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

Abstract

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.

A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes

“…Subjective measures, on the other hand, are better at capturing complex everyday situations, but are more easily influenced by confounding emotional states [88]. Since the discrepancy between subjective and objective measures of cognition is often larger among persons with schizophrenia than in healthy samples, caution should be exercised in the interpretation of the mechanisms of change in subjective EF in the present study [89][90][91][92]. That is not to say that self-reported executive functioning is not of clinical importance as it has been shown to predict important life outcomes, for example academic performance in college [93], and impulse control in younger people [94].…”

European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia

“…The CANTAB [239] offers a selection of cognitive tests, representing the core neurocognitive domains, and has proven sensitive to cognitive deficits in patients with a FEP [223] and UHR individuals [240,241]. Hence, the CANTAB tests Finally, the Measure of Insight into Cognition-Self Report (MIC-SR) represents a measure of self-perceived cognitive ability that has been recently found to be related with overall functioning and QoL in UHR individuals [242].…”

“…Finally, the Measure of Insight into Cognition-Self Report (MIC-SR) represents a measure of self-perceived cognitive ability that has been recently found to be related with overall functioning and QoL in UHR individuals [ 242 ].…”

Moderators of metacognitive strategy training for executive functioning in early schizophrenia and psychosis risk

“…A substantial portion of people with schizophrenia report fewer subjective cognitive complaints relative to their objectively measured difficulties ( Harvey and Pinkham, 2015 ; Haugen et al, 2021 ; Potvin et al, 2014 ). Individuals with psychosis risk syndromes, on the other hand, are more likely to report greater subjective complaints compared to objective test performance ( Glenthøj et al, 2020 ). Discrepancy in either direction could be an obstacle for GMT.…”

“…In two other remediation trials subjective complaints was not a prerequisite for gains in objective cognition, but was associated with better attendance ( Burton and Twamley, 2015 ; Saperstein et al, 2020 ). A study in psychosis risk found that subjective cognition did not moderate outcome ( Glenthøj et al, 2020 ).…”