Failures of metacognition and lack of insight in neuropsychiatric disorders

Lack of insight or unawareness of illness are the hallmarks of many psychiatric disorders, especially schizophrenia (SCZ) and other psychoses and could be conceived of as a failure in metacognition. Research in this area in the mental health field h as burgeoned with the development and widespread use of standard assessment instruments and the mapping out of the clinical and neuropsychological correlates of insight and its loss. There has been a growing appreciation of the multi-faceted nature of the concept and of the different 'objects' of insight, such as the general awareness that one is ill, to more specific metacognitive awareness of individual symptoms, impairments and performance. This in turn has led to the notion that insight may show modularity and may fractionate across different domains and disorders, supported by work that directly compares metacognition of memory deficits and illness awareness in patients with SCZ, Alzheimer's disease and brain injury. The focus of this paper will be on the varieties of metacognitive failure in psychiatry, particularly the psychoses. We explore cognitive models based on self-reflectiveness and their possible social and neurological bases, including data from structural and functional MRI. The medial frontal cortex appears to play an important role in self-appraisal in health and disease.     

Metacognition and mentalizing are associated with distinct neural representations of decision uncertainty

Metacognition and mentalizing are both associated with meta-level mental state representations. Conventionally, metacognition refers to monitoring one’s own cognitive processes, while mentalizing refers to monitoring others’ cognitive processes. However, this self-other dichotomy is insufficient to delineate the 2 high-level mental processes. We here used functional magnetic resonance imaging (fMRI) to systematically investigate the neural representations of different levels of decision uncertainty in monitoring different targets (the current self, the past self [PS], and others) performing a perceptual decision-making task. Our results reveal diverse formats of internal mental state representations of decision uncertainty in mentalizing, separate from the associations with external cue information. External cue information was commonly represented in the right inferior parietal lobe (IPL) across the mentalizing tasks. However, the internal mental states of decision uncertainty attributed to others were uniquely represented in the dorsomedial prefrontal cortex (dmPFC), rather than the temporoparietal junction (TPJ) that also represented the object-level mental states of decision inaccuracy attributed to others. Further, the object-level and meta-level mental states of decision uncertainty, when attributed to the PS, were represented in the precuneus and the lateral frontopolar cortex (lFPC), respectively. In contrast, the dorsal anterior cingulate cortex (dACC) represented currently experienced decision uncertainty in metacognition, and also uncertainty about the estimated decision uncertainty (estimate uncertainty), but not the estimated decision uncertainty per se in mentalizing. Hence, our findings identify neural signatures to clearly delineate metacognition and mentalizing and further imply distinct neural computations on internal mental states of decision uncertainty during metacognition and mentalizing.

The relationship between metacognition and mentalizing is still a matter of debate, as both are associated with meta-representations. This study adapts a task paradigm used in metacognition to apply in mentalizing and compares the neural representations of decision uncertainty in metacognition and mentalizing.     

Relating Pupil Dilation and Metacognitive Confidence during Auditory Decision-Making

The sources of evidence contributing to metacognitive assessments of confidence in decision-making remain unclear. Previous research has shown that pupil dilation is related to the signaling of uncertainty in a variety of decision tasks. Here we ask whether pupil dilation is also related to metacognitive estimates of confidence. Specifically, we measure the relationship between pupil dilation and confidence during an auditory decision task using a general linear model approach to take into account delays in the pupillary response. We found that pupil dilation responses track the inverse of confidence before but not after a decision is made, even when controlling for stimulus difficulty. In support of an additional post-decisional contribution to the accuracy of confidence judgments, we found that participants with better metacognitive ability – that is, more accurate appraisal of their own decisions – showed a tighter relationship between post-decisional pupil dilation and confidence. Together our findings show that a physiological index of uncertainty, pupil dilation, predicts both confidence and metacognitive accuracy for auditory decisions.     

Neuronal correlates of metacognition in primate frontal cortex

Humans are metacognitive: they monitor and control their cognition. Our hypothesis was that neuronal correlates of metacognition reside in the same brain areas responsible for cognition, including frontal cortex. Recent work demonstrated that nonhuman primates are capable of metacognition, so we recorded from single neurons in the frontal eye field, dorsolateral prefrontal cortex, and supplementary eye field of monkeys (Macaca mulatta) that performed a metacognitive visual-oculomotor task. The animals made a decision and reported it with a saccade, but received no immediate reward or feedback. Instead, they had to monitor their decision and bet whether it was correct. Activity was correlated with decisions and bets in all three brain areas, but putative metacognitive activity that linked decisions to appropriate bets occurred exclusively in the SEF. Our results offer a survey of neuronal correlates of metacognition and implicate the SEF in linking cognitive functions over short periods of time.     

A computational framework for the study of confidence in humans and animals

Confidence judgements, self-assessments about the quality of a subject's knowledge, are considered a central example of metacognition. Prima facie, introspection and self-report appear the only way to access the subjective sense of confidence or uncertainty. Contrary to this notion, overt behavioural measures can be used to study confidence judgements by animals trained in decision-making tasks with perceptual or mnemonic uncertainty. Here, we suggest that a computational approach can clarify the issues involved in interpreting these tasks and provide a much needed springboard for advancing the scientific understanding of confidence. We first review relevant theories of probabilistic inference and decision-making. We then critically discuss behavioural tasks employed to measure confidence in animals and show how quantitative models can help to constrain the computational strategies underlying confidence-reporting behaviours. In our view, post-decision wagering tasks with continuous measures of confidence appear to offer the best available metrics of confidence. Since behavioural reports alone provide a limited window into mechanism, we argue that progress calls for measuring the neural representations and identifying the computations underlying confidence reports. We present a case study using such a computational approach to study the neural correlates of decision confidence in rats. This work shows that confidence assessments may be considered higher order, but can be generated using elementary neural computations that are available to a wide range of species. Finally, we discuss the relationship of confidence judgements to the wider behavioural uses of confidence and uncertainty.     

Metacognition in human decision-making: confidence and error monitoring

People are capable of robust evaluations of their decisions: they are often aware of their mistakes even without explicit feedback, and report levels of confidence in their decisions that correlate with objective performance. These metacognitive abilities help people to avoid making the same mistakes twice, and to avoid overcommitting time or resources to decisions that are based on unreliable evidence. In this review, we consider progress in characterizing the neural and mechanistic basis of these related aspects of metacognition-confidence judgements and error monitoring-and identify crucial points of convergence between methods and theories in the two fields. This convergence suggests that common principles govern metacognitive judgements of confidence and accuracy; in particular, a shared reliance on post-decisional processing within the systems responsible for the initial decision. However, research in both fields has focused rather narrowly on simple, discrete decisions-reflecting the correspondingly restricted focus of current models of the decision process itself-raising doubts about the degree to which discovered principles will scale up to explain metacognitive evaluation of real-world decisions and actions that are fluid, temporally extended, and embedded in the broader context of evolving behavioural goals.     

A Bayesian Attractor Model for Perceptual Decision Making

Even for simple perceptual decisions, the mechanisms that the brain employs are still under debate. Although current consensus states that the brain accumulates evidence extracted from noisy sensory information, open questions remain about how this simple model relates to other perceptual phenomena such as flexibility in decisions, decision-dependent modulation of sensory gain, or confidence about a decision. We propose a novel approach of how perceptual decisions are made by combining two influential formalisms into a new model. Specifically, we embed an attractor model of decision making into a probabilistic framework that models decision making as Bayesian inference. We show that the new model can explain decision making behaviour by fitting it to experimental data. In addition, the new model combines for the first time three important features: First, the model can update decisions in response to switches in the underlying stimulus. Second, the probabilistic formulation accounts for top-down effects that may explain recent experimental findings of decision-related gain modulation of sensory neurons. Finally, the model computes an explicit measure of confidence which we relate to recent experimental evidence for confidence computations in perceptual decision tasks.     

Higher-order awareness, misrepresentation and function

Conscious mental states are states we are in some way aware of. I compare higher-order theories of consciousness, which explain consciousness by appeal to such higher-order awareness (HOA), and first-order theories, which do not, and I argue that higher-order theories have substantial explanatory advantages. The higher-order nature of our awareness of our conscious states suggests an analogy with the metacognition that figures?in the regulation of psychological processes and behaviour. I argue that, although both consciousness and metacognition involve higher-order psychological states, they have little more in common. One thing they do share is the possibility of misrepresentation; just as metacognitive processing can misrepresent one's cognitive states and abilities, so the HOA in virtue of which one's mental states are conscious can, and sometimes does, misdescribe those states. A striking difference between the two, however, has to do with utility for psychological processing. Metacognition has considerable benefit for psychological processing; in contrast, it is unlikely that there is much, if any, utility to mental states' being conscious over and above the utility those states have when they are not conscious.     

Metacognitive Confidence Increases with,but Does Not Determine,Visual Perceptual Learning

While perceptual learning increases objective sensitivity, the effects on the constant interaction of the process of perception and its metacognitive evaluation have been rarely investigated. Visual perception has been described as a process of probabilistic inference featuring metacognitive evaluations of choice certainty. For visual motion perception in healthy, naive human subjects here we show that perceptual sensitivity and confidence in it increased with training. The metacognitive sensitivity–estimated from certainty ratings by a bias-free signal detection theoretic approach–in contrast, did not. Concomitant 3Hz transcranial alternating current stimulation (tACS) was applied in compliance with previous findings on effective high-low cross-frequency coupling subserving signal detection. While perceptual accuracy and confidence in it improved with training, there were no statistically significant tACS effects. Neither metacognitive sensitivity in distinguishing between their own correct and incorrect stimulus classifications, nor decision confidence itself determined the subjects’ visual perceptual learning. Improvements of objective performance and the metacognitive confidence in it were rather determined by the perceptual sensitivity at the outset of the experiment. Post-decision certainty in visual perceptual learning was neither independent of objective performance, nor requisite for changes in sensitivity, but rather covaried with objective performance. The exact functional role of metacognitive confidence in human visual perception has yet to be determined.     

A detection theoretic explanation of blindsight suggests a link between conscious perception and metacognition

Blindsight refers to the rare ability of V1-damaged patients to perform visual tasks such as forced-choice discrimination, even though these patients claim not to consciously see the relevant stimuli. This striking phenomenon can be described in the formal terms of signal detection theory. (i) Blindsight patients use an unusually conservative criterion to detect targets. (ii) In discrimination tasks, their confidence ratings are low and (iii) such confidence ratings poorly predict task accuracy on a trial-by-trial basis. (iv) Their detection capacity (d') is lower than expected based on their performance in forced-choice tasks. We propose a unifying explanation that accounts for these features: that blindsight is due to a failure to represent and update the statistical information regarding the internal visual neural response, i.e. a failure in metacognition. We provide computational simulation data to demonstrate that this model can qualitatively account for the detection theoretic features of blindsight. Because such metacognitive mechanisms are likely to depend on the prefrontal cortex, this suggests that although blindsight is typically due to damage to the primary visual cortex, distal influence to the prefrontal cortex by such damage may be critical. Recent brain imaging evidence supports this view.     

The human toxicity potential and a Strategy for Evaluating Model Performance in Life Cycle Impact Assessment

The Human Toxicity Potential (HTP) is a quantita tive toxic equivalency potential (TEP) that has been introduced previously to express the potential harm of a unit of chemical released into the environment. HTP includes both inherent toxicity and generic source-to-dose relationships for pollutant emissions. Three issues associated with the use of HTP in Life Cycle Impact Assessment (LCIA) are evaluated here. First is the use of regional multimedia models to define source-to-dose relationships for the HTP. Second is uncertainty and variability in sourceto-dose calculations. And third is model performance evaluation for TEP models. Using the HTP as a case study, we consider important sources of uncertainty/variability in the development of source-to-dose models — including parameter variability/uncertainty, model uncertainty, and decision rule uncertainty. Once sources of uncertainty are made explicit, a model performance evaluation is appropriate and useful and thus introduced. Model performance evaluation can illustrate the relative value of increasing model complexity, assembling more data, and/or providing a more explicit representation of uncertainty. This work reveals that an understanding of the uncertainty in TEPs as well as a model performance evaluation are needed to a) refine and target the assessment process and b) improve decision making.     

Suprathreshold perceptual decisions constrain models of confidence

Perceptual confidence is an important internal signal about the certainty of our decisions and there is a substantial debate on how it is computed. We highlight three confidence metric types from the literature: observers either use 1) the full probability distribution to compute probability correct (Probability metrics), 2) point estimates from the perceptual decision process to estimate uncertainty (Evidence-Strength metrics), or 3) heuristic confidence from stimulus-based cues to uncertainty (Heuristic metrics). These metrics are rarely tested against one another, so we examined models of all three types on a suprathreshold spatial discrimination task. Observers were shown a cloud of dots sampled from a dot generating distribution and judged if the mean of the distribution was left or right of centre. In addition to varying the horizontal position of the mean, there were two sensory uncertainty manipulations: the number of dots sampled and the spread of the generating distribution. After every two perceptual decisions, observers made a confidence forced-choice judgement whether they were more confident in the first or second decision. Model results showed that the majority of observers were best-fit by either: 1) the Heuristic model, which used dot cloud position, spread, and number of dots as cues; or 2) an Evidence-Strength model, which computed the distance between the sensory measurement and discrimination criterion, scaled according to sensory uncertainty. An accidental repetition of some sessions also allowed for the measurement of confidence agreement for identical pairs of stimuli. This N-pass analysis revealed that human observers were more consistent than their best-fitting model would predict, indicating there are still aspects of confidence that are not captured by our modelling. As such, we propose confidence agreement as a useful technique for computational studies of confidence. Taken together, these findings highlight the idiosyncratic nature of confidence computations for complex decision contexts and the need to consider different potential metrics and transformations in the confidence computation.     

Doubly Bayesian Analysis of Confidence in Perceptual Decision-Making

Humans stand out from other animals in that they are able to explicitly report on the reliability of their internal operations. This ability, which is known as metacognition, is typically studied by asking people to report their confidence in the correctness of some decision. However, the computations underlying confidence reports remain unclear. In this paper, we present a fully Bayesian method for directly comparing models of confidence. Using a visual two-interval forced-choice task, we tested whether confidence reports reflect heuristic computations (e.g. the magnitude of sensory data) or Bayes optimal ones (i.e. how likely a decision is to be correct given the sensory data). In a standard design in which subjects were first asked to make a decision, and only then gave their confidence, subjects were mostly Bayes optimal. In contrast, in a less-commonly used design in which subjects indicated their confidence and decision simultaneously, they were roughly equally likely to use the Bayes optimal strategy or to use a heuristic but suboptimal strategy. Our results suggest that, while people’s confidence reports can reflect Bayes optimal computations, even a small unusual twist or additional element of complexity can prevent optimality.     

The neural basis of metacognitive ability

Ability in various cognitive domains is often assessed by measuring task performance, such as the accuracy of a perceptual categorization. A similar analysis can be applied to metacognitive reports about a task to quantify the degree to which an individual is aware of his or her success or failure. Here, we review the psychological and neural underpinnings of metacognitive accuracy, drawing on research in memory and decision-making. These data show that metacognitive accuracy is dissociable from task performance and varies across individuals. Convergent evidence indicates that the function of the rostral and dorsal aspect of the lateral prefrontal cortex (PFC) is important for the accuracy of retrospective judgements of performance. In contrast, prospective judgements of performance may depend upon medial PFC. We close with a discussion of how metacognitive processes relate to concepts of cognitive control, and propose a neural synthesis in which dorsolateral and anterior prefrontal cortical subregions interact with interoceptive cortices (cingulate and insula) to promote accurate judgements of performance.     

Tuned inhibition in perceptual decision-making circuits can explain seemingly suboptimal confidence behavior

Current dominant views hold that perceptual confidence reflects the probability that a decision is correct. Although these views have enjoyed some empirical support, recent behavioral results indicate that confidence and the probability of being correct can be dissociated. An alternative hypothesis suggests that confidence instead reflects the magnitude of evidence in favor of a decision while being relatively insensitive to the evidence opposing the decision. We considered how this alternative hypothesis might be biologically instantiated by developing a simple neural network model incorporating a known property of sensory neurons: tuned inhibition. The key idea of the model is that the level of inhibition that each accumulator unit receives from units with the opposite tuning preference, i.e. its inhibition ‘tuning’, dictates its contribution to perceptual decisions versus confidence judgments, such that units with higher tuned inhibition (computing relative evidence for different perceptual interpretations) determine perceptual discrimination decisions, and units with lower tuned inhibition (computing absolute evidence) determine confidence. We demonstrate that this biologically plausible model can account for several counterintuitive findings reported in the literature where confidence and decision accuracy dissociate. By comparing model fits, we further demonstrate that a full complement of behavioral data across several previously published experimental results—including accuracy, reaction time, mean confidence, and metacognitive sensitivity—is best accounted for when confidence is computed from units without, rather than units with, tuned inhibition. Finally, we discuss predictions of our results and model for future neurobiological studies. These findings suggest that the brain has developed and implements this alternative, heuristic theory of perceptual confidence computation by relying on the diversity of neural resources available.     

Leading compounds for the validation of animal models of psychopathology

Modelling of complex psychiatric disorders, e.g., depression and schizophrenia, in animals is a major challenge, since they are characterized by certain disturbances in functions that are absolutely unique to humans. Furthermore, we still have not identified the genetic and neurobiological mechanisms, nor do we know precisely the circuits in the brain that function abnormally in mood and psychotic disorders. Consequently, the pharmacological treatments used are mostly variations on a theme that was started more than 50 years ago. Thus, progress in novel drug development with improved therapeutic efficacy would benefit greatly from improved animal models. Here, we review the available animal models of depression and schizophrenia and focus on the way that they respond to various types of potential candidate molecules, such as novel antidepressant or antipsychotic drugs, as an index of predictive validity. We conclude that the generation of convincing and useful animal models of mental illnesses could be a bridge to success in drug discovery.     

Steady state analysis of influx and transbilayer distribution of ergosterol in the yeast plasma membrane

Mathematical modeling is now frequently used in outbreak investigations to understand underlying mechanisms of infectious disease dynamics, assess patterns in epidemiological data, and forecast the trajectory of epidemics. However, the successful application of mathematical models to guide public health interventions lies in the ability to reliably estimate model parameters and their corresponding uncertainty. Here, we present and illustrate a simple computational method for assessing parameter identifiability in compartmental epidemic models. We describe a parametric bootstrap approach to generate simulated data from dynamical systems to quantify parameter uncertainty and identifiability. We calculate confidence intervals and mean squared error of estimated parameter distributions to assess parameter identifiability. To demonstrate this approach, we begin with a low-complexity SEIR model and work through examples of increasingly more complex compartmental models that correspond with applications to pandemic influenza, Ebola, and Zika. Overall, parameter identifiability issues are more likely to arise with more complex models (based on number of equations/states and parameters). As the number of parameters being jointly estimated increases, the uncertainty surrounding estimated parameters tends to increase, on average, as well. We found that, in most cases, R0 is often robust to parameter identifiability issues affecting individual parameters in the model. Despite large confidence intervals and higher mean squared error of other individual model parameters, R0 can still be estimated with precision and accuracy. Because public health policies can be influenced by results of mathematical modeling studies, it is important to conduct parameter identifiability analyses prior to fitting the models to available data and to report parameter estimates with quantified uncertainty. The method described is helpful in these regards and enhances the essential toolkit for conducting model-based inferences using compartmental dynamic models.     

Self-Knowledge Dim-Out: Stress Impairs Metacognitive Accuracy

Modulation of frontal lobes activity is believed to be an important pathway trough which the hypothalamic-pituitary-adrenal (HPA) axis stress response impacts cognitive and emotional functioning. Here, we investigate the effects of stress on metacognition, which is the ability to monitor and control one''s own cognition. As the frontal lobes have been shown to play a critical role in metacognition, we predicted that under activation of the HPA axis, participants should be less accurate in the assessment of their own performances in a perceptual decision task, irrespective of the effect of stress on the first order perceptual decision itself. To test this prediction, we constituted three groups of high, medium and low stress responders based on cortisol concentration in saliva in response to a standardized psycho-social stress challenge (the Trier Social Stress Test). We then assessed the accuracy of participants'' confidence judgments in a visual discrimination task. As predicted, we found that high biological reactivity to stress correlates with lower sensitivity in metacognition. In sum, participants under stress know less when they know and when they do not know.     

Incorporating uncertainty in predictive species distribution modelling

Motivated by the need to solve ecological problems (climate change, habitat fragmentation and biological invasions), there has been increasing interest in species distribution models (SDMs). Predictions from these models inform conservation policy, invasive species management and disease-control measures. However, predictions are subject to uncertainty, the degree and source of which is often unrecognized. Here, we review the SDM literature in the context of uncertainty, focusing on three main classes of SDM: niche-based models, demographic models and process-based models. We identify sources of uncertainty for each class and discuss how uncertainty can be minimized or included in the modelling process to give realistic measures of confidence around predictions. Because this has typically not been performed, we conclude that uncertainty in SDMs has often been underestimated and a false precision assigned to predictions of geographical distribution. We identify areas where development of new statistical tools will improve predictions from distribution models, notably the development of hierarchical models that link different types of distribution model and their attendant uncertainties across spatial scales. Finally, we discuss the need to develop more defensible methods for assessing predictive performance, quantifying model goodness-of-fit and for assessing the significance of model covariates.     

Reducing the treatment gap for mental disorders: a WPA survey

The treatment gap for people with mental disorders exceeds 50% in all countries of the world, approaching astonishingly high rates of 90% in the least resourced countries. We report the findings of the first systematic survey of leaders of psychiatry in nearly 60 countries on the strategies for reducing the treatment gap. We sought to elicit the views of these representatives on the roles of different human resources and health care settings in delivering care and on the importance of a range of strategies to increase the coverage of evidence-based treatments for priority mental disorders for each demographic stage (childhood, adolescence, adulthood and old age). Our findings clearly indicate three strategies for reducing the treatment gap: increasing the numbers of psychiatrists and other mental health professionals; increasing the involvement of a range of appropriately trained non-specialist providers; and the active involvement of people affected by mental disorders. This is true for both high income and low/middle income countries, though relatively of more importance in the latter. We view this survey as a critically important first step in ascertaining the position of psychiatrists, one of the most influential stakeholder communities in global mental health, in addressing the global challenge of scaling up mental health services to reduce the treatment gap.