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1) Structures involved in Reality Testing

A Specific Brain Structural Basis for Individual Differences in Reality Monitoring


Marie Buda, Alex Fornito, Zara M. Bergstrm, and Jon S. Simons

Neuroimaging research has implicated the medial anterior prefrontal cortex (PFC) in reality monitoring, and here
we sought to determine whether morphological variability in a specific anteromedial PFC brain structure, the
paracingulate sulcus (PCS), might underlie performance.
Fifty-three healthy volunteers were selected on the basis of MRI scans and classified into four groups according
to presence or absence of the PCS in their left or right hemisphere.
The group with absence of the PCS in both hemispheres showed significantly reduced reality monitoring
performance, and ability to introspect metacognitively about their performance, compared with the other
participants.
Consistent with the prediction that sulcal absence might mean greater volume in the surrounding frontal gyri,
voxel-based morphometry revealed a significant negative correlation between anterior PFC gray matter and
reality monitoring performance.
The findings provide evidence that individual differences in introspective abilities like reality monitoring may be
associated with specific structural variability in the PFC.

2) Pyschosis vs Psychotic Disorders


Psychosis is a cluster of symptoms that occur in certain illnesses or physiological states, due to a disturbance in
the functioning of the brain. Features of psychosis include: Disturbed thinking and cognitive skills, Disturbed
mood, Hallucinations, Delusion.
DSM V: The term psychosis holds different meanings, but beginning with DSM-III, the term has had a more
restricted definition that requires the person to experience a break with reality. In the psychoanalytic era, the
term was often used to describe persons who were severely ill and functionally impaired but had a broad range
of problems and symptoms.
Kaplan: Psychosis - Mental disorder in which the thoughts, affective response, ability to recognize reality, and
ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal
with reality; the classical characteristics of psychosis are impaired reality testing, hallucinations, delusions, and
illusions.

Hallucinations - hallucinations occur when someone senses or feels something that is not there, even though it seems very
real to the person experiencing it. This can affect any of the five senses: sight, hearing, touch, taste or smell. Examples
include hearing voices, seeing colours or visions, or feeling a crawling sensation on or under the skin. Hallucinations often
cause feelings of confusion, worry or fear and can trigger unusual behaviour.

Delusions - a delusion is a false and sometimes bizarre belief, not shared by others in that culture or environment. A person
may feel the need to defend the belief, even if there is evidence against it. Delusions include ideas of persecution or
conspiracy; getting special messages through radio, TV or newspapers; feeling that one has a special relationship to a
religious figure or famous person; or believing that private thoughts are being broadcast aloud.

Those types of illness in which psychosis is a common feature are sometimes grouped together and called
psychotic disorders.

3) Judgment

Mental act of comparing or evaluating choices within the framework of a given set of values for the purpose of
electing a course of action. If the course of action chosen is consonant with reality or with mature adult
standards of behavior, then judgment is said to be intact or normal; judgment is said to be impaired if the
chosen course of action is frankly maladaptive, results from impulsive decisions based on the need for immediate
gratification, or is otherwise not consistent with reality as measured by mature adult standard.

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