Schizophrenia and Metacognition: An Investigation of Course of Illness and Metacognitive Beliefs Within a First Episode Psychosis

Abstract

The Self Regulatory Executive Function (S-REF) model implicates maladaptive metacognitive beliefs and processes in the predisposition and/or maintenance of positive psychotic symptoms. In the model, metacognitive beliefs guide cognitive and behavioural responses to cognitive experiences. This study tested for relationships between course of illness and levels of specific metacognitions in schizophrenia spectrum disorders. A large cohort of people with first episode psychosis (n = 578) recruited as part the OPUS trial (1998)(1999)(2000) were tested.Information about course of illness (remitted, episodic or continually psychotic) and metacognitive belief ratings were collected. Data obtained from 367 participants revealed that levels of maladaptive metacognitive beliefs varied as a function of course of illness and distinguished between remitted patients and non-patients. Metacognitive beliefs explained 17 % additional variance displayed in course of illness in a multinomial regression analysis when controlling for other causal factors. In addition, beliefs concerning Need to Control thoughts (RR 1.13, 95 % CI 1.03-1.22, p \ 0.01) predicted a continually psychotic course of illness. Elevations in metacognitive beliefs were associated with the severity and duration of psychotic symptoms, consistent with the S-REF model. Moreover, metacognition was a better predictor of course of illness than anxiety and depression. If these associations are shown to be causal, clinical interventions that modify metacognitive beliefs may also impact on positive symptoms and course of illness within schizophrenia.

A meta-analysis of metacognitive beliefs as implicated in the self-regulatory executive function model in clinical psychosis

“…Only few longitudinal studies have investigated these relationships to date (e.g. Austin et al 2015;Morrison et al 2002). Methodological quality has been assessed in this context.…”

“…Currently, only a small number of longitudinal studies have investigated these relationships. However, findings indicate that an increased number of unhelpful metacognitive beliefs is associated with transition to clinical psychosis in people with at risk mental state (Morrison, Bentall, et al, 2002) and higher levels of negative metacognitive beliefs predict a more severe and chronic course of illness in people with a diagnosis of psychosis (Austin et al, 2015).…”

“…Research using samples of people at risk of developing psychosis suggests that at risk mental state (Morrison et al, 2006) and subsequent transition to first episode psychosis (Barbato et al, 2013;Morrison, Bentall, et al, 2002) is associated with a greater endorsement of negative metacognitive beliefs. A higher number of negative beliefs has also been related to increased distress (Barbato et al, 2013;Brett, Johns, Peters, & McGuire, 2009;Oosterhout, Krabbendam, Smeets, & van der Gaag, 2013) and a more severe and chronic course of illness (Austin et al, 2015).…”

Metacognitive profiles in schizophrenia and bipolar disorder: Comparisons with healthy controls and correlations with negative symptoms

“…From another perspective (Wells, 2000), dysfunctional metacognitive beliefs have also been reported in schizophrenia. These include negative appraisals about the benefit of becoming involved in cognitive activities and heightened anticipation of the uncontrollability, and danger of thoughts (Sellers et al, 2016) and have been associated with positive symptoms (Baker and Morrison, 1998;Morrison et al, 2011), especially hallucinations Hill et al, 2012;Austin et al, 2015).…”

Unhelpful metacognitive beliefs in early psychosis are associated with affective symptoms and childhood social adjustment

“…Notably, we found no significant relationships between positive symptoms and metacognitive beliefs in our early psychosis sample when controlling for depression/anxiety. Hence it could be questioned whether metacognitive beliefs have any direct relevance to positive symptoms in early psychosis, contrary to findings in more mixed or chronic psychosis samples (44,137,163), where such beliefs have also been linked to a more chronic illness trajectory (138). It should be noted that the levels of positive symptoms in our study sample was fairly low (PANSS Positive item mean = 2.4, range 1 to 5.5), which could affect our ability to detect a relationship.…”