Cargando…

T149. METACOGNITIVE DEFICITS IN INTEROCEPTION ARE ASSOCIATED WITH DISSOCIATIVE EXPERIENCES IN PATIENTS WITH FIRST EPISODE PSYCHOSIS

BACKGROUND: Dissociative experiences, including depersonalization and derealisation, represent perturbations of consciousness and selfhood, and are commonly reported by patients during early stages of a psychotic illness. The continuity and integrity of a conscious sense of self is proposed to be gr...

Descripción completa

Detalles Bibliográficos
Autores principales: Garfinkel, Sarah, Greenwood, Kathy, Rae, Charlotte, Davies, Geoff, van Praag, Cassandra Gould, Seth, Anil, Nick, Medford, Critchley, Hugo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887419/
http://dx.doi.org/10.1093/schbul/sby016.425
_version_ 1783312298411032576
author Garfinkel, Sarah
Greenwood, Kathy
Rae, Charlotte
Davies, Geoff
van Praag, Cassandra Gould
Seth, Anil
Nick, Medford
Critchley, Hugo
author_facet Garfinkel, Sarah
Greenwood, Kathy
Rae, Charlotte
Davies, Geoff
van Praag, Cassandra Gould
Seth, Anil
Nick, Medford
Critchley, Hugo
author_sort Garfinkel, Sarah
collection PubMed
description BACKGROUND: Dissociative experiences, including depersonalization and derealisation, represent perturbations of consciousness and selfhood, and are commonly reported by patients during early stages of a psychotic illness. The continuity and integrity of a conscious sense of self is proposed to be grounded upon the control of internal physiological state and its predictive representation through interoception, i.e. the sensing of internal bodily changes. We tested the hypothesized relationship between dissociation and interoceptive deficits in patients with first episode psychosis (FEP), combining behavioural testing with functional neuroimaging. METHODS: Individuals with first episode psychosis (N=41) and matched community control participants (N=21) performed an interoceptive task (heart-tone synchrony judgments) during functional magnetic resonance imaging (fMRI). Trial-by-trial confidence ratings indexed subjective performance, and measures of metacognitive interoceptive awareness (insight) were derived from confidence-accuracy correspondence. We tested for regional brain activity relating to dissociative symptom scores and objective, subjective and metacognitive aspects of interoception. RESULTS: In patients with FEP, metacognitive impairments in interoception predicted magnitude of dissociative symptoms, accompanied by hypoactivation of right insula cortex. Other dimensions of interoception, and accuracy, confidence and metacognitive insight on an exteroceptive task were unrelated to dissociative symptoms and there were no group differences between FEP patient and control groups. DISCUSSION: Our findings suggest that symptoms of disturbed conscious integrity and selfhood in early psychosis arise through selective disruption of higher-order metacognitive representations of interoceptive signals. Brain systems supporting the conscious integration of bodily feelings may represent a target for interventions to enhance functioning and, speculatively, mitigate illness progression in psychosis.
format Online
Article
Text
id pubmed-5887419
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-58874192018-04-11 T149. METACOGNITIVE DEFICITS IN INTEROCEPTION ARE ASSOCIATED WITH DISSOCIATIVE EXPERIENCES IN PATIENTS WITH FIRST EPISODE PSYCHOSIS Garfinkel, Sarah Greenwood, Kathy Rae, Charlotte Davies, Geoff van Praag, Cassandra Gould Seth, Anil Nick, Medford Critchley, Hugo Schizophr Bull Abstracts BACKGROUND: Dissociative experiences, including depersonalization and derealisation, represent perturbations of consciousness and selfhood, and are commonly reported by patients during early stages of a psychotic illness. The continuity and integrity of a conscious sense of self is proposed to be grounded upon the control of internal physiological state and its predictive representation through interoception, i.e. the sensing of internal bodily changes. We tested the hypothesized relationship between dissociation and interoceptive deficits in patients with first episode psychosis (FEP), combining behavioural testing with functional neuroimaging. METHODS: Individuals with first episode psychosis (N=41) and matched community control participants (N=21) performed an interoceptive task (heart-tone synchrony judgments) during functional magnetic resonance imaging (fMRI). Trial-by-trial confidence ratings indexed subjective performance, and measures of metacognitive interoceptive awareness (insight) were derived from confidence-accuracy correspondence. We tested for regional brain activity relating to dissociative symptom scores and objective, subjective and metacognitive aspects of interoception. RESULTS: In patients with FEP, metacognitive impairments in interoception predicted magnitude of dissociative symptoms, accompanied by hypoactivation of right insula cortex. Other dimensions of interoception, and accuracy, confidence and metacognitive insight on an exteroceptive task were unrelated to dissociative symptoms and there were no group differences between FEP patient and control groups. DISCUSSION: Our findings suggest that symptoms of disturbed conscious integrity and selfhood in early psychosis arise through selective disruption of higher-order metacognitive representations of interoceptive signals. Brain systems supporting the conscious integration of bodily feelings may represent a target for interventions to enhance functioning and, speculatively, mitigate illness progression in psychosis. Oxford University Press 2018-04 2018-04-01 /pmc/articles/PMC5887419/ http://dx.doi.org/10.1093/schbul/sby016.425 Text en © Maryland Psychiatric Research Center 2018. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Garfinkel, Sarah
Greenwood, Kathy
Rae, Charlotte
Davies, Geoff
van Praag, Cassandra Gould
Seth, Anil
Nick, Medford
Critchley, Hugo
T149. METACOGNITIVE DEFICITS IN INTEROCEPTION ARE ASSOCIATED WITH DISSOCIATIVE EXPERIENCES IN PATIENTS WITH FIRST EPISODE PSYCHOSIS
title T149. METACOGNITIVE DEFICITS IN INTEROCEPTION ARE ASSOCIATED WITH DISSOCIATIVE EXPERIENCES IN PATIENTS WITH FIRST EPISODE PSYCHOSIS
title_full T149. METACOGNITIVE DEFICITS IN INTEROCEPTION ARE ASSOCIATED WITH DISSOCIATIVE EXPERIENCES IN PATIENTS WITH FIRST EPISODE PSYCHOSIS
title_fullStr T149. METACOGNITIVE DEFICITS IN INTEROCEPTION ARE ASSOCIATED WITH DISSOCIATIVE EXPERIENCES IN PATIENTS WITH FIRST EPISODE PSYCHOSIS
title_full_unstemmed T149. METACOGNITIVE DEFICITS IN INTEROCEPTION ARE ASSOCIATED WITH DISSOCIATIVE EXPERIENCES IN PATIENTS WITH FIRST EPISODE PSYCHOSIS
title_short T149. METACOGNITIVE DEFICITS IN INTEROCEPTION ARE ASSOCIATED WITH DISSOCIATIVE EXPERIENCES IN PATIENTS WITH FIRST EPISODE PSYCHOSIS
title_sort t149. metacognitive deficits in interoception are associated with dissociative experiences in patients with first episode psychosis
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887419/
http://dx.doi.org/10.1093/schbul/sby016.425
work_keys_str_mv AT garfinkelsarah t149metacognitivedeficitsininteroceptionareassociatedwithdissociativeexperiencesinpatientswithfirstepisodepsychosis
AT greenwoodkathy t149metacognitivedeficitsininteroceptionareassociatedwithdissociativeexperiencesinpatientswithfirstepisodepsychosis
AT raecharlotte t149metacognitivedeficitsininteroceptionareassociatedwithdissociativeexperiencesinpatientswithfirstepisodepsychosis
AT daviesgeoff t149metacognitivedeficitsininteroceptionareassociatedwithdissociativeexperiencesinpatientswithfirstepisodepsychosis
AT vanpraagcassandragould t149metacognitivedeficitsininteroceptionareassociatedwithdissociativeexperiencesinpatientswithfirstepisodepsychosis
AT sethanil t149metacognitivedeficitsininteroceptionareassociatedwithdissociativeexperiencesinpatientswithfirstepisodepsychosis
AT nickmedford t149metacognitivedeficitsininteroceptionareassociatedwithdissociativeexperiencesinpatientswithfirstepisodepsychosis
AT critchleyhugo t149metacognitivedeficitsininteroceptionareassociatedwithdissociativeexperiencesinpatientswithfirstepisodepsychosis