Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis.

The 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 metacognition 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.

Stereotype endorsement, metacognitive capacity, and self-esteem as predictors of stigma resistance in persons with schizophrenia.

OBJECTIVE: While research continues to document the impact of internalized stigma among persons with schizophrenia, little is known about the factors which promote stigma resistance or the ability to recognize and reject stigma. This study aimed to replicate previous findings linking stigma resistance with lesser levels of depression and higher levels of self-esteem while also examining the extent to which other factors, including metacognitive capacity and positive and negative symptoms, are linked to the ability to resist stigma. METHOD: Participants were 62 adults with schizophrenia-spectrum disorders who completed self-reports of stigma resistance, internalized stigma, self-esteem, and rater assessments of positive, negative, disorganization, and emotional discomfort symptoms, and metacognitive capacity. RESULTS: Stigma resistance was significantly correlated with lower levels of acceptance of stereotypes of mental illness, negative symptoms, and higher levels of metacognitive capacity, and self-esteem. A stepwise multiple regression revealed that acceptance of stereotypes of mental illness, metacognitive capacity, and self-esteem all uniquely contributed to greater levels of stigma resistance, accounting for 39% of the variance. CONCLUSION: Stigma resistance is related to, but not synonymous with, internalized stigma. Greater metacognitive capacity, better self-esteem, and fewer negative symptoms may be factors which facilitate stigma resistance.

La relación entre el estigma y los síntomas positivos y de malestar emocional en la esquizofrenia / Associations of stigma with positive and emotional discomfort symptoms in schizophrenia

La investigación sugiere que el estigma se comporta como una barrera para la autoestima y el logro de un funcionamiento psicosocial adecuado en las personas con esquizofrenia. Es menos claro cómo las experiencias estigmatizadoras se asocian con los síntomas tanto en forma concurrente como prospectiva. Para evaluar este aspecto se valoraron los síntomas positivos y de malestar emocional mediante la escala para el síndrome positivo y negativo (Positive and Negative Syndrome Scale), y la experiencia estigmatizadora mediante la escala del estigma internalizado de la enfermedad mental (Internalized Stigma of Mental Illness Scale), en 75 personas con esquizofrenia en dos momentos separados por 5 meses. Los mayores niveles de estigma se asociaron con mayores niveles de síntomas positivos y de malestar emocional, tanto en forma concurrente como prospectiva. Los síntomas también se asociaron prospectivamente con el grado de estigma. Los resultados de la replicación de hallazgos previos indican que existe una relación estrecha entre la experiencia estigmatizadora y los síntomas. Ambos pueden exacerbarse recíprocamente dando lugar a un círculo vicioso.