Metacognitive profiles in schizophrenia and bipolar disorder: Comparisons with healthy controls and correlations with negative symptoms

Investigating the relationship between specific negative symptoms and metacognitive functioning in psychosis: A systematic review

BACKGROUND

Disrupted metacognition is implicated in development and maintenance of negative symptoms, but more fine-grained analyses would inform precise treatment targeting for individual negative symptoms.

AIMS

This systematic review identifies and examines datasets that test whether specific metacognitive capacities distinctly influence negative symptoms.

MATERIALS & METHODS

PsycINFO, EMBASE, Medline and Cochrane Library databases plus hand searching of relevant articles, journals and grey literature identified quantitative research investigating negative symptoms and metacognition in adults aged 16+ with psychosis. Authors of included articles were contacted to identify unique datasets and missing information. Data were extracted for a risk of bias assessment using the Quality in Prognostic Studies tool.

RESULTS

85 published reports met criteria and are estimated to reflect 32 distinct datasets and 1623 unique participants. The data indicated uncertainty about the relationship between summed scores of negative symptoms and domains of metacognition, with significant findings indicating correlation coefficients from 0.88 to -0.23. Only eight studies investigated the relationship between metacognition and individual negative symptoms, with mixed findings. Studies were mostly moderate-to-low risk of bias.

DISCUSSION

The relationship between negative symptoms and metacognition is rarely the focus of studies reviewed here, and negative symptom scores are often summed. This approach may obscure relationships between metacognitive domains and individual negative symptoms which may be important for understanding how negative symptoms are developed and maintained.

CONLCLUSION

Methodological challenges around overlapping participants, variation in aggregation of negative symptom items and types of analyses used, make a strong case for use of Individual Participant Data Meta-Analysis to further elucidate these relationships.

Narrative-Derived Indices of Metacognition among People with Schizophrenia: Associations with Self-Reported and Performance-Based Social Functioning

Metacognitive functioning-which broadly encompasses the mental processes involved in thinking about the thinking of one's self and the thinking of others-is often impaired among individuals living with schizophrenia and may contribute to difficulties in social and interpersonal functioning. Although the majority of studies assessing metacognition among individuals with schizophrenia use standardized, laboratory-based measurements, an increasing number of studies have measured metacognitive capacity using natural language produced by individuals living with mental illness. At the same time, less is known about how language-derived indices of metacognitive function relate to key social outcomes among people with schizophrenia. The primary objective of this study was to employ a validated language coding system (the Metacognition Assessment Scale, Abbreviated; MAS-A) to assess metacognitive functioning from the spoken life narratives of individuals with schizophrenia (n = 32) and community controls (n = 15). Among individuals with schizophrenia, we also examined the associations between language-derived metacognition and measures of self-reported and performance-based social functioning. Our results suggest that most aspects of metacognition in our sample were not significantly diminished in people with schizophrenia compared to community controls. Unexpectedly, the MAS-A subscale related to one's ability to master psychological difficulties was rated higher among individuals with schizophrenia. Further, our results suggest that among people with schizophrenia, higher metacognitive functioning in the domain of self-reflectivity was associated with poorer self-reported social functioning, while a greater metacognitive awareness of other individuals' minds was associated with better scores on aspects of performance-based social functioning. Collectively, these results underscore the utility of assessing metacognitive functioning via life-story narratives to understand social outcomes and highlight possible aspects of resiliency among individuals who have experienced a serious mental illness.

The relationship between metacognitive processes and cognitive performances in older adults with no significant impairment: a cross-sectional study

BACKGROUND

Metacognitive dysfunctions have been implicated in several neuropsychiatric conditions, while cognitive performances have been evaluated by measuring cognitive domains in older adults. This study investigated a relationship between metacognitive processes and cognitive performances in older adults.

METHODS

A sociodemographic form, the Standardised Mini-Mental State Examination (SMMSE) and the Metacognitions Questionnaire-30 (MCQ-30) were applied to participants aged >65 years who had no significant cognitive decline defined as normal or with mild cognitive impairment.

RESULTS

'Negative beliefs about worry' and 'need to control thoughts' domains of MCQ-30 were related to cognitive performance measured with SMMSE. Increased negative beliefs about worry were a predicting factor for total cognitive performance as a means of contributing to cognitive impairment, whereas an increased need to control thoughts was related to having a less likely cognitive impairment.

CONCLUSIONS

Metacognitive dysfunctional processes, in particular about worry, might contribute to determining more decent outcomes for cognitive conditions in older adults with no significant cognitive dysfunction.

Meta-analysis of the relationship between metacognition and disorganized symptoms in psychosis

OBJECTIVE

Disorganized symptoms show associations with metacognitive deficits in psychosis. However, the magnitude of this relationship is unclear. This meta-analysis aimed to 1) quantify relationships between metacognition and both disorganized symptoms and disorganized speech; and 2) examine moderators of these relationships (e.g., metacognition type, neurocognition).

METHOD

A literature search was conducted using PsycINFO, Web of Science, PubMed, and EMBASE databases. English-language studies measuring disorganized symptoms and metacognition (i.e., introspective accuracy, metacognitive beliefs, or metacognitive capacity) in psychosis were included. Random effects meta-analyses were conducted using Pearson's r.

RESULTS

Meta-analysis of 20 studies (n = 1490) resulted in a significant negative medium correlation between disorganized symptoms and metacognition (r = -0.332, 95 % CI [-0.423, -0.235]). Magnitude was moderated by metacognition type. A significant negative small correlation between disorganized speech and metacognition (r = -0.173, 95 % CI [-0.254, -0.089], n = 1470) was observed, with no significant moderators.

CONCLUSIONS

Results clarify the magnitude of the relationships between metacognition and both disorganized symptoms and disorganized speech. Significant relationships may indicate conceptual links, yet the different magnitudes may reflect a distinction between disorganized symptoms and speech. The moderator finding highlights that metacognitive capacity has an especially strong link to disorganized symptoms and underscores the need for careful distinction between types of metacognition in future work.

Link between metacognition and social cognition in schizophrenia: a systematic review and meta-analysis

Introduction

Metacognition is the ability to reflect on one's own cognitive processes, monitor and regulate them to enhance mental performance. Social cognition involves the capacity to perceive and respond to social cues from others. The study of metacognition and social cognition is an expanding research field in psychiatry. Both domains are related to neurocognition, symptoms and psychosocial functioning in schizophrenia. Understanding the relationship between social cognition and metacognition may be pivotal for enhancing the treatment of cognitive symptoms in schizophrenia.

Methods

We conducted a PRISMA systematic review and meta-analysis on quantitative studies comparing metacognition to social cognitive outcomes in adult outpatients with a schizophrenia spectrum disorder. Reports were retrieved from the Medline, ScienceDirect and PsycINFO databases up to July 13th, 2023. Risk of bias was assessed with the Cochrane tool.

Results

Our review included 1,036 participants across 17 reports, with 12 reports included in the meta-analysis. We found a significant positive correlation (r = 0.28, 95% CI: [0.14, 0.41]) between social cognition and metacognition. Subgroup analyses indicated that metacognition was specifically associated with theory of mind, attribution, and emotion processing. Different patterns of correlations were observed according to the assessment of metacognition and its subdimensions.

Conclusion

Despite discrepancies among the included studies, no publication bias was detected. The results suggest that metacognition and social cognition are distinct but related constructs. Those processes should be assessed and treated together, along with neurocognition, in schizophrenia.

Conceptual disorganization as a mediating variable between visual learning and metacognition in schizophrenia

Objectives

The aim of this study was to evaluate the relative contributions of visual learning and conceptual disorganization to specific metacognitive domains in a sample of outpatients with stable schizophrenia.

Methods

A total of 92 consecutive outpatients with stable schizophrenia were recruited in a cross-sectional study. We analyzed the data with five path analyses based on multiple regressions to analyze the specific effect of visual learning on metacognitive capacity and metacognitive domains and the possible mediating role of conceptual disorganization.

Results

We found that (i) visual learning was negatively correlated to metacognitive capacity and its domains on the one hand and conceptual disorganization on the other hand; (ii) conceptual disorganization was negatively associated with metacognition and its domains; and (iii) when the mediation effect was considered, conceptual disorganization fully mediated the relationship between visual learning and mastery, whereas it served as a partial mediator of the effect of visual learning on the other metacognition domains, i.e., self-reflectivity, understanding others' mind, and decentration.

Conclusion

These results delineate an articulated panorama of relations between different dimensions of metacognition, visual learning, and conceptual disorganization. Therefore, studies unable to distinguish between different components of metacognition fail to bring out the possibly varying links between neurocognition, disorganization, and metacognition.

Lower cohesion and altered first-person pronoun usage in the spoken life narratives of individuals with schizophrenia

Usage of computational tools to quantify language disturbances among individuals with psychosis is increasing, improving measurement efficiency and access to fine-grained constructs. However, few studies apply automated linguistic analysis to life narratives in this population. Such research could facilitate the measurement of psychosis-relevant constructs such as sense of agency, capacity to organize one's personal history, narrative richness, and perceptions of the roles that others play in one's life. Furthermore, research is needed to understand how narrative linguistic features relate to cognitive and social functioning. In the present study, individuals with schizophrenia (n = 32) and individuals without a psychotic disorder (n = 15) produced personal life narratives within the Indiana Psychiatric Illness Interview. Narratives were analyzed using the Coh-Metrix computational tool. Linguistic variables analyzed were indices of connections within causal and goal-driven speech (deep cohesion), unique word usage (lexical diversity), and pronoun usage. Individuals with schizophrenia compared to control participants produced narratives that were lower in deep cohesion, contained more first-person singular pronouns, and contained fewer first-person plural pronouns. Narratives did not significantly differ between groups in lexical diversity, third-person pronoun usage, or total word count. Cognitive-linguistic relationships emerged in the full sample, including significant correlations between greater working memory capacity and greater deep cohesion and lexical diversity. In the schizophrenia group, social problem-solving abilities did not correlate with linguistic variables but were associated with cognition. Findings highlight the relevance of psychotherapies which aim to promote recovery among individuals with psychosis through the construction of coherent life narratives and increasing agency and social connectedness.

The mediating role of negative symptoms in "secondary factors" determining social functioning in chronic schizophrenia

Background

Chronic schizophrenia is significantly influenced by negative symptoms, with several known contributors to secondary negative symptoms. However, the impact of these factors and negative symptoms on social functioning warrants further exploration.

Methods

We assessed the clinical symptoms, antipsychotic adverse reactions, and social functioning of 283 hospitalized patients with chronic schizophrenia using various standardized interviews and scales. We conducted multiple regression and mediation analyses to elucidate the impact of secondary factors on negative symptoms, and the relationship among these "secondary factors," negative symptoms, and social functioning.

Results

Our findings identified depressive symptoms, extrapyramidal symptoms, and positive symptoms as significant contributors to secondary negative symptoms. We found that negative symptoms play a notable mediating role in the effect of depressive and positive symptoms on social functioning. However, the relationship between positive symptoms, negative symptoms, and social functioning proved to be intricate.

Conclusion

Our findings propose that negative symptoms act as pivotal mediators in the correlation between "secondary factors" (including the depressive symptoms and positive symptoms) and social functioning. The treatment of chronic schizophrenia necessitates focusing on key factors such as depressive and positive symptoms, which might significantly contribute to the development of secondary negative symptoms. Further research is essential to clarify the complex relationship among positive symptoms, negative symptoms, and social functioning in schizophrenia.

Metacognition in Schizophrenia Spectrum Disorders-Current Methods and Approaches

Metacognition essentially represents "thinking about thinking", or the individual's capacity to control and monitor their own cognitive processes. Metacognition impairment in schizophrenia represents a core feature of the disease, and, in the last fifteen years, the subject has evolved into a growing study area concentrating on a wide variety of processes, such as clinical insight, autobiographical memory, cognitive beliefs, reasoning, and memory biases. Since metacognition is a complex subject, we wanted to focus on the different nuances of metacognition transposed into the lives of patients diagnosed with either schizophrenia or a schizoaffective disorder. Therefore, this narrative review aims to analyze the literature in order to provide an insight regarding the current methods and approaches in the study of metacognition in schizophrenia or schizoaffective disorders, as well as the results provided. Results from the reviewed studies showed that patients with schizophrenia have a lower metacognitive ability, which is strongly reflected in their lives. Studies to date have highlighted the interaction between schizophrenia symptoms and metacognition, which shows how metacognition impacts work performance, autobiographical memory, motivation, the severity of symptoms, and social cognition.

Metacognition and insight dynamics exploration in borderline personality disorder: Exploring the underlying dynamics

Metacognition and Insight are related to hard-to-treat disorders and among them is Borderline Personality Disorder (BPD). We recruited 190 BPD patients and measured Insight, Metacognition, Impulsivity, and BPD traits. Results showed BPD's significant links with Insight and Metacognition. Metacognition significantly correlated with two Impulsivity dimensions, whereas Insight significantly correlated with most of them. Regressions analysis revealed a significant relationship between Insight and Metacognition on Impulsivity and Borderline traits. Mediation analysis proved the indirect effect of Metacognition/Insight on Borderline traits through Impulsivity at a significative level. Both seem relevant for research and therapeutic application in BPD following different dynamics even if the limitation of our study stands in its gender ratio and possible comorbidity issues. Urgency appears as a critical factor to assess, notably with Positive emotion-based impulsivity.

Integrating Loss and Processing Grief in Psychotherapy of Psychosis

Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person's identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.

Metacognition in schizophrenia: A practical overview of psychometric metacognition assessment tools for researchers and clinicians

Metacognition refers to the cognitive ability to control, monitor and modulate cognitive processes thus guiding and orienting behavior: a continuum of mental activities that ranges from more discrete ones, such as the awareness of the accuracy of others' judgment, to more integrated activities, such as the knowledge of cognitive processes. Metacognition impairment in schizophrenia, which is considered a core feature of the illness, has become a growing research field focusing on a wide range of processes including reasoning, autobiographical memory, memory biases, cognitive beliefs and clinical insight. There is a well-established relationship between metacognition and schizophrenia symptoms severity, as well as between impaired metacognitive functioning and specific symptomatic sub-domains, such as positive symptoms, negative symptoms, or disorganization. The development of specific cognitive-derived psychotherapies for metacognitive deficits in schizophrenia has been ongoing in the last years. Although sharing a metacognitive feature, these treatments focus on different aspects: false or unhelpful beliefs for metacognitive therapy; cognitive biases for metacognitive training; schematic dysfunctional beliefs for cognitive behavioral therapy (CBT) for psychoses; metacognitive knowledge and sense of identity for MERIT; interpersonal ideas or events triggering delusional thinking for MIT-P. This article reviews the instruments designed to assess metacognitive domains and functions in individuals with schizophrenia, providing mental health professionals with an overview of the heterogeneous current scenario ranging from self-administered scales to semi-structured interviews, which are supported by a variety of theoretical frameworks. Future directions may address the need for more specific and refined tools, also able to follow-up psychotherapeutic-induced improvements.

Comparison of Obsessive-Compulsive Disorder and Schizophrenia With Comorbid Obsessive-Compulsive Disorder in Terms of Insight, Metacognitive Beliefs, and Clinical Features

The aim was to compare insight levels into obsessive-compulsive symptoms (OCS), and metacognitions of patients with obsessive-compulsive disorder (OCD) and with schizophrenia with comorbid OCD (SZ-OCD). Thirty OCD patients and 30 SZ-OCD patients were evaluated; no significant difference was found between the groups in the Brown Assessment of Beliefs Scale (BABS) and the Metacognition Questionnaire-30 (MCQ-30). When all patients were divided into two groups regardless of the presence or absence of schizophrenia as "good insight" and "poor or no insight," the MCQ-30 total score was found to be higher in the "poor or no insight" group and showed a significant but moderate positive correlation with the BABS score. This study supports that the level of insight into OCS in SZ-OCD is not significantly different from patients with OCD. Metacognitions differ not according to the distinction between OCD and SZ-OCD but according to the level of insight in whole OCD sample.

Contrasting the Social Cognitive and Metacognitive Capacities Among Patients With Schizophrenia and Autism Spectrum Disorders Enrolled in Psychiatric Rehabilitation

ABSTRACT

Unique deficits in synthetic metacognition have been found in schizophrenia when compared with other psychiatric conditions and community controls. Although persons with autism spectrum disorders (ASD) display similar deficits in social cognition relative to those with schizophrenia, to date no study has compared metacognitive function between these groups. We aimed to compare the metacognitive capacities of persons with schizophrenia and ASD and their associations with other outcomes (neurocognition, social cognition, depression, and quality of life). Fifty-six outpatients with schizophrenia or ASD (mean age, 32.50 [9.05]; 67.9% male) were recruited from two French Centers of Reference for Psychiatric Rehabilitation of the REHABase cohort. Evaluation included the Indiana Psychiatric Illness Interview, Metacognition Assessment Scale-Abbreviated, Movie for the Assessment of Social Cognition, and a large cognitive battery. Compared with those with schizophrenia, participants with ASD had higher self-reflectivity ( p = 0.025; odds ratio, 1.38 [1.05-1.86]) in univariable analyses. Metacognitive deficits may be found in ASD with a profile that varies from what is found in schizophrenia. It is possible that methods for enhancing metacognitive abilities during psychiatric rehabilitation may be refined to assist adults with ASD to better manage their own recovery.

Finding the Person in the Disorder: Adapting Metacognitive Reflection and Insight Therapy for Bipolar Mood Disorder (MERIT-BD)

Metacognitive Reflection and Insight Therapy (MERIT) was originally developed as an integrative recovery-oriented therapeutic approach to address the needs of people with a diagnosis of schizophrenia and other forms of severe mental illness. The approach, conceptualized as transtheoretical, aims to promote a more coherent and synthetic sense of self, through stimulating insight, sense of coherence, and metacognitive capacity. We argue that MERIT therapy, designed to facilitate peoples’ ability to form complex ideas about themselves and others and to use this knowledge to respond to psychological problems, has application in addressing deficits associated with bipolar disorder (BD), where there may be a significant injury to the person’s sense of self. That is, the therapy addresses the nascent sense of self in a context where disturbance of mood is dominant, and in relation to the experience of episodic manic episodes which may be understood as dissociative events, often associated with shame. The application of the therapeutic approach, which we term MERIT-BD draws upon MERIT’s primary principle of facilitating complexity and integration of the self, and additionally addresses shame, allowing for the facilitation of metacognitive capacity and insight in the context of finding the person. This approach will be illustrated with case vignettes illustrating the application of key components of MERIT-BD. Early findings drawn from a series of case studies are encouraging.

Cognitive attentional syndrome and metacognitive beliefs as potential treatment targets for metacognitive therapy in bipolar disorder

Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder (BD). However, relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD. Given its unique view in the explanation of psychopathological states, metacognitive therapy (MCT) might be helpful for BD. Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome (CAS) and that it is influenced and maintained by dysfunctional metacognitive beliefs, perseverative thinking, attentional biases, and dysfunctional coping strategies. In this review, literature data regarding these areas in BD are examined. Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD. Regarding attentional biases, literature data show that state-dependent, mood-changing attentional biases and a ruminative self-focused attention are present. Studies also suggest that cognitive self-consciousness is higher in BD compared to controls. It is seen that maladaptive coping strategies are frequently reported in BD, and that these strategies are associated with depression severity, negative affect and relapse risk. Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs, self-consciousness, need to control thoughts, and a lack of cognitive confidence. Also, dysfunctional metacognitive beliefs were associated with depressive symptomatology. These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD. For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions, MCT might be an alternative way to consider as a treatment option. In conclusion, taken the available data together, we propose a sequential treatment protocol for BD, mainly based on the MCT treatment plan of depressive disorders.

[Metacognition as a pathway to the study and treatment of fragmentation in schizophrenia]

This paper explores the potential of recent research on metacognition to offer new avenues to assess and address the phenomenon of fragmentation in schizophrenia, which was described by E.Bleuler as «splitting». The concepts of metacognition characterize and quantify alterations or decrements in the processes by which fragments or pieces of information are integrated into a coherent sense of self and others. A method for assessing metacognition is presented along with research examining the presence and importance of metacognitive deficits in schizophrenia. Greater levels of metacognitive deficits have been detected in different phases of schizophrenia and linked to poorer psychosocial outcomes. These data were obtained both in foreign and preliminary Russian studies. The authors suggest that treatments, which successfully target metacognitive capacity, may uniquely promote wellness and recovery in schizophrenia.

Metacognitions and repetitive negative thinking in bipolar disorder and healthy controls: A comparative study

BACKGROUND

Metacognitive deficits and repetitive negative thinking are poorly explored in bipolar disorder (BD). The majority of the published studies concerned patients with bipolar depression, without differentiating among BD subtypes. The most common dysfunctional metacognitions, measured with the Metacognition Questionnaire-30 (MCQ-30), were Negative Beliefs about the Uncontrollability and Danger of Worry (NB), Cognitive Confidence (CC) and Beliefs about the Need to Control Thoughts (NC). Worry and rumination also seem to influence every phase of BD. This study aimed to investigate metacognitions and repetitive negative thinking in euthymic patients with BD.

METHOD

Using the MCQ-30, the Penn State Worry Questionnaire (PSWQ) and the Ruminative Responses Scale (RRS), we compared 57 BD-I and 48 BD-II patients with 78 healthy controls.

RESULTS

Both BD groups showed significantly higher NB, CC, NC and total MCQ-30 scores. 'Positive Beliefs About Worry' (PBW) showed a significantly higher score only in the BD-II group. Rumination scores were significantly higher in both patient samples. Worry did not show any significant differences between groups.

LIMITATIONS

The primary limitations are related to the size of the samples and the research design.

CONCLUSIONS

Our findings suggested that metacognitive deficits and negative repetitive thinking were associated with euthymic BD. Rumination, NB, CC, and TC may represent trait-dependent features related to the inter-episodic phase of the disorder. A higher PBW score seemed to be a distinctive feature only for patients with euthymic BD-II. The results offer new perspectives in the psychotherapeutic treatment of these patients.

Contrasting metacognitive profiles and their association with negative symptoms in groups with schizophrenia, early psychosis and depression in a Russian sample

Research has suggested that negative symptoms in psychotic disorders may be in part fueled by deficits in metacognition or the ability to form integrated ideas about oneself and others. One limitation of this work is that it has largely come from North America and Western Europe. To further the literature, we assessed symptoms using the Positive and Negative Syndrome Scale and Metacognition using the Metacognitive Assessment Scale - Abbreviated in a sample of outpatients with prolonged schizophrenia (n = 41), early episode psychosis (n = 37) and major depression (n = 30) gathered in Moscow, Russia. Verbal memory was assessed for use as a potential covariate. ANOVA revealed the two groups with psychosis had significantly poorer metacognitive function in terms of self-reflectivity and awareness of the other, than the group with depression. In both psychosis groups negative symptoms were more robustly related to metacognition than other forms of symptoms after controlling for neurocognition. Results support the possibility that metacognitive deficits are a psychological factor which cross culturally contributes to negative symptoms and point to metacognition as a potentially important target for intervention.

Giving a Voice to Gambling Addiction: Analysis of Personal Narratives

Gambling addiction (GA) is now considered a worldwide health issue. Although the topic of disorder awareness is a central issue in clinical practice, there are few studies examining this dimension in relation to GA. To bridge this gap, we conducted a qualitative study, administering interviews focused on awareness of GA and eliciting narratives of both the disorder and the whole life of participants. We adopted both qualitative and quantitative methods of research, using computer-aided content analysis. We administered to a sample of 15 treatment-seeking gamblers the Psychiatric Interview for Gambling Addiction and performed a qualitative analysis of the text using the T-Lab software. Five main thematic domains and four factors emerged, shedding light on specific aspects underlying the development of and recovery from GA. Specifically, the results suggested that dissociation processes, materialistic thinking and difficulties in social achievement underlie the subjective experience of GA. Moreover, closeness in interpersonal relationships and awareness of the disorder emerged as core features in the process of change. As a whole, the results highlight the specificities of disorder awareness in addicted gamblers. We discuss these results within the context of previous research and suggest clinical implications for the treatment of GA.

Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis

Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT's capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed.

Metacognitive functioning in bipolar disorder versus controls and its correlations with neurocognitive functioning in a cross-sectional design

INTRODUCTION

Metacognition is an important factor in the development and persistence of bipolar disorder. One of the most striking examples of impairment in metacognitive functioning in bipolar disorder is the lack of insight these patients have in their disorder. Despite its importance, research regarding metacognition in bipolar disorder is scarce. Furthermore, the neurocognitive basis of metacognitive functioning is unknown.

METHODS

The current study included 29 patients with bipolar disorder and 29 age, educational level and gender matched healthy controls. All the participants filled in a metacognition questionnaire that examined their metacognitive beliefs. In addition, it was tested how well they estimated their performance on a neurocognitive test-battery beforehand (metacognitive knowledge) and afterwards (metacognitive experience).

RESULTS

Bipolar disorder patients showed maladaptive metacognitive beliefs in comparison with the healthy controls. They also showed impaired metacognitive knowledge and experience. That is, they overestimated their own cognitive performance. However, the latter result was also true for the healthy controls. In addition, metacognition had neurocognitive correlates. However, for the bipolar patients, depressive symptomatology had an important effect on this relationship and on metacognition in general.

CONCLUSION

Maladaptive metacognitive skills are related to depression in bipolar disorder. A more healthy metacognitive thinking should be promoted. An effective training for this could be a therapy that includes various elements, from basic cognitive- to higher order metacognitive training.

Testing the expanded continuum hypothesis of schizophrenia and bipolar disorder. Neural and psychological evidence for shared and distinct mechanisms

Despite the traditional view of Schizophrenia (SZ) and Bipolar disorder (BD) as separate diagnostic categories, the validity of such a categorical approach is challenging. In recent years, the hypothesis of a continuum between Schizophrenia (SZ) and Bipolar disorder (BD), postulating a common pathophysiologic mechanism, has been proposed. Although appealing, this unifying hypothesis may be too simplistic when looking at cognitive and affective differences these patients display. In this paper, we aim to test an expanded version of the continuum hypothesis according to which the continuum extends over three clusters: the psychotic, the cognitive, and the affective. We applied an innovative approach known as Source-based Morphometry (SBM) to the structural images of 46 individuals diagnosed with SZ, 46 with BD and 66 healthy controls (HC). We also analyzed the psychological profiles of the three groups using cognitive, affective, and clinical tests. At a neural level, we found evidence for a shared psychotic core in a distributed network involving portions of the medial parietal and temporo-occipital areas, as well as parts of the cerebellum and the middle frontal gyrus. We also found evidence of a cognitive core more compromised in SZ, including alterations in a fronto-parietal circuit, and mild evidence of an affective core more compromised in BD, including portions of the temporal and occipital lobes, cerebellum, and frontal gyrus. Such differences were confirmed by the psychological profiles, with SZ patients more impaired in cognitive tests, while BD in affective ones. On the bases of these results we put forward an expanded view of the continuum hypothesis, according to which a common psychotic core exists between SZ and BD patients complemented by two separate cognitive and affective cores that are both impaired in the two patients' groups, although to different degrees.

Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments

Bleuler suggested that fragmentation of thought, emotion and volition were the unifying feature of the disorders he termed schizophrenia. In this paper we review research seeking to measure some of the aspects of fragmentation related to the experience of the self and others described by Bleuler. We focus on work which uses the concept of metacognition to characterize and quantify alterations or decrements in the processes by which fragments or pieces of information are integrated into a coherent sense of self and others. We describe the rationale and support for one method for quantifying metacognition and its potential to study the fragmentation of a person's sense of themselves, others and the relative place of themselves and others in the larger human community. We summarize research using that method which suggests that deficits in metacognition commonly occur in schizophrenia and are related to basic neurobiological indices of brain functioning. We also present findings indicating that the capacity for metacognition in schizophrenia is positively related to a broad range of aspects of psychological and social functioning when measured concurrently and prospectively. Finally, we discuss the evolution and study of one therapy that targets metacognitive capacity, Metacognitive Reflection and Insight Therapy (MERIT) and its potential to treat fragmentation and promote recovery.

Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis

The integrated model of insight in schizophrenia suggests that poor insight is the result of multiple factors which compromise persons' abilities to integrate streams of information into a personal awareness of psychiatric challenges, and make adaptive responses. This model hypothesizes that metacognitive deficits, or difficulties forming a complex and integrated understanding of the self and others, influence insight, regardless of other proximal causes including clinical profile. To explore this possibility, we performed a latent class analysis on 324 adults with schizophrenia or schizoaffective disorder. This analysis produced 4 groups on the basis of assessment of insight and Positive and Negative Syndrome Scale (PANSS) positive, negative, cognitive, and hostility symptoms. The resultant groups were characterized as: Good Insight/Low Symptoms (n = 71), Impaired Insight/High Negative Symptoms, (n = 43), Impaired Insight/High Positive Symptoms (n = 50) and Impaired Insight/Diffuse Symptoms (n = 160). When we compared metacognitive function as assessed with the Metacognition Assessment Scale - Abbreviated (MAS-A) across groups, we found that the good insight group had better overall metacognition as well as higher levels of self-reflectivity, awareness of the other and mastery as compared to all 3 groups with impaired insight. When controlling for total symptoms, all differences in metacognitive function between the good insight and the impaired insight groups remained significant. These results are consistent with the view that, independent of symptoms, impaired metacognition contributes to difficulties integrating information and hence impedes insight, or awareness of psychiatric challenges. Consistent with extant literature, results suggest that interventions focusing on metacognition as the target may lead to improved insight.

Evaluation of paliperidone on social function in patients with chronic schizophrenia

BACKGROUND

The impairment of social function is widespread in the patients with chronic schizophrenia, which seriously affects family, life and work conditions.

AIMS

The main purpose of this study was to investigate the efficacy of paliperidone in the treatment of social function in chronic schizophrenia.

METHODS

A total of 81 patients who met the standard criteria for schizophrenia and long-term hospitalised inpatients were randomly divided into the treatment group and normal control group following a 1- year prospective follow-up study. The reatment group (41 cases) used paliperidone extended-release tablets for reducing dosage, as appropriate, based on the original treatment strategy; and the control group (40 cases) used the former drugs. All patients were assessed using the Positive and Negative Symptom Scales (PANSS), and the Treatment Emergent Symptom Scale (TESS) was used to assess adverse drug reactions. The Hospitalised Psychiatric Patients' Social Functions Rating Scale (SSPI) was used to assess social function of participants before and after 8  weeks, 6  months and 1 year of treatment.

RESULTS

At baseline there were no significant differences between the two groups in age, duration of illness, educational background and dosage of antipsychotic drugs (converted into chlorpromazine equivalency). There was statistically significant difference in PANSS positive symptoms by interaction effect (F_group×time=18.24, df=3237, p<0.001) and time effect (F_time=21.66, df=3, p<0.01) and the difference in PANSS positive symptoms by grouping effect (F_group=0.68, df=1, p=0.41) was not statistically significant. The difference of grouping effect of PANSS negative symptoms (F_group=9.93, df=1, p=0.002), time effect (F_time=279.15, df=3, p<0.001) and interaction effect (F_{group × time}=279.15, df=3237, p<0.001) were statistically significant. There were statistically significant differences in the grouping effect (F_{gr oup}=6.59, df=1, p=0.012), time effect (F_time=152.97, df=3, p<0.001) and interaction effect (F_{group × time}=148.82, df=3237, p<0.001) of PANSS general pathological symptoms, the same as the total score of the PANSS, which showed large differences in grouping effect (F_{g roup}=7.04, df=1, p=0.001), time effect (F_time=210.78, df=3, p<0.001) and interaction effect (F_{group × time}=205.20, df=3237, p<0.01). We found in the total SSPI score, grouping effect (F_group=31.70, df=1, p<0.001), time effect (F_time=161.84, df=3, p<0.001) and interaction effect (F_{group × time}=132.74, df=3237, p<0.001) were demonstrated to be significantly different. Even though adverse reactions occurred 7 times in the treatment group and 44 times in the control group based on the Treatment Emergent Symptom Scale (TESS), incidence rate was significantly lower than that of the control group (χ²=18.854, p<0.001).

CONCLUSION

Paliperidone can safely and effectively improve negative symptoms and social function in patients with chronic schizophrenia.

The centrality of cognitive symptoms and metacognition within the interacting network of symptoms, neurocognition, social cognition and metacognition in schizophrenia

Schizophrenia involves a range of interrelated impairments in functioning due to symptoms and deficits in varying domains of cognition including neurocognition, social cognition and metacognition. Yet little is known whether certain symptoms or cognitive impairments play a more central role than others. To explore, we conducted a network analysis of five types of symptoms, six domains of neurocognition and multiple aspects of both social cognition and metacognition. Participants were 81 adults with a schizophrenia spectrum disorder in a non-acute phase of the disorder. Results of the network analysis suggest that the cognitive symptoms node is most central in the network, metacognition abilities have high strength centrality measures followed by visual learning and emotion identification. In addition, distinction between the four groups of variables was supported. This suggests the need for both cognitive remediation and metacognitively oriented therapies in order to promote recovery from schizophrenia.

Metacognition in schizophrenia disorders: Comparisons with community controls and bipolar disorder: Replication with a Spanish language Chilean sample

Metacognition refers to the activities which allow for the availability of a sense of oneself and others in the moment. Research mostly in North America with English-speaking samples has suggested that metacognitive deficits are present in schizophrenia and are closely tied to negative symptoms. Thus, replication is needed in other cultures and groups. The present study accordingly sought to replicate these findings in a Spanish speaking sample from Chile. Metacognition and symptoms were assessed among 26 patients with schizophrenia, 26 with bipolar disorder and 36 community members without serious mental illness. ANCOVA controlling for age and education revealed that the schizophrenia group had greater levels of metacognitive deficits than the bipolar disorder and community control groups. Differences in metacognition between the clinical groups persisted after controlling for symptom levels. Spearman correlations revealed a unique pattern of associations of metacognition with negative and cognitive symptoms. Results largely support previous findings and provide added evidence of the metacognitive deficits present in schizophrenia and the link to outcome cross culturally. Implications for developing metacognitively oriented interventions are discussed.

A Disorder by Any Other Name: Metacognition, Schizophrenia, and Diagnostic Practice

Humanistic psychology has made us aware that any understanding of schizophrenia must see persons diagnosed with this condition as whole persons who are making sense of what wellness and recovery mean to them. This has raised questions about what the diagnosis of schizophrenia means and whether the diagnostic label of schizophrenia is helpful when we try to conceptualize the actions and aims of treatment. To examine this issue we propose it is essential to consider what is systematically occuring psychologicaly in recovery when persons experience, interpret and agentically respond to emerging challenges. We then review how the integrated model of metacognition provides a systematic, person-centered, evidence-based approach to understanding psychological processes which impact recovery, and discuss how this guides a form of psychotherapy, metacognitive reflection and insight therapy, which promotes metacognitive abilities and support recovery. We suggest this work indicates that metacognitive capacity is something that can be diagnosed without stigmatizing persons. It can be used to meaningfully inform clinical practice across various theoretical models and offers concrete implications for rehabilitation.

Promoting recovery from severe mental illness: Implications from research on metacognition and metacognitive reflection and insight therapy

Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals’ abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient’s purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.

Hypnotic susceptibility and affective states in bipolar I and II disorders

BACKGROUND

Highly hypnotizable individuals have impaired executive function, elevated motor impulsivity and increased emotional sensitivity, which are sometimes found in bipolar disorder patients. It is then reasonable to assume that certain aspects of hypnotic susceptibility differ with the types of bipolar disorder.

METHODS

The Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) test, the Mood Disorder Questionnaire (MDQ), the Hypomanic Checklist-32 (HCL-32) and the Plutchick-van Praag Depression Inventory (PVP) were applied to 62 patients with bipolar I disorder, 33 bipolar II disorder, and 120 healthy volunteers.

RESULTS

The passing rate of the SHSS:C 'Moving hands apart' item was higher in bipolar I patients than in controls, whereas for 'Mosquito hallucination' the rate was lower. Bipolar I and II patients scored significantly higher on MDQ, HCL-32 and PVP scales than controls. The passing rates of 'Mosquito hallucination' in controls, 'Arm rigidity' in bipolar I, and 'Age regression' in bipolar II predicted the respective MDQ scores.

CONCLUSION

In contrast to cognitive suggestions, bipolar I patients followed motor suggestions more often under hypnosis. Furthermore, both bipolar disorder patients and healthy volunteers demonstrated associations between mania levels and certain hypnotic susceptibility features. Our study aids in better understanding the altered conscious states in bipolar disorders, and encourages the use of related psychotherapy for these patients.