Exploring the Latent Structure and Convergent and Incremental Validity of the Metacognition Assessment Scale - Abbreviated in a Sample of Patients with Non-Affective Psychosis.

Synthetic metacognition is a heterogeneous construct related to psychotic disorders. One important tool to assess this construct is the Metacognition Assessment Scale - Abbreviated (MAS-A). In this study, we investigated the latent structure as well as the interrater reliability and convergent and incremental validity of the MAS-A in a sample of patients with non-affective psychosis. Analyses indicated that the scale might be one-dimensional. Interrater reliability of the MAS-A total score was good. In terms of convergent validity, correlational analyses showed significant associations of MAS-A metacognition with the Operationalized Psychodynamic Diagnosis Level of Structural Integration Axis (OPD-LSIA) and the Levels of Emotional Awareness Scale (LEAS). In terms of construct validity, a significant association was observed between MAS-A metacognition and a short version of the International Classification of Functioning, Disability and Health (MINI-ICF), which persisted after self-report measures of impairments in structural capacities (Structure Questionnaire of Operationalized Psychodynamic Diagnosis [OPD-SQS]) and mentalizing abilities (Mentalization Questionnaire [MZQ]) were included as covariates, but not after symptom dimensions were included. There was a significant correlation with the current living situation, but not with other external criteria like diagnosis or duration of illness. Future studies should explore alternative outcomes and replicate results in longitudinal designs.

Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review.

Exposure to childhood trauma is a well-known risk factor for severe mental disorders including schizophrenia and other non-affective psychoses. Beyond childhood trauma, there is increasing evidence that bullying, social exclusion, and discrimination during adolescence and adulthood may increase the risk of developing a psychotic disorder, and that such forms of traumatization may also underlie the elevated psychosis risk among migrants or persons with a visible minority status. In this umbrella review, we systematically assess meta-analyses regarding trauma and social adversity. A systematic literature review yielded 11 meta-analyses that met inclusion criteria and could be summarized quantitatively with a random effect model. Furthermore, six meta-analyses were evaluated qualitatively. Heterogeneity and publication bias were apparent in several meta-analyses. We observed that most significant social risk factors for psychosis were vulnerability for racist discrimination [OR = 3.90 (3.25-4.70)], migration [OR = 2.22 (1.75-2.80)], and childhood adversities [OR = 2.81 (2.03-3.83)]. Furthermore, social factors increasing the risk for psychosis were variation/impairment of parental communication, aversive adult life events, bullying, and factors associated with social isolation and discrimination. In spite of these environmental risk factors, there is a lack of evidence regarding treatment of trauma and psychosis, although some psychotherapeutic and art therapy approaches appear to be promising. Beyond individual interventions, stigmatization, racism, and other forms of discrimination need to be targeted to increase solidarity and communal support.

The Metacognition Assessment Scale (MAS-A): Results of a pilot study applying a German translation to individuals with schizophrenia spectrum disorders.

OBJECTIVES: Metacognition, the capacity 'to think about thinking' and thus to reflect and to master interpersonal problems on a mentalistic basis, is often impaired among patients with schizophrenia spectrum disorders and has been suggested as a potential treatment target. However, little is known about the reliability of its measurement and links with related phenomena. The aim of this study was to validate a German translation of the Metacognition Assessment Scale (MAS-A) as a measure to assess metacognition from free narratives of patients' personally relevant episodes and relationships. DESIGN AND METHODS: MAS-A was applied to narratives of 22 individuals with schizophrenia spectrum disorders together with self-ratings and behavioural tests of metacognitive and related functions such as mentalizing and emotional awareness. Multi-level modelling allowed to calculate inter-rater reliability (IRR) and inter-rater agreement (IRA) and to include test results as level-2 predictors of the aggregated scorings on the MAS-A subscales in order to explore convergent validity. After considering neurocognition and symptom scores as further predictors, aggregated scorings were correlated with psychosocial functioning. RESULTS: There were high IRRs and IRAs all over the ratings. None of the related measures accounted for variance in MAS-A scorings, indicating the existence of separable, non-overlapping constructs. Verbal memory and positive symptoms were significant predictors for MAS-A subscales. MAS-A, but no other measure, displayed significant associations with psychosocial functioning. CONCLUSIONS: MAS-A is a reliable expert rating to assess metacognition from patients' free narratives. Considering the link to psychosocial functioning, MAS-A appears to be a promising tool for the evaluation of metacognition. PRACTITIONER POINTS: MAS-A is a reliable tool to evaluate metacognitive function from narratives about emotionally relevant topics and meaningful relationships. Metacognition appears separate from neighbouring constructs such as mentalizing, ToM, or emotional awareness. MAS-A scales are significantly predicted by verbal memory and positive symptoms. Only MAS-A scales display significant associations with psychosocial functioning, and it thus is a promising tool to evaluate metacognition in psychotherapy research.

Different aspects of theory of mind in paranoid schizophrenia: evidence from a video-based assessment.

In schizophrenia, impairments of theory of mind (ToM) may be due to excessive ('overmentalizing') or defective ('undermentalizing') attribution of mental states. However, most ToM tests differentiate neither between 'overmentalizing' and 'undermentalizing' nor between cognitive and affective ToM in schizophrenia. This study aimed at differentiating these aspects of ToM in 80 patients diagnosed with paranoid schizophrenia and 80 matched healthy controls using the 'Movie for the Assessment of Social Cognition' (MASC). Outcome parameters comprised 1) error counts representing 'undermentalizing' or 'overmentalizing', 2) decoding of cognitive or emotional mental states and 3) non-social inferencing. Multivariate analysis of covariance (MANCOVA) showed significantly abnormal scores for two dimensions of 'undermentalizing' as well as for cognitive and emotional ToM that were not explained by global cognitive deficits. Scores for 'overmentalizing' did not differ between groups, when age, gender, non-social reasoning and memory were controlled. In schizophrenic patients, negative symptoms were associated with a lack of a mental state concept, while positive symptoms like delusions were associated with 'overmentalizing', supporting respective etiological concepts of delusions.