobes, and some find nothing at all
How does grey matter density differ in those with low vs high insight in psychosis?
Most deficits in the midline medial band, particularly at the front
▪️ Medial frontal
▪️ Anterior cingulate
▪️ Possibly posterior cingulate
What areas of cortical thickness have been associated with awareness of mental disorder in FEP?
Left frontal and temporal poles
What areas of cortical thickness have been associated with awareness of need for treatment in FEP?
Left frontal, parietal, and temporal poles
How do you summarise the brain correlates found with lack of insight?
▪️ Generally quite diffuse
▪️ Recurring involvement of medial/midline structure
What white matter deficits have been associated with symptoms of unawareness?
Fronto-temporal
What white matter deficits have been associated with misattribution of symptoms?
Temporal-parietal
What brain activation has been found with fMRI during self-appraisal and self-reflection?
Activation of the Cortical Midline System (CMS):
▪️ Medial prefrontal cortex
▪️ Anterior cingulate
▪️ Possibly posterior cingulate and rDLPFC
How does medial (CMS) activation in relation to insight and illness awareness differ across illness types?
Generally the same!
How does medial frontal activation for other- and self-appraisal differ between SCZ and HC?
▪️ Both activate same amount when appraising others
▪️ Increased activation in HC with self-appraisal but no change for SCZ
Is there a genetic component to insight?
Possibly
Those with highest polygenic burden for SCZ have highest risk for poor insight (3.2% of variance?)
Can tDCS be used for insight?
Yes - appears to show some transient improvements
