Depersonalization is characterised by a profound disruption of self-awareness mainly characterised by feelings of disembodiment and subjective emotional numbing.It has been proposed that depersonalization is caused by a fronto-limbic suppressive mechanism – presumably mediated via attention – which manifests subjectively as emotional numbing, and disables the process by which perception and cognition normally become emotionally coloured, giving rise to a subjective feeling of ‘unreality’.Our functional neuroimaging and psychophysiological studies support the above model and indicate that, compared with normal and clinical (...) controls, DPD patients show increased prefrontal activation as well as reduced activation in insula/limbic-related areas to aversive, arousing emotional stimuli.Although a putative inhibitory mechanism on emotional processing might account for the emotional numbing and characteristic perceptual detachment, it is likely, as suggested by some studies, that parietal mechanisms underpin feelings of disembodiment and lack of agency feelings. (shrink)

These are set against introductory essays describing the philosophical, historical and psychological approaches, making this a uniquely inclusive overview.

Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the “frontal lobe syndrome”). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit (...) and thinking about psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI, and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)

We developed a technique to examine the effects of emotional content and context on verbal memory. Two sets of sentences were devised: in the first, each sentence was emotionally arousing due to the inclusion of an emotional “target” word. In the second set, “targets” were replaced with well-matched neutral words. Subjects read aloud a selection of emotional and neutral sentences, and were then surprised with memory tasks after a range of time delays. Emotional target words were remembered significantly better than (...) neutral words in all experiments. Recognition of emotional words was relatively stable despite increasing delays between encoding and recognition testing, in contrast to memory for neutral words, which decayed over time. Memory for neutral non-target words was enhanced when words had been presented in an emotional context. The results confirm the phenomenon of emotional enhancement of memory at short and long delays and suggest that emotional context may be encoded independently of word meaning. (shrink)

Mindreading in schizophrenia has been shown to be impaired in a multitude of studies. Furthermore, there is increasing evidence to suggest that metacognition is damaged as well. Lack of insight, or the inability to recognise one's own disorder, is an example of such a failure. We suggest that mindreading and metacognition are linked, but separable.

Medical ethicist, Guidry-Grimes has critically reviewed the concept of insight, voicing concerns that it lacks consensus as to its components and that it undermines patient perspectives. We respond by briefly summarising research over the last 30 years that she overlooks which has helped establish the clinical validity of the construct. This includes the adoption of standardised assessment tools—at least in research—and longitudinal and cross-sectional studies quantifying associations with psychopathological, clinical and cognitive measures. We also make the distinction between the current (...) standards for assessing decision-making capacity leading to, where appropriate, involuntary treatment in clinical and medico-legal settings which in most legislations do not include insight assessments, and anecdotal reports of the use and misuse of ‘lack of insight’ as a proxy for more comprehensive evaluation. We conclude by encouraging a broader view of insight akin to self-knowledge. (shrink)

Before a general cognitive model for recurrent complex visual hallucinations (RCVH) is accepted, there must be more research into the neuropsychological and cognitive characteristics of the various disorders in which they occur. Currently available data are insufficient to distinguish whether the similar phenomenology of RCVH across different disorders is in fact produced by a single or by multiple cognitive mechanisms.