Metacognitive awareness of cognitive problems in schizophrenia: exploring the role of symptoms and self-esteem

Abstract

BackgroundPeople with a diagnosis of schizophrenia have limited metacognitive awareness of their symptoms. This is also evident for cognitive difficulties when neuropsychological assessments and self-reports are compared. Unlike for delusions and hallucinations, little attention has been given to factors that may influence the mismatch between objective and subjectively reported cognitive problems. Symptom severity, and also self-esteem and social functioning, can have an impact on cognitive problem perception and help to explain the gap between objective and subjective cognitive assessments in psychosis.MethodOne-hundred participants with a diagnosis of schizophrenia were recruited and assessed with a comprehensive neuropsychological battery, a measure of awareness of cognitive problems and measures of psychotic symptoms, social and behavioural functioning and self-esteem. Regression was used to investigate the influence of symptoms, social functioning and self-esteem, and patients with different levels of cognitive problem awareness were contrasted.ResultsSimple correlation analysis replicated the lack of association between objective cognitive measures and metacognitive awareness of cognitive problems. However, the results of the regression analyses highlight that self-esteem and negative symptoms predict metacognitive awareness. When significant predictors were controlled, individuals with better awareness had more impaired working memory but higher IQ.ConclusionsPoor self-esteem and high negative symptoms are negatively associated with metacognitive awareness in people with schizophrenia. Interventions that aim to improve cognition should consider that cognitive problem reporting in people with schizophrenia correlates poorly with objective measures and is biased not only by symptoms but also by self-esteem. Future studies should explore the causal pathways using longitudinal designs.

Feasibility and acceptability of brief cognitive remediation targeting metacognition in acute inpatients with psychosis: a case series

“…In this study, subjective cognitive complaints decreased over time, with objective cognitive performance presenting a general post-treatment improvement. This appears as a congruous direction of change between objective and subjective measurements following CR, and is in accordance with previous findings (Cella, Swan, Medin, Reeder, & Wykes, 2014;Medalia et al, 2008;Strip et al, 2003).…”

La conscience des déficits neurocognitifs dans la schizophrénie : une méta-analyse

“…o 2 Durant la dernière décennie, des efforts accrus ont été investis dans l'étude de la conscience (ou l'absence de conscience) que les patients atteints de la schizophrénie ont de leurs déficits cognitifs. En comparant les plaintes cognitives subjectives des patients à leur performance cognitive objective, telle qu'évaluée par des tests cognitifs validés, certaines études ont montré une absence de corrélation entre les mesures subjectives et objectives (Cella et al, 2013 ;Donohoe et al, 2009 ;Sellwood et al, 2013), alors que d'autres études ont montré des associations significatives, quoique généralement modestes, entre les deux types de mesures (Hake et al, 2007 ;Potvin et al, 2005 ;Stip et al, 2003). Pris ensemble, ces résultats suggèrent que dans la schizophrénie, l'autocritique par rapport aux déficits cognitifs est compromise, voire absente.…”

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