Metacognitive and social cognition approaches to understanding the impact of schizophrenia on social quality of life.

While some studies view metacognition and social cognition as representing the same phenomenon, others suggest that they represent distinctive sets of abilities that are related to different outcomes. The current study used a cross-sectional design that includes samples of persons with schizophrenia (N=39) and healthy individuals (N=60) to further explore the distinction between social cognition and metacognition and their associations with social quality of life. The Face Emotion Identification Task (FEIT), Faux-Pas Task, Indiana Psychiatric Illness Interview (IPII), Metacognition Assessment Scale - Abbreviated (MAS-A), and Social Quality of Life Scale were administrated to all participants. Correlations, t-tests and regressions were conducted. Results showed that persons with schizophrenia performed more poorly on all measures than healthy controls. Social cognition and metacognition measures were related for the combined total sample, but only a few associations were found among both sub-samples. A diagnosis of schizophrenia and metacognitive capacity, but not social cognition, predicted social quality of life. Self-reflectivity had a negative relationship to social quality of life while understanding of others' minds had a positive relation to social quality of life. The current study provides evidence that many with schizophrenia experience deficits in both social cognition and metacognition and that those deficits may be distinct and have different kinds of relationships with social quality of life. Clinical implications include the need to emphasize narrative aspects of psychotherapy in order to promote metacognition.

Metacognition in schizophrenia and schizotypy: relation to symptoms of schizophrenia, traits of schizotypy and Social Quality of Life.

OBJECTIVE: The current study examined a mediation model in which symptoms of schizophrenia and schizotypy traits mediate the positive relations between metacognition and Social Quality of Life (SQoL) among persons with schizophrenia and persons without mental illness. METHOD: 39 persons diagnosed with schizophrenia and 60 persons without a severe mental illness diagnosis participated in this study. Instruments included the Metacognition Assessment Scale-Abbreviated (MAS-A), the SQoL scale of the QLI-MH, the PANSS scale and the O-LIFE self-report questionnaire that assesses schizotypy traits. RESULTS: Persons with schizophrenia exhibit lower SQoL and metacognitive abilities than persons without mental illness. For persons with schizophrenia, negative symptoms mediate the positive relation between the ability to understand other persons' minds and SQoL. However, although for persons without mental illness, understanding other minds was found to correlate negatively with introvertive anhedonia and SQoL, a mediation model was not confirmed. DISCUSSION: Understanding of others' minds seems relevant to the SQoL for both samples. In addition, negative symptoms of schizophrenia and introvertive anedonia traits are also related to SQoL among persons with schizophrenia and among persons without mental illness respectively. The lack of support for a mediation model for persons without mental illness is consistent with the theories that claim schizotypy is not a mirror image of schizophrenia and, therefore, may not necessarily lead to schizophrenia. Limitations of this study and suggestions for future research are discussed.

Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders.

Controversy exists as to the cognitive, emotional and behavioral consequences of lack of insight for persons with schizophrenia. This study tested a mediation model of the relations between insight into mental illness, hope, and the aspects of quality of life of persons with schizophrenia. According to this model, insight into mental illness may impact negatively on the quality of life of persons with schizophrenia by reducing these persons' hope. Sixty persons with schizophrenia or schizoaffective disorder completed questionnaires that assessed their insight, quality of life, and hope. The study's results show that for six of seven aspects of quality of life and for general awareness of illness, the above-hypothesized mediation model was confirmed. These results suggest that increasing the hope of persons with schizophrenia may directly and positively increase both their quality of life and the usefulness of their insight into their illness.

Donepezil augmentation of clozapine monotherapy in schizophrenia patients: a double blind cross-over study.

Increasing evidence suggests that the cholinergic system is involved in the pathogenesis of schizophrenia. Donepezil, a central cholinesterase inhibitor, improves psychotic symptomatology in demented patients, however, evidence for its role in the management of active psychosis in schizophrenia remains limited. An 18-week double blind cross-over study was conducted in which eight patients were randomly assigned to either donepezil (5 mg/day for the first 4 weeks and 10 mg/day for the following 4 weeks) or placebo as augmentation treatment to clozapine. After this initial phase, there was a 2-week washout period of the study medication after which the same regimen was crossed over at the same dose and for the same period (8 weeks). No significant difference was noted in the total positive and negative symptom scale scores when donepezil was compared with placebo (16.7%+12.97% vs 3.20%+13.94% respectively, p = 0.18). However, three patients improved (>15%) in the total PANSS scores (37.03%, 16.6% and 25.33%) during the donepezil treatment phase, while only one patient improved (20.87%) during the placebo phase. No differences were noted in the Calgary depression scale (p = 0.305), Simpson Angus scale (p = 0.374), clinical global impression-improvement scale (p = 0.23) and clinical global impression-severity of illness scores (p = 0.116). Although this preliminary study failed to demonstrate a clear effect of donepezil augmentation in clozapine treated chronic schizophrenia patients, it seems that the subtle positive effect of donepezil observed in some of our patients should encourage further investigation in a larger sample of this patient subpopulation.