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

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.

Metacognition and Intersubjectivity: Reconsidering Their Relationship Following Advances From the Study of Persons With Psychosis

“…Of note, to a large extent many contemporary approaches to metacognition, including Flavell's relatively later work (Flavell et al, 2002), emphasize the practical purposes of metacognitive knowledge and the self-regulatory aspects of metacognition. These components are evident in theoretical discussion of metacognition and the Lysaker et al (2018) review of different metacognitive approaches to the treatment of psychosis which treat metacognitive processes as having a regulatory function that allows person to doubt and subsequently decide upon different courses of action. One aspect of metacognition, however, that is often overlooked, is that metacognition is entwined with intersubjective experience.…”

Schizophrenia, recovery and the self: An introduction to the special issue on metacognition

“…Moritz et al (2018) make a similar point that exercises designed to combat reasoning bias may also impact health when they enhance the capacity for self-reflection in the world. Others have suggested that diverse approaches, including psychodynamic and humanistic psychotherapy, might also promote health via their effects on metacognition (Knauss et al, 2018; Lysaker et al, 2019a).…”

Cognitive Training and Remediation in First-Episode Psychosis: A Literature Review

“…The effects of combined interventions on social functioning should also be explored. For example, metacognition, or the ability to form an integrated and complex understanding of the self and others, has been associated with social functioning and insight in psychotic disorders (Lysaker et al, 2019). No studies in this review incorporated metacognitive approaches, and addressing metacognition may lead to improved insight into cognitive impairments and treatment needs, thus promoting engagement in CTR interventions (Vohs et al, 2018).…”