How does awareness of cognitive impairment impact motivation and treatment outcomes during cognitive remediation for schizophrenia?

Saperstein, Alice M.; Lynch, David A.; Qian, Min; Medalia, Alice

doi:10.1016/j.schres.2020.02.014

Cited by 9 publications

(14 citation statements)

References 29 publications

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“…In keeping with previous literature in psychosis [11][12][13][14] and other psychiatric disorders such as depression 24 and bipolar disorder 25 , we did not find a significant association between subjective and objectively measured cognitive deficits in UHR individuals. This discrepancy could reflect general difficulties in self-evaluation in psychotic disorders 26 , or it could reflect the notion that subjectively reported, and laboratory based assessment of neuropsychological functioning may measure different aspect of cognition, with self-reported measures having greater ecological validity as they tap cognitive difficulties as the appear in the individuals daily life [27][28][29] .…”

Section: Discussionsupporting

confidence: 90%

“…This potential of measures of subjective and objective cognitive deficits tapping different aspects of cognition is further reflected in the finding of subjective cognitive deficits being unrelated to estimated IQ, while objective cognitive deficits (BACS composite score) were significantly related. Furthermore, our study found UHR individuals to report self-perceived cognitive deficits of a magnitude exceeding that of patients with established psychosis (mean MIC-SR total score in UHR = 21/SD = 7, schizophrenia = 14.0/SD = 9.7 and 13.9/SD = 9.40) 12,14 . This is rather surprising as UHR individuals in general display performance-based cognitive deficits of a smaller magnitude than patients with schizophrenia 7 .…”

Section: Discussionmentioning

confidence: 57%

“…Neither did it significantly associate with change scores on the global neurocognitive outcome. In previous reports from patients with schizophrenia, poor insight into neurocognitive deficits has not been adversely related to cognitive remediation attendance, treatment satisfaction 13 , or cognitive benefits 13,14 , although it may impact engagement in treatment via its interaction with perceived competency, a motivational construct that promotes treatment engagement 14 .…”

Section: Discussionmentioning

confidence: 87%

“…As performance-based cognitive testing is the preferred assessment measure employed in psychosis research, few studies have elucidated on patient's self-perceived cognitive impairments: in general, the studies do not find an association between objective and subjective neurocognitive deficits in patients with established psychosis [11][12][13][14] . To the best of our knowledge, no previous study has, however, investigated whether this discrepancy between objective and subjective cognitive deficits also apply to the UHR state of psychosis.…”

Section: Introductionmentioning

confidence: 99%

“…Cognitive remediation is one of the most promising interventions to alleviate cognitive deficits, with proven effectiveness in first-episode and more chronic states of psychosis with small to medium effect sizes on cognitive and functional outcomes [15][16][17][18][19][20][21] . The existing, albeit small, literature does not indicate awareness of cognitive deficits is a pre-requisite for positive outcome of a cognitive remediation intervention in schizophrenia 13,14 . While considerably less studied, preliminary data indicate efficacy of cognitive remediation in the UHR state of psychosis 22 , but it remains, however, unclear whether self-perceived cognitive deficits may influence adherence to cognitive remediation in the UHR population.…”

Section: Introductionmentioning

confidence: 99%

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Self-perceived cognitive impairments in psychosis ultra-high risk individuals: associations with objective cognitive deficits and functioning

et al. 2020

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There is a scarcity of evidence on subjectively reported cognitive difficulties in individuals at ultra-high risk (UHR) for psychosis and whether these self-perceived cognitive difficulties may relate to objective cognitive deficits, psychopathology, functioning, and adherence to cognitive remediation (CR). Secondary, exploratory analyses to a randomized, clinical trial were conducted with 52 UHR individuals receiving a CR intervention. Participants completed the Measure of Insight into Cognition—Self Report (MIC-SR), a measure of daily life cognitive difficulties within the domains of attention, memory, and executive functions along with measures of neuropsychological test performance, psychopathology, functioning, and quality of life. Our study found participants with and without objectively defined cognitive deficits reported self-perceived cognitive deficits of the same magnitude. No significant relationship was revealed between self-perceived and objectively measured neurocognitive deficits. Self-perceived cognitive deficits associated with attenuated psychotic symptoms, overall functioning, and quality of life, but not with adherence to, or neurocognitive benefits from, a CR intervention. Our findings indicate that UHR individuals may overestimate their cognitive difficulties, and higher levels of self-perceived cognitive deficits may relate to poor functioning. If replicated, this warrants a need for both subjective and objective cognitive assessment in at-risk populations as this may guide psychoeducational approaches and pro-functional interventions. Self-perceived cognitive impairments do not seem to directly influence CR adherence and outcome in UHR states. Further studies are needed on potential mediator between self-perceived cognitive deficits and functioning and quality of life.

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