Clinical insight, cognitive insight and metacognition in psychosis: Evidence of mediation. (August 2021)

• Record Type: Journal Article
• Authors: Lysaker, Paul H.; Chernov, Nikita; Moiseeva, Tatyana; Sozinova, Marta; Dmitryeva, Nadezhda; Alyoshin, Vitaliy; Luther, Lauren; Karpenko, Olga; Kostyuk, Georgiy
• Is Part Of: Journal of psychiatric research. Volume 140(2021)
• Page Start: 1
• Page End: 6
• Publication Date: 2021-08
• Subjects: Metacognition -- Clinical insight -- Cognitive insight -- Psychosis -- Neurocognition -- Schizophrenia -- Positive symptoms; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2021.05.030
• Languages: English
• ISSNs: 0022-3956

Abstract

Abstract: Objective: Schizophrenia is increasingly understood as an interactive network of disturbances in different elements of self-awareness. In this study we have examined the relationship between disturbances in two forms of awareness: cognitive insight and clinical insight by exploring whether their relationship is mediated by a third form of larger awareness: metacognition. Methods: Participants were 41 outpatients with schizophrenia and 37 outpatients with early episode psychosis gathered in Moscow, Russia. Metacognition was assessed with the Metacognition Assessment Scale - Abbreviated. Verbal memory and positive symptoms were assessed for use as additional mediators. Results: Mediation analyses revealed that after accounting for the effects of positive symptoms and verbal memory, the relationship between the self-reflection domain of cognitive insight and clinical insight was significantly mediated by overall metacognitive capacity. Further, positive symptoms were a significant mediator between the cognitive insight self-reflection domain and clinical insight. Neither metacognition nor positive symptoms or verbal memory were found to mediate the relationship of the cognitive insight domain of self-certainty with clinical insight. Conclusions: Decrements in some forms of ability to reflect upon one's thinking may reduce the ability to form complex and integrated ideas of oneself and others, leading to less coherent and complete accounts of the experience of schizophrenia.