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Metacognitive deficits predict impaired insight in schizophrenia across symptom profiles: a latent class analysis
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posted on 2023-06-09, 15:32 authored by Paul H Lysaker, Emily Gagen, Abigail Christine Wright, Jenifer L Vohs, Marina Kukla, Phillip T Yanos, Ilanit Hasson-OhayonThe 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 metacogni-tion 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.
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Publication status
- Published
File Version
- Published version
Journal
Schizophrenia BulletinISSN
0586-7614Publisher
Oxford University PressExternal DOI
Issue
1Volume
45Page range
48-56Department affiliated with
- Psychology Publications
Research groups affiliated with
- Astronomy Centre Publications
Full text available
- No
Peer reviewed?
- Yes
Legacy Posted Date
2018-10-17First Compliant Deposit (FCD) Date
2018-10-17Usage metrics
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