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Leonhardt BL, Visco AC, Hamm JA, Vohs JL. A Recovery-Oriented Approach: Application of Metacognitive Reflection and Insight Therapy (MERIT) for Youth with Clinical High Risk (CHR) for Psychosis. Behav Sci (Basel) 2024; 14:325. [PMID: 38667121 PMCID: PMC11047690 DOI: 10.3390/bs14040325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
Clinical High Risk for psychosis (CHR) refers to a phase of heightened risk for developing overt psychosis. CHR often emerges during adolescence or early adulthood. CHR has been identified as a group to target for intervention, with the hope that early intervention can both stave off prolonged suffering and intervene before mental health challenges become part of an individual's identity. However, there are few treatment modalities that can address some of the specific needs of CHR. Metacognitive Reflection and Insight Therapy (MERIT) is an integrative psychotherapy that can be applied to the CHR population. MERIT offers unique advantages to working with the CHR population as it aims to improve self-direction and recovery through stimulation of metacognitive capacity, a phenomenon that has been associated with recovery. This paper explores unique aspects of the CHR population and how MERIT can address barriers to recovery for individuals experiencing psychosis-like symptoms. Several case examples and a clinical vignette using MERIT to support patients with CHR are offered to exemplify this approach. MERIT offers a way to assist persons with CHR to address barriers to their personal recovery and to develop nuanced understandings of ways to master challenges.
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Affiliation(s)
- Bethany L. Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
| | - Andrew C. Visco
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
| | - Jay A. Hamm
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
- College of Pharmacy Practice, Purdue University, West Lafayette, IN 47907, USA
| | - Jenifer L. Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
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2
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Motut A, Isaac C, Castillo MC, Januel D. Link between metacognition and social cognition in schizophrenia: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1285993. [PMID: 38188042 PMCID: PMC10766774 DOI: 10.3389/fpsyt.2023.1285993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
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.
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Affiliation(s)
- Alex Motut
- Centre de Recherche Clinique 93G03, Etablissement Public de Santé de Ville-Evrard, Neuilly-sur-Marne, France
- Laboratoire Psychopathologie et Processus de Changement, Université Paris 8, Saint-Denis, France
| | - Clémence Isaac
- Centre de Recherche Clinique 93G03, Etablissement Public de Santé de Ville-Evrard, Neuilly-sur-Marne, France
- Laboratoire Psychopathologie et Processus de Changement, Université Paris 8, Saint-Denis, France
| | - Marie-Carmen Castillo
- Laboratoire Psychopathologie et Processus de Changement, Université Paris 8, Saint-Denis, France
| | - Dominique Januel
- Centre de Recherche Clinique 93G03, Etablissement Public de Santé de Ville-Evrard, Neuilly-sur-Marne, France
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McGuire N, Gumley A, Hasson-Ohayon I, Allan S, Aunjitsakul W, Aydin O, Bo S, Bonfils KA, Bröcker AL, de Jong S, Dimaggio G, Inchausti F, Jansen JE, Lecomte T, Luther L, MacBeth A, Montag C, Pedersen MB, Pijnenborg GHM, Popolo R, Schwannauer M, Trauelsen AM, van Donkersgoed R, Wu W, Wang K, Lysaker PH, McLeod H. Investigating the relationship between specific negative symptoms and metacognitive functioning in psychosis: A systematic review. Psychol Psychother 2023. [PMID: 37864383 DOI: 10.1111/papt.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Orkun Aydin
- International University of Sarajevo, Sarajevo, Bosnia and Herzegovinia
| | - Sune Bo
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Steven de Jong
- Lentis Psychiatric Institute, Groningen, The Netherlands
| | | | - Felix Inchausti
- Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | - Jens Einar Jansen
- Mental Health Center Copenhagen, Capital Region, Copenhagen, Denmark
| | | | | | | | | | - Marlene Buch Pedersen
- Early Psychosis Intervention Centre, Psychiatry East, Region Zealand, Roskilde, Denmark
| | | | | | | | | | | | - Weiming Wu
- Anhui Medical University, Hefei City, China
| | - Kai Wang
- Anhui Medical University, Hefei City, China
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Wright AC, Lysaker PH, Fowler D, Greenwood K. Clinical insight in first episode psychosis: the role of metacognition. J Ment Health 2023; 32:78-86. [PMID: 33999747 DOI: 10.1080/09638237.2021.1922629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Poor clinical insight has been commonly reported in those with First Episode Psychosis (FEP) and thought to be influenced by a range of factors, including neurocognition and symptoms. Clinical insight may be compromised as a result of alterations in higher-level reflective processes, such as metacognitive ability and cognitive insight. AIMS To explore whether metacognitive ability and cognitive insight are associated with clinical insight while controlling for IQ, depression, and symptoms in FEP. METHODS 60 individuals with FEP completed measures for clinical insight, metacognitive ability, cognitive insight, positive and negative symptoms, depression, and IQ. RESULTS Higher levels of metacognitive ability were associated with better clinical insight, even when controlling for IQ, depression, positive and negative symptoms, and medication. Integration subscale of metacognitive ability was most strongly associated with clinical insight. Cognitive insight was associated with clinical insight when controlling for covariates. However, when including metacognitive ability and cognitive insight in the predictive model, only metacognitive ability was significantly related to clinical insight. DISCUSSION Metacognitive ability, specifically the ability to describe one's evolving mental state to provide a coherent narrative, was significantly related to clinical insight, independent of covariates, and may be a potentially important target for intervention in FEP.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Paul H Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA.,School of Medicine, Indiana University, Indianapolis, IN, USA
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK.,Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, UK.,Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
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5
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Prasannakumar A, Korann V, Jacob A, Bharath RD, Kumar V, Varambally S, Venkatasubramanian G, Rao NP. Relation between frontal pole volumes and cognitive insight in Schizophrenia. Asian J Psychiatr 2022; 76:103204. [PMID: 35907267 DOI: 10.1016/j.ajp.2022.103204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cognitive insight comprising self-reflection and self-certainty is an important determinant of functional outcomes in Schizophrenia. The neural correlates of cognitive insight in Schizophrenia are underexamined. The frontal pole (FP) is implicated in metacognitive function in healthy individuals, but its role is not well examined in Schizophrenia. We had earlier reported the relationship between Frontal pole volumes and cognitive insight in a small sample of only male patients. Hence, we studied this relationship in an independent sample of schizophrenia patients and healthy controls. METHODS We examined 41 healthy volunteers (HV) and 57 patients with Schizophrenia (SCZ). We used a previously validated manual morphometric method to perform FP parcellation on images obtained from a 3 T scanner and calculated the volumes. Cognitive insight was measured using Beck's Cognitive insight scale (BCIS). To assess the relationship between FP volumes and BCIS scores, multiple linear regression analyses were performed. RESULTS In the overall sample, age, years of education, and intracranial volume were significant predictors of BCIS scores. Within the SCZ group, age and left FP volume were significant predictors of BCIS composite scores and age, ICV for BCIS-self certainty. There was no significant relationship between age and FP volumes in either SCZ or HV group. DISCUSSION The current study in an independent sample further supports the critical role of the frontal pole in cognitive insight, earlier reported by us. As cognitive insight has a vital role in functional outcome, our findings have potential clinical implications.
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Affiliation(s)
- Akash Prasannakumar
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vittal Korann
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Arpitha Jacob
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rose Dawn Bharath
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vijay Kumar
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shivarama Varambally
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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Recovery-Focused Metacognitive Interpersonal Therapy (MIT) for Adolescents with First-Episode Psychosis. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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7
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Gan J, Fu H, Zhu X. Relationships Between Multiple Dimensions of Insight and Neurocognition, Metacognition, and Social Cognition: A Meta-Analysis. J Nerv Ment Dis 2022; 210:577-584. [PMID: 35900777 DOI: 10.1097/nmd.0000000000001495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Insight is a complex and multidimensional concept, and has a complex relationship with cognition. A meta-analysis of 102 studies of 9396 patients was conducted to determine the magnitude of the relationship between insight and neurocognition, higher-order cognition in multiple mental disorders. Insight has been found moderately related to higher-order cognition, but only weakly related to neurocognition. The different relationship has been found between the dimensions of insight and higher-order cognition. Almost none of the correlational coefficients of insight and cognitive domains were found to differ significantly among the different diagnostic groups. In conclusion, insight may be essentially related to higher-order cognition, but not to neurocognition. The orientation and expression of different dimensions of insight might be different, and the relationship of insight and cognition might not be explained by specific diagnosis.
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Affiliation(s)
- Jun Gan
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu
| | - Hong Fu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu
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8
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Lysaker PH, Chernov N, Moiseeva T, Sozinova M, Dmitryeva N, Alyoshin V, Luther L, Karpenko O, Kostyuk G. Clinical insight, cognitive insight and metacognition in psychosis: Evidence of mediation. J Psychiatr Res 2021; 140:1-6. [PMID: 34087750 DOI: 10.1016/j.jpsychires.2021.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/18/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Schizophrenia is increasingly understood as an interactive network of disturbances in different elements of self-awareness. In this study we have examined the relationship between disturbances in two forms of awareness: cognitive insight and clinical insight by exploring whether their relationship is mediated by a third form of larger awareness: metacognition. METHODS Participants were 41 outpatients with schizophrenia and 37 outpatients with early episode psychosis gathered in Moscow, Russia. Metacognition was assessed with the Metacognition Assessment Scale - Abbreviated. Verbal memory and positive symptoms were assessed for use as additional mediators. RESULTS Mediation analyses revealed that after accounting for the effects of positive symptoms and verbal memory, the relationship between the self-reflection domain of cognitive insight and clinical insight was significantly mediated by overall metacognitive capacity. Further, positive symptoms were a significant mediator between the cognitive insight self-reflection domain and clinical insight. Neither metacognition nor positive symptoms or verbal memory were found to mediate the relationship of the cognitive insight domain of self-certainty with clinical insight. CONCLUSIONS Decrements in some forms of ability to reflect upon one's thinking may reduce the ability to form complex and integrated ideas of oneself and others, leading to less coherent and complete accounts of the experience of schizophrenia.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, 116A, 1481 W. 10th Street, Indianapolis, IN, 46202, United States.
| | - Nikita Chernov
- Psychotherapy and Social Rehabilitation Department, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia; Mental-Health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Tatyana Moiseeva
- Medical Psychologist Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Marta Sozinova
- Medical Psychologist Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Nadezhda Dmitryeva
- Medical Psychologist Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia
| | - Vitaliy Alyoshin
- Medical Psychologist Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Lauren Luther
- Psychologist Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street Boston, MA, 02115, USA.
| | - Olga Karpenko
- Deputy Director of Education Center Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Georgiy Kostyuk
- Mental-Health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
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9
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Rocca P, Brasso C, Montemagni C, Bellino S, Rossi A, Bertolino A, Gibertoni D, Aguglia E, Amore M, Andriola I, Bellomo A, Bucci P, Buzzanca A, Carpiniello B, Cuomo A, Dell'Osso L, Favaro A, Giordano GM, Marchesi C, Monteleone P, Oldani L, Pompili M, Roncone R, Rossi R, Siracusano A, Vita A, Zeppegno P, Galderisi S, Maj M. Accuracy of self-assessment of real-life functioning in schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:11. [PMID: 33589645 PMCID: PMC7884703 DOI: 10.1038/s41537-021-00140-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Abstract
A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-reporting their real-life functioning. In a large (n = 618) cohort of stable, community-dwelling schizophrenia patients we sought to: (1) examine the concordance of patients' reports of their real-life functioning with the reports of their key caregiver; (2) identify which patient characteristics are associated to the differences between patients and informants. Patient-caregiver concordance of the ratings in three Specific Level of Functioning Scale (SLOF) domains (interpersonal relationships, everyday life skills, work skills) was evaluated with matched-pair t tests, the Lin's concordance correlation, Somers' D, and Bland-Altman plots with limits of agreement (LOA). Predictors of the patient-caregiver differences in SLOF ratings were assessed with a linear regression with multivariable fractional polynomials. Patients' self-evaluation of functioning was higher than caregivers' in all the evaluated domains of the SLOF and 17.6% of the patients exceeded the LOA, thus providing a self-evaluation discordant from their key caregivers. The strongest predictors of patient-caregiver discrepancies were caregivers' ratings in each SLOF domain. In clinically stable outpatients with a moderate degree of functional impairment, self-evaluation with the SLOF scale can become a useful, informative and reliable clinical tool to design a tailored rehabilitation program.
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Affiliation(s)
- Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy.
| | - Claudio Brasso
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Cristiana Montemagni
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Silvio Bellino
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Ileana Andriola
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Antonello Bellomo
- Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonino Buzzanca
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Liliana Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angela Favaro
- Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy
| | | | - Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Lucio Oldani
- Department of Psychiatry, University of Milan, Milan, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Psychiatry and Clinical Psychology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy
- Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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10
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Birulés I, López-Carrilero R, Cuadras D, Pousa E, Barrigón ML, Barajas A, Lorente-Rovira E, González-Higueras F, Grasa E, Ruiz-Delgado I, Cid J, de Apraiz A, Montserrat R, Pélaez T, Moritz S, Ochoa S. Cognitive Insight in First-Episode Psychosis: Changes during Metacognitive Training. J Pers Med 2020; 10:jpm10040253. [PMID: 33260823 PMCID: PMC7711871 DOI: 10.3390/jpm10040253] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/28/2023] Open
Abstract
Background: Metacognitive training (MCT) has demonstrated its efficacy in psychosis. However, the effect of each MCT session has not been studied. The aim of the study was to assess changes in cognitive insight after MCT: (a) between baseline, post-treatment, and follow-up; (b) after each session of the MCT controlled for intellectual quotient (IQ) and educational level. Method: A total of 65 patients with first-episode psychosis were included in the MCT group from nine centers of Spain. Patients were assessed at baseline, post-treatment, and 6 months follow-up, as well as after each session of MCT with the Beck Cognitive Insight Scale (BCIS). The BCIS contains two subscales: self-reflectiveness and self-certainty, and the Composite Index. Statistical analysis was performed using linear mixed models with repeated measures at different time points. Results: Self-certainty decreased significantly (p = 0.03) over time and the effect of IQ was negative and significant (p = 0.02). From session 4 to session 8, all sessions improved cognitive insight by significantly reducing self-certainty and the Composite Index. Conclusions: MCT intervention appears to have beneficial effects on cognitive insight by reducing self-certainty, especially after four sessions. Moreover, a minimum IQ is required to ensure benefits from MCT group intervention.
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Affiliation(s)
- Irene Birulés
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.); (R.L.-C.); (D.C.); (A.d.A.); (R.M.); (T.P.)
- Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, 08035 Barcelona, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.); (R.L.-C.); (D.C.); (A.d.A.); (R.M.); (T.P.)
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; (E.L.-R.); (E.G.)
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Santa Rosa, 39-57, 3a planta 08950 Esplugues de Llobregat, Barcelona, Spain
- Institut de Recerca en Salut Mental Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - Daniel Cuadras
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.); (R.L.-C.); (D.C.); (A.d.A.); (R.M.); (T.P.)
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Santa Rosa, 39-57, 3a planta 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Esther Pousa
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Consorci Corporació Sanitària Parc Taulí de Sabadell, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain
| | - Maria Luisa Barrigón
- Psychiatry Service, Area de Gestión Sanitaria Sur Granada, Motril, 18600 Granada, Spain;
- Department of Psychiatry, IIS-Fundación Jiménez Díaz Hospital, 28040 Madrid, Spain
| | - Ana Barajas
- Centre d’Higiene Mental Les Corts, 08029 Barcelona, Spain; or
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Ester Lorente-Rovira
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; (E.L.-R.); (E.G.)
- Psychiatry Service, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | | | - Eva Grasa
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; (E.L.-R.); (E.G.)
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Institut d’Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Isabel Ruiz-Delgado
- Unidad de Salud Mental Comunitaria Málaga Norte, UGC Salud Mental Carlos Haya, Servicio Andaluz de Salud Psychiatry Service, Antequera, 29200 Málaga, Spain;
| | - Jordi Cid
- Mental Health & Addiction Research Group, IdiBGi, Institut d’Assistència Sanitària, 17190 Girona, Spain;
| | - Ana de Apraiz
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.); (R.L.-C.); (D.C.); (A.d.A.); (R.M.); (T.P.)
| | - Roger Montserrat
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.); (R.L.-C.); (D.C.); (A.d.A.); (R.M.); (T.P.)
- Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, 08035 Barcelona, Spain
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.); (R.L.-C.); (D.C.); (A.d.A.); (R.M.); (T.P.)
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; (E.L.-R.); (E.G.)
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, 20251 Hamburg, Germany;
| | | | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.); (R.L.-C.); (D.C.); (A.d.A.); (R.M.); (T.P.)
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; (E.L.-R.); (E.G.)
- Institut de Recerca en Salut Mental Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain
- Correspondence: ; Tel.: +34-936-406-350 (ext. 12538)
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11
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Exploring the relationship of insight with psychopathology and gender in individuals with schizophrenia spectrum disorders with structural equation modelling. Arch Womens Ment Health 2020; 23:643-655. [PMID: 32385644 DOI: 10.1007/s00737-020-01031-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 04/07/2020] [Indexed: 12/18/2022]
Abstract
To model the influence of psychopathology on insight deficits in schizophrenia spectrum patients with a gender-stratified analysis. Five hundred sixteen patients (65.1% men) with schizophrenia spectrum disorders were evaluated in four centres of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using different PANSS factors. Insight and its three main dimensions were assessed by means of the Scale of Unawareness of Mental Disorder: awareness of the disease (SUMD-1), of the effect of medication (SUMD-2) and of the social consequences of the disease (SUMD-3). Structural equation models (SEMs) were used to fix the model in the total sample and by gender. Additional analyses included age, duration of illness (DOI) and education status (ES). There were no significant differences between men and women in the three main dimensions of insight. The SEMs in the total sample showed a modest fitting capacity. Fitting improved after a gender-stratified analysis (particularly in women). In men, positive and excited symptoms were associated with poorer insight in all SUMD dimensions, whereas depressive symptoms were associated with better insight. ES in men was also associated with better SUMD-2 or SUMD-3. In contrast, in women, symptoms did not have a negative effect on SUMD-1 or SUMD-2. However, positive symptoms were associated with a poorer SUMD-3, whereas depressive symptoms were associated with better SUMD-3. Moreover, education level was also associated with a better SUMD-3. A gender approach improved the comprehension of the model, supporting the relevance of gender analysis in the study of insight.
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Abstract
Lack of clinical insight in patients with schizophrenia is an obstacle to optimal treatment. Social cognition is one of several variables central to insight deficits in schizophrenia. The aim of this study was to investigate clinical insight in relation to one domain of social cognition, social perception, while controlling for effects of nonsocial cognition and symptom severity. Clinical insight was measured in 55 patients with schizophrenia or schizoaffective disorder, using the Birchwood Insight Scale. Relationships across domains were used to assess social perception. Social perception predicted one of three subscales of clinical insight, "awareness of illness," and was the only unique contributor to this subscale. This indicates that social perception is linked to clinical insight through awareness of illness. More research is needed to fully understand the relationship between social and nonsocial cognition and symptoms in relation to clinical insight.
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13
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Leonhardt BL, Vohs JL, Bartolomeo LA, Visco A, Hetrick WP, Bolbecker AR, Breier A, Lysaker PH, O'Donnell BF. Relationship of Metacognition and Insight to Neural Synchronization and Cognitive Function in Early Phase Psychosis. Clin EEG Neurosci 2020; 51:259-266. [PMID: 31241355 DOI: 10.1177/1550059419857971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Metacognition is the process of thinking about one's own mental states. It involves a range of faculties that allow an individual to integrate information and form understanding of self and others, and use this understanding to respond to life challenges. Clinical insight is the awareness of one's mental illness, its consequences, and the need for treatment. Persons with psychotic disorders show impaired metacognition and insight, but the neurobiological bases for these impairments are not well characterized. We hypothesized that metacognition and insight may depend on capacity of neural circuits to synchronize at gamma frequencies, as well as the integrity of underlying cognitive processes. In order to test these hypotheses, 17 adults with early phase psychosis were evaluated. Metacognition was assessed with the Metacognition Assessment Scale-Abbreviated, and insight was assessed with the Scale of Unawareness of Illness-Abbreviated. The auditory steady state response (ASSR) to gamma range stimulation (40 Hz) was used as an index of neural synchronization. Cognitive function was assessed using the Brief Assessment of Cognition in Schizophrenia. Increases in ASSR power were associated with poorer metacognition and insight. Higher cognitive performance was associated with higher levels of metacognitive function and insight. These findings suggest that altered neural synchronization and constituent cognitive processes affect both metacognition and insight in early phase psychosis and may offer targets for both pharmacological and psychotherapeutic interventions.
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Affiliation(s)
- Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
| | - Lisa A Bartolomeo
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
| | - Andrew Visco
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William P Hetrick
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
| | - Amanda R Bolbecker
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paul H Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.,Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Brian F O'Donnell
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
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14
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Arnon-Ribenfeld N, Hasson-Ohayon I, Lavidor M, Atzil-Slonim D, Lysaker P. The association between metacognitive abilities and outcome measures among people with schizophrenia: A meta-analysis. Eur Psychiatry 2020; 46:33-41. [PMID: 28992534 DOI: 10.1016/j.eurpsy.2017.08.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 12/12/2022] Open
Abstract
AbstractBackground:Deficits in metacognition are one of the major causes of the difficulties experienced by individuals with schizophrenia. Studies have linked these deficits to symptom exacerbation and deterioration in psychosocial functioning. The aim of the present meta-analysis was to examine the extensive existing literature regarding metacognitive deficits among persons with schizophrenia; a further aim was to assess the extent to which metacognitive abilities are linked to outcome measures of symptoms and psychosocial functioning.Method:We conducted a systematic literature search of studies examining the relationship between metacognitive abilities and outcome measures among people with schizophrenia. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size.Results:Heterogeneity analyses (k = 32, Cohen's d = −.12, 95% CI.−1.92 to 1.7) produced a significant Q-statistic (Q = 456.89) and a high amount of heterogeneity, as indicated by the I2 statistic (93.04%), suggesting that moderator analyses were appropriate. As hypothesized, measure type moderated the metacognitive deficit with homogenous effect for psychosocial functioning measures (Q = 9.81, I2 = 19.47%, d = .94. 95% CI .58 to 1.2) and symptoms (Q = 19.87, I2 = 0%, d = −1.07, 95% CI −1.18 to −.75). Further analysis found homogenous effects for MAS-A subscales as well as PANSS factors of symptoms.Conclusion:Our meta-analysis results illustrated a significant association between metacognitive deficits and both symptomatic and psychosocial functioning measures. These links suggest that the associations between metacognitive abilities and symptomatic outcomes are different from those between metacognitive abilities and psychosocial functioning measures. Intriguing hypotheses are raised regarding the role that metacognitive abilities play in both symptoms and psychosocial functioning measures of people diagnosed with schizophrenia spectrum disorders.
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15
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Elowe J, Conus P. Much ado about everything: A literature review of insight in first episode psychosis and schizophrenia. Eur Psychiatry 2020; 39:73-79. [DOI: 10.1016/j.eurpsy.2016.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022] Open
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16
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Lysaker PH, Minor KS, Lysaker JT, Hasson-Ohayon I, Bonfils K, Hochheiser J, Vohs JL. Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100142. [PMID: 31828019 PMCID: PMC6889776 DOI: 10.1016/j.scog.2019.100142] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Paul H Lysaker
- Roudebush Veteran Affairs Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kyle S Minor
- Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA
| | | | | | - Kelsey Bonfils
- VA Pittsburgh Healthcare System, Mental Illness Research, Education, & Clinical Center (MIRECC), Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
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17
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Lysaker PH, Gagen E, Wright A, Vohs JL, Kukla M, Yanos PT, Hasson-Ohayon I. Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis. Schizophr Bull 2019; 45:48-56. [PMID: 30321433 PMCID: PMC6293218 DOI: 10.1093/schbul/sby142] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN,Department of Psychiatry Indiana University School of Medicine, Indianapolis, IN,To whom correspondence should be addressed; Department of Psychiatry, Richard L. Roudebush VA Medical Center, 116A, 1481 West 10th St. Indianapolis, IN 46202, US; tel: 317-988-2546, e-mail:
| | - Emily Gagen
- Department of Psychology and Neuroscience University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Abigail Wright
- Department of Psychology University of Sussex, Falmer, Sussex, UK
| | - Jenifer L Vohs
- Department of Psychiatry Indiana University School of Medicine, Indianapolis, IN
| | - Marina Kukla
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN
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18
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Inchausti F, García-Poveda NV, Ballesteros-Prados A, Ortuño-Sierra J, Sánchez-Reales S, Prado-Abril J, Aldaz-Armendáriz JA, Mole J, Dimaggio G, Ottavi P, Fonseca-Pedrero E. The Effects of Metacognition-Oriented Social Skills Training on Psychosocial Outcome in Schizophrenia-Spectrum Disorders: A Randomized Controlled Trial. Schizophr Bull 2018; 44:1235-1244. [PMID: 29267940 PMCID: PMC6192494 DOI: 10.1093/schbul/sbx168] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A pilot study of the effects of metacognition-oriented social skills training (MOSST) on social functioning in patients with schizophrenia spectrum disorders (SSDs) reported promising results. The main purpose of the current trial was to compare the effectiveness and potential benefits of MOSST vs conventional social skills training (SST). Single-blind randomized controlled trial with 2 groups of patients aged 18-65 with SSDs on partial hospitalization. Participants were randomly assigned (1:1) to receive 16 group sessions with MOSST or conventional SST, both in addition to standard care, over 4 months, with a 6-month follow-up. Psychosocial functioning, metacognition, and symptom outcomes were measured by blind assessors. Statistical analyses used mixed models to estimate treatment effects in each postrandomization time point. Thirty-six patients were randomly assigned to the MOSST group and 33 patients to the conventional SST group. Between-group differences were significant in favor of MOSST on Social and Occupational Functioning Assessment Scale (SOFAS) and Personal and Social Performance Scale (PSP) total scores at post-treatment and follow-up. Concerning PSP subscales, there were significant between-group differences in favor of MOSST at follow-up on socially useful activities, personal and social relationships, and disturbing and aggressive behaviors. Metacognition only improved following MOSST group. For people with SDDs, MOSST appears to have short- and long-term beneficial effects on social functioning and symptoms. Further studies are required to replicate the current results in other samples.
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Affiliation(s)
- Felix Inchausti
- Complejo Hospitalario of Navarra, CSM Ermitagaña, Pamplona, Spain,School of Medicine, University of Navarra, Pamplona, Spain,To whom correspondence should be addressed; Complejo Hospitalario of Navarra, CSM Ermitagaña, Pamplona, Spain; tel: 948-198-590, fax: 948-198-179, e-mail:
| | | | | | | | | | - Javier Prado-Abril
- Complejo Hospitalario of Navarra, CSMIJ Natividad Zubieta, Sarriguren, Spain,Research Network on Preventive Activities and Health Promotion (REDIAPP) (RD12/0005), Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | | | - Joe Mole
- Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK
| | | | - Paolo Ottavi
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
| | - Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain,P3 Prevention Program of Psychosis, Oviedo, Spain
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19
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Allott K, Fraguas D, Bartholomeusz CF, Díaz-Caneja CM, Wannan C, Parrish EM, Amminger GP, Pantelis C, Arango C, McGorry PD, Rapado-Castro M. Duration of untreated psychosis and neurocognitive functioning in first-episode psychosis: a systematic review and meta-analysis. Psychol Med 2018; 48:1592-1607. [PMID: 29173201 DOI: 10.1017/s0033291717003002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP). METHOD MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses. RESULTS The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES -0.213, 95% confidence interval (CI) (-0.344 to -0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES -0.031, 95% CI (-0.048 to -0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ. CONCLUSION There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking.
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Affiliation(s)
- K Allott
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - D Fraguas
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - C F Bartholomeusz
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - C M Díaz-Caneja
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - C Wannan
- Department of Psychiatry,Melbourne Neuropsychiatry Centre,The University of Melbourne and Melbourne Health,Parkville,Australia
| | - E M Parrish
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - G P Amminger
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - C Pantelis
- Department of Psychiatry,Melbourne Neuropsychiatry Centre,The University of Melbourne and Melbourne Health,Parkville,Australia
| | - C Arango
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - P D McGorry
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - M Rapado-Castro
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
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20
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Vohs JL, Leonhardt BL, James AV, Francis MM, Breier A, Mehdiyoun N, Visco AC, Lysaker PH. Metacognitive Reflection and Insight Therapy for Early Psychosis: A preliminary study of a novel integrative psychotherapy. Schizophr Res 2018; 195:428-433. [PMID: 29108671 DOI: 10.1016/j.schres.2017.10.041] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 10/26/2017] [Accepted: 10/28/2017] [Indexed: 12/23/2022]
Abstract
Poor insight impedes treatment in early phase psychosis (EPP). This manuscript outlines preliminary findings of an investigation of the novel metacognitively oriented integrative psychotherapy, Metacognitive Reflection and Insight Therapy, for individuals with early phase psychosis (MERIT-EP). Twenty adults with EPP and poor insight were randomized to either six months of MERIT-EP or treatment as usual (TAU). Therapists were trained and therapy was successfully delivered under routine, outpatient conditions. Insight, assessed before and after treatment, revealed significant improvement for the MERIT-EP, but not TAU, group. These results suggest MERIT-EP is feasible to deliver, accepted by patients, and leads to clinically significant improvements in insight.
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Affiliation(s)
- Jenifer L Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Alison V James
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Michael M Francis
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Alan Breier
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Nikki Mehdiyoun
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Andrew C Visco
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Paul H Lysaker
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Richard L Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN 46202, USA
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Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry 2018; 17:12-23. [PMID: 29352540 PMCID: PMC5775127 DOI: 10.1002/wps.20508] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle L Pattison
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Eskenazi Health-Midtown Community Mental Health, Indianapolis, IN, USA
| | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
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Béland S, Lepage M. The relative contributions of social cognition and self-reflectiveness to clinical insight in enduring schizophrenia. Psychiatry Res 2017; 258:116-123. [PMID: 28992548 DOI: 10.1016/j.psychres.2017.09.082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/06/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
Poor clinical insight represents a major barrier to recovery in schizophrenia. Research suggests that higher-order social cognitive abilities such as theory of mind (TOM) and metacognition contribute to levels of clinical insight. However, few studies have examined whether social cognitive abilities other than TOM are related to clinical insight. Moreover, to date, no investigation has attempted to determine whether the contribution of metacognitive ability to clinical insight can be differentiated from the contribution of higher-order social cognition, despite their conceptual similarity. Therefore, the purpose of this study was to examine the relative contribution of different social cognitive abilities, as well as metacognition, to clinical insight in a large sample of 139 enduring schizophrenia patients, and controlling for established predictors of clinical insight. Hierarchical regression analyses were used to evaluate the portion of variance explained by 3 social cognitive abilities: emotion recognition, TOM, and affective empathy, and the metacognitive ability of self-reflectiveness. Clinical insight levels were assessed using the Schedule for the Assessment of Insight-Expanded version. Results indicated that affective empathy and self-reflectiveness are the strongest predictors of clinical insight. These results provide insights on the development of targeted interventions for improving clinical insight in this population.
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Affiliation(s)
- Sophie Béland
- Integrated Program in Neuroscience, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Verdun, Canada
| | - Martin Lepage
- Integrated Program in Neuroscience, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Verdun, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
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23
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Cognitive insight: A systematic review. Clin Psychol Rev 2017; 55:12-24. [DOI: 10.1016/j.cpr.2017.04.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 03/12/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
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24
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Ochoa S, López-Carrilero R, Barrigón ML, Pousa E, Barajas A, Lorente-Rovira E, González-Higueras F, Grasa E, Ruiz-Delgado I, Cid J, Birulés I, Esteban-Pinos I, Casañas R, Luengo A, Torres-Hernández P, Corripio I, Montes-Gámez M, Beltran M, De Apraiz A, Domínguez-Sánchez L, Sánchez E, Llacer B, Pélaez T, Bogas JL, Moritz S. Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis. Psychol Med 2017; 47:1573-1584. [PMID: 28166848 DOI: 10.1017/s0033291716003421] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome. METHOD A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition. RESULTS Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001-0.032). CONCLUSIONS MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias.
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Affiliation(s)
- S Ochoa
- Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain
| | - R López-Carrilero
- Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain
| | - M L Barrigón
- Department of Psychiatry,IIS-Fundación Jiménez Díaz Hospital,Madrid,Spain
| | - E Pousa
- Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain
| | - A Barajas
- Centre d'Higiene Mental Les Corts,Barcelona,Spain
| | - E Lorente-Rovira
- Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain
| | | | - E Grasa
- Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain
| | - I Ruiz-Delgado
- Unidad de Salud Mental Comunitaria Malaga Norte, UGC Salud Mental Carlos Haya,Servicio Andaluz de Salud Málaga,Spain
| | - J Cid
- Mental Health & Addiction Research Group, IdiBGi. Institut d'Assistencia Sanitària,Girona,Spain
| | - I Birulés
- Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain
| | - I Esteban-Pinos
- Psychiatry Service, Area de Gestión Sanitaria Sur Granada,Motril,Granada,Spain
| | - R Casañas
- Centre d'Higiene Mental Les Corts,Barcelona,Spain
| | - A Luengo
- Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain
| | | | - I Corripio
- Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain
| | - M Montes-Gámez
- Unidad de Salud Mental Comunitaria Malaga Norte, UGC Salud Mental Carlos Haya,Servicio Andaluz de Salud Málaga,Spain
| | - M Beltran
- Mental Health & Addiction Research Group, IdiBGi. Institut d'Assistencia Sanitària,Girona,Spain
| | - A De Apraiz
- Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain
| | - L Domínguez-Sánchez
- Psychiatry Service, Area de Gestión Sanitaria Norte de Málaga,Antequera,Málaga,Spain
| | - E Sánchez
- Centre d'Higiene Mental Les Corts,Barcelona,Spain
| | - B Llacer
- Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain
| | - T Pélaez
- Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain
| | - J L Bogas
- Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain
| | - S Moritz
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg,Hamburg,Germany
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Inchausti F, García-Poveda NV, Ballesteros-Prados A, Fonseca-Pedrero E, Ortuño-Sierra J, Sánchez-Reales S, Prado-Abril J, Aldaz-Armendáriz JA, Mole J. A pilot study on feasibility, acceptance and effectiveness of metacognitive-oriented social skills training in schizophrenia. BMC Psychiatry 2017; 17:217. [PMID: 28606061 PMCID: PMC5468977 DOI: 10.1186/s12888-017-1378-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 06/05/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In preparation for a randomized controlled trial, a pilot study was conducted to investigate the feasibility, acceptability and effectiveness of a psychotherapy group based on metacognitive-oriented social skills training (MOSST). METHODS Twelve outpatients with schizophrenia were offered 16 group-sessions of MOSST. Effect sizes were calculated for changes from baseline to treatment end for both psychosocial functioning and metacognitive abilities measured by the Personal and Social Performance Scale (PSP) and the Metacognition Assessment Scale-Abbreviated (MAS-A) respectively. RESULTS AND DISCUSSION Ten patients finished the full treatment protocol and nonsignificant moderate effect sizes were obtained on PSP and MAS-A scores. To date, this is the first study in Spain to suggest that outpatients with schizophrenia will accept metacognitive therapy for social skills training and evidence improvements in psychosocial functioning and metacognition. CONCLUSION Despite limitations inherent in a pilot study, including a small sample size and the absence of a control group, sufficient evidence of effectiveness was found to warrant further investigation. TRIAL REGISTRATION ISRCTN10917911 . Retrospectively registered 30 November 2016.
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Affiliation(s)
- Felix Inchausti
- Complejo Hospitalario of Navarra, CSM Ermitagaña, and School of Medicine, University of Navarra, Pamplona, Spain.
| | | | | | - Eduardo Fonseca-Pedrero
- 0000 0001 2174 6969grid.119021.aDepartment of Educational Sciences, University of La Rioja, and P3 Prevention Program of Psychosis, Oviedo, Spain
| | - Javier Ortuño-Sierra
- 0000 0001 2174 6969grid.119021.aDepartment of Educational Sciences, University of La Rioja, Logroño, Spain
| | | | - Javier Prado-Abril
- 0000 0004 1795 1427grid.419040.8Complejo Hospitalario of Navarra, CSMIJ Natividad Zubieta, Sarriguren, and Research Network on Preventive Activities and Health Promotion (REDIAPP) (RD12/0005), Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | | | - Joe Mole
- 0000 0004 1936 8948grid.4991.5Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK
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Francis MM, Hummer TA, Leonhardt BL, Vohs JL, Yung MG, Mehdiyoun NF, Lysaker PH, Breier A. Association of medial prefrontal resting state functional connectivity and metacognitive capacity in early phase psychosis. Psychiatry Res Neuroimaging 2017; 262:8-14. [PMID: 28208070 DOI: 10.1016/j.pscychresns.2016.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023]
Abstract
Metacognition refers to a range of cognitive processes that allow one to form complex ideas of self and others and to use this information to navigate psychosocial challenges. Several studies in both early-phase and prolonged schizophrenia have demonstrated not only that significant deficits in metacognitive ability are present, but importantly that they are associated with significant functional impairment and decreased quality of life. In spite of the importance of metacognitive impairment in schizophrenia, relatively little is known about the biological substrates that may contribute to this dysfunction. In this study, we examined the relationship between resting state functional connectivity of the medial prefrontal cortex (mPFC), a structure shown in prior voxel-based morphometry studies to be associated with metacognition, with metacognitive function in an early-phase psychosis cohort (n=18). Analyses revealed a positive association of resting state functional connectivity between the mPFC and precuneus and posterior cingulate structures and metacognitive ability. These results provide evidence of disrupted resting state connectivity in structures relevant to metacognitive dysfunction in early-phase psychosis, which may have implications for pathophysiological models of complex cognitive deficits in this illness.
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Affiliation(s)
- Michael M Francis
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Tom A Hummer
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Matt G Yung
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA.
| | - Nicole F Mehdiyoun
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Paul H Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Roudebush VA Medical Hospital, 1481 W 10th St., Indianapolis, IN 46202, USA.
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
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Passerieux C, Bulot V, Hardy-Baylé MC, Roux P. Assessing cognitive-related disability in schizophrenia: Reliability, validity and underlying factors of the evaluation of cognitive processes involved in disability in schizophrenia scale. Disabil Rehabil 2017; 40:1953-1959. [DOI: 10.1080/09638288.2017.1312568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Christine Passerieux
- Service Universitaire de Psychiatrie d’adultes, Centre Hospitalier de Versailles, Le Chesnay, France
- EA4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
- Fondation FondaMental, Créteil, France
| | - Virginie Bulot
- Service Universitaire de Psychiatrie d’adultes, Centre Hospitalier de Versailles, Le Chesnay, France
- EA4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
- Fondation FondaMental, Créteil, France
| | - Marie-Christine Hardy-Baylé
- Service Universitaire de Psychiatrie d’adultes, Centre Hospitalier de Versailles, Le Chesnay, France
- EA4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
- Fondation FondaMental, Créteil, France
| | - Paul Roux
- Service Universitaire de Psychiatrie d’adultes, Centre Hospitalier de Versailles, Le Chesnay, France
- EA4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
- Fondation FondaMental, Créteil, France
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Caldiroli A, Buoli M, Serati M, Cahn W, Altamura AC. General and social cognition in remitted first-episode schizophrenia patients: a comparative study. Eur Arch Psychiatry Clin Neurosci 2016; 266:639-47. [PMID: 27250978 DOI: 10.1007/s00406-016-0701-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/23/2016] [Indexed: 02/03/2023]
Abstract
The aim of this paper was to investigate whether both neurocognitive and social cognitive performances were different between remitted first-episode schizophrenia patients, non-remitters and healthy controls (HC). We assessed social cognition (Degraded Facial Affect Recognition Task-DFAR and Emotional Mentalizing Task-EMT) and neurocognition (Wechsler Adult Intelligence Scale and Word Learning Test-WLT) in 174 remitted first-episode schizophrenia patients, 110 non-remitted first-episode schizophrenia patients and 320 HC. Multivariate analyses of variance with age, gender and IQ as covariates (MANCOVA) were performed to compare mean cognitive test scores between the three groups. Remitted first-episode schizophrenia patients performed significantly worse than HC only in one verbal memory task (WLT immediate recall; p = 0.004); in the same test, they were significantly better than non-remitters (p = 0.027). Non-remitted first-episode schizophrenia patients, differently from remitters, performed significantly worse than HC in terms of social cognition (EMT-p < 0.05 and DFAR-p < 0.05). Remitted first-episode schizophrenia patients presented worse cognitive performance than HC in verbal memory tasks, but not in facial affect recognition and in ToM, while non-remitters did; these results suggest that neurocognitive deficits are the core hallmark of schizophrenia and that social cognition is relatively unaffected in remitted patients after their first episode.
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Affiliation(s)
- Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.,Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marta Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Wiepke Cahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
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Cobo J, Nieto L, Ochoa S, Pousa E, Usall J, Baños I, González B, Ruiz I, Ruiz AI. Insight and gender in schizophrenia and other psychoses. Psychiatry Res 2016; 243:268-77. [PMID: 27423634 DOI: 10.1016/j.psychres.2016.04.089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 12/30/2015] [Accepted: 04/25/2016] [Indexed: 12/24/2022]
Abstract
This study aimed to evaluate gender differences in the deficit of insight in psychosis and determine influences of clinical, functional, and sociodemographic variables. A multicenter sample of 401 adult patients with schizophrenia and other psychotic disorders who agreed to participate was evaluated in four centers of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using the Positive and Negative Syndrome Scale Lindenmayers' Factors. Insight and its dimensions were assessed by means of the Scale of Unawareness of Mental Disorder. Significant differences were apparent neither between men and women in the three dimensions of insight, nor in the total awareness, nor in the total attribution subscales. However, statistically significant differences were found in awareness and attribution of particular symptoms. Women showed a worse awareness of thought disorder and alogia and a higher misattribution of apathy. Higher cognitive and positive symptoms, early stage of the illness, and having been married explained deficits of insight dimensions in women. In men, other variables such as lower functioning, higher age, other psychosis diagnosis, and, to a lower extent, higher scores in cognitive, positive, and excitative symptoms, explained deficits of insight dimensions. These data could help to design gender-specific preventive and therapeutic strategies.
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Affiliation(s)
- Jesus Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí, Hospital Universitari - UAB Sabadell, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine. Universitat Autònoma de Barcelona Bellaterra, Barcelona, Catalonia, Spain; Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain.
| | - Lourdes Nieto
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Department of Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Susana Ochoa
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Esther Pousa
- Mental Health Department, Corporació Sanitària Parc Taulí, Hospital Universitari - UAB Sabadell, Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar Barcelona, Catalonia, Spain
| | - Judith Usall
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Iris Baños
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Beatriz González
- Mental Health Department, Hospital Benito Menni Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Isabel Ruiz
- Department of Health and Clinical Psychology - Research Unit. Universitat Autònoma de Barcelona Bellaterra, Barcelona, Catalonia, Spain
| | | | - Ada I Ruiz
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar Barcelona, Catalonia, Spain; IMIM - Hospital del Mar Medical Research Institut Barcelona, Catalonia, Spain
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Vohs JL, George S, Leonhardt BL, Lysaker PH. An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments. Expert Rev Neurother 2016; 16:1193-204. [PMID: 27278672 DOI: 10.1080/14737175.2016.1199275] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops. AREAS COVERED To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause. Expert commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.
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Affiliation(s)
- Jenifer L Vohs
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Sunita George
- b School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,c Roudebush VA Medical Hospital , Indianapolis , IN , USA
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Targeting Insight in First Episode Psychosis: A Case Study of Metacognitive Reflection Insight Therapy (MERIT). JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9332-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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32
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Theory of Mind in Schizophrenia: Associations With Clinical and Cognitive Insight Controlling for Levels of Psychopathology. J Nerv Ment Dis 2016; 204:240-3. [PMID: 26919303 DOI: 10.1097/nmd.0000000000000454] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Poor insight in schizophrenia is a risk factor for both poor outcomes and treatment adherence. Accordingly, interest in identifying causes of poor insight has increased. This study explored whether theory of mind (ToM) impairments are linked to poor clinical and cognitive insight independent of psychopathology. Participants with schizophrenia (n = 37) and control subjects (n = 40) completed assessments of ToM with the Hinting Task and the Brüne Picture Sequencing Task, clinical insight and psychopathology with the Positive and Negative Syndrome Scale, and cognitive insight with the Beck Cognitive Insight Scale. Results indicated that the schizophrenia group had greater impairments in ToM relative to control subjects. In the schizophrenia group, the Hinting Task performance was related to both cognitive and clinical insight, with only the relationship with cognitive insight persisting after controlling for psychopathology. Picture Sequencing Task performance was related to cognitive insight only. Future research directions and clinical implications are discussed.
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Associations of symptoms, neurocognition, and metacognition with insight in schizophrenia spectrum disorders. Compr Psychiatry 2016; 65:63-9. [PMID: 26773992 DOI: 10.1016/j.comppsych.2015.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 11/21/2022] Open
Abstract
Many persons with schizophrenia experience poor insight and, as a result, are at risk for treatment non-adherence and numerous negative outcomes. However, to date, the etiology of poor insight has not yet been fully elucidated. One recent theory concerning the roots of poor insight in schizophrenia has proposed that it may result, in part, from impairments in metacognition, or the capacity to think about thinking. The present study thus aims to examine whether metacognition is associated with insight even after controlling for the effects of psychiatric symptomatology and neurocognition. In this study, 95 adults with a schizophrenia spectrum disorder were assessed on measures of insight (i.e., awareness of symptoms, treatment needs, and illness consequences), psychiatric symptoms (i.e., positive symptoms, negative symptoms, and general psychopathology), neurocognitive functions (i.e., executive function, memory, and attention), and metacognitive capacities (i.e., self-reflectivity and theory of mind). Univariate correlations followed by stepwise multiple regressions, which controlled for symptoms and neurocognition, indicated that both self-reflectivity and theory of mind were significantly linked with awareness of symptoms; theory of mind was linked with awareness of treatment needs; and self-reflectivity was linked with awareness of illness consequences. Importantly, these findings suggest that metacognitive capacities may be related to insight independent of concurrent psychiatric symptoms and neurocognitive deficits. Moreover, awareness of different facets of the illness may require contributions from different components of metacognition. Future research should investigate how existing metacognitive skill training programs could potentially be tailored, or modified, to help persons with schizophrenia to develop and enhance insight.
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Metacognition in Early Phase Psychosis: Toward Understanding Neural Substrates. Int J Mol Sci 2015; 16:14640-54. [PMID: 26132568 PMCID: PMC4519863 DOI: 10.3390/ijms160714640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/10/2015] [Accepted: 06/23/2015] [Indexed: 11/21/2022] Open
Abstract
Individuals in the early phases of psychotic illness have disturbed metacognitive capacity, which has been linked to a number of poor outcomes. Little is known, however, about the neural systems associated with metacognition in this population. The purpose of this study was to elucidate the neuroanatomical correlates of metacognition. We anticipated that higher levels of metacognition may be dependent upon gray matter density (GMD) of regions within the prefrontal cortex. Examining whole-brain structure in 25 individuals with early phase psychosis, we found positive correlations between increased medial prefrontal cortex and ventral striatum GMD and higher metacognition. These findings represent an important step in understanding the path through which the biological correlates of psychotic illness may culminate into poor metacognition and, ultimately, disrupted functioning. Such a path will serve to validate and promote metacognition as a viable treatment target in early phase psychosis.
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