The Project
Insight in Psychosis: New Insights from Cognitive Neuropsychiatry.
Winner
Dr André Aleman
BCN Research School and University Medical Center Groningen
A. Deusinglaan 2
Groningen NL-9713AW
The Netherlands
http://www.bcn-nic.nl
Thirty-one year old Dutch researcher André Aleman, currently an Associate Professor at the University of Groningen, is an outstanding young scientist with a highly promising project of both theoretical and practical relevance. He currently supervises 8 Ph.D. projects and in addition to being widely published, has guest edited an issue of Cognitive Neuropsychiatry. He gained his Ph.D. and M.A. cum laude from Utrecht University.
Dr Aleman said: “The project will combine different methodologies in an innovative way and have the potential of providing a new aspect of thinking and theorizing about schizophrenia and other mental disorders in clinical psychology and psychiatry.”
Provisional Award
€ 1,224,000
Project Description
Lack of insight (unawareness of illness) is a common and clinically relevant feature of psychosis*. Because psychotic patients maintain that nothing is wrong with them, they refuse to be treated. The cognitive and neural basis of insight in psychosis remains unclear, however, rendering it a scientific mystery. This project will test the hypothesis that reduced insight arises from abnormalities in brain circuits subserving self-evaluation and emotion regulation.
In short, it is presumed that implicit, experiential self-processing is biased towards maintaining a positive self-image (which excludes severe mental illness). To obtain insight in psychosis, rational, explicit self-processing must overrule this automatic response.
This will only occur in the face of sufficient cognitive capacity and motivation. However, a large number of psychotic patients lack both. These hypotheses will be tested using methods from cognitive social psychology and functional neuroscience. Futhermore, in an attempt to further dissect the cognitive and neural basis of insight, I propose different neurocognitive mechanisms for the three dimensions of insight that have been described.
Advanced brain mapping methods will be applied, including functional magnetice resonance imaging (fMRI) and repetitive transcranial magnetic stimulation (rTMS), to test these hypotheses. Research questions will also include whether such neurofunctional abnormalities differ across diagnostic categories, and whether they are stable over time. Utlimately, the findings will be integrated, to allow a unifying model which can satisfactorily explain the neural and cognitive-emotional origins of poor insight in psychosis.
Moreover, the results are expected to yield strong clues as to effective treatment (specifically, cognitive-emotional therapy and magnetic brain stimulation) and its underlying mechanism, making significant strides forward in combating this insistent and burdensome feature of psychotic disorders.
*Psychosis is a generic psychiatric term for a mental state in which thought and perception are severely impaired. Persons experiencing a psychotic episode may experience hallucinations, hold delusional beliefs (e.g., grandiose or paranoid delusions), demonstrate personality changes and exhibit disorganized thinking.
