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Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures

Primary aim of this study was to determine the extent and type of self‐reported interpersonal problems in patients with non‐affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”, which describes an insufferable inner tension caused by an individual's struggle of being torn between “self‐oriented” and “object‐oriented” tendencies. In a cross‐sectional study among 129 patients with non‐affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' “dilemma” were obtained during a clinical research visit. Self‐report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP‐64D) and compared with a German representative standard sample. Second, IIP‐64D scores were compared between groups with or without Mentzos' “dilemma”. Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP‐64D scores differed significantly from healthy controls, except for “self‐centred” and “intrusive” interpersonal styles. Participants with a potential “psychotic dilemma” scored significantly higher on the subscales: “domineering”, “self‐centred”, “cold”, and “socially avoidant” than the group without a “psychotic dilemma”. The total amount of interpersonal problems, and particularly high scores on the IIP‐64D “socially avoidant” subscale, predicted psychosocial dysfunction, whereas a “cold” interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”.

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