Impaired causal awareness and associated cortical–basal ganglia structural changes in youth psychiatric disorders

BACKGROUND Cognitive impairments contribute significantly to disease burden in young individuals presenting with major psychiatric disorders. The capacity to encode the consequences of one's actions may be of particular importance for real-world functioning due to its fundamental role in goal-directed behavior. METHODS Here, we investigated a dimensional measure of causal awareness during a probabilistic learning task in 92 young individuals with an admixture of major mood and psychotic illnesses, at early and more established stages. Using automated gray matter segmentation of T1-weighted images, we estimated the volume and shapes of major subcortical structures and investigated their association with causal awareness. RESULTS The low causal awareness (LCA) group (n = 35) reported increased social disability (p = .004) and reduced right pallidal size, specifically within the dorsolateral surfaces (p = .02), relative to the unimpaired high causal awareness (HCA) patients (n = 57). In early-stage illness, LCA had a smaller right thalamus (p = .002) relative to HCA. Exploratory investigations suggested that in developed psychotic syndromes, causal awareness was correlated with left hippocampal size (p = .006) whereas, in more persistent affective disorders, causal awareness was correlated with left amygdala size (p = .013), specifically within the anterior aspect. DISCUSSION Low causal awareness occurs across diagnoses and stages of illness and is associated with poor functional outcomes. Our results suggest that there may be shared neural underpinnings of its dysfunction in the early course of mood and psychotic disorders, however in more established illness, there is greater neurobiological divergence in causal awareness correlates between diagnoses.