No abstract

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.

Assertive community treatment (ACT) provides comprehensive clinical services, including vocational rehabilitation, to individuals with psychiatric disorders for which traditional community mental health services are insufficient. ACT is an evidence-based intervention yielding many positive outcomes, yet service recipients continue to struggle with workforce involvement. The purpose of this study is to determine whether internalized stigma, psychiatric hospitalization, and psychiatric symptoms are associated with work-related self-efficacy among ACT service recipients. A total of 72 individuals with severe mental illness were recruited from ACT programs in three counties in a Mid-Atlantic state. Multiple linear regression was conducted to examine the relationship between work-related self-efficacy and the independent variables of internalized stigma, psychiatric hospitalization, and psychiatric symptoms. Higher internalized stigma scores were negatively associated with work-related self-efficacy (β = −.31, t = −2.32, p < .05), while psychiatric hospitalization in the past year was positively associated with work-related self-efficacy (β = .22−.27, t = −2.13, p < .05). Findings from this study suggests internalized stigma to be an important recovery variable requiring the attention of ACT team members when preparing individuals for work, while countering the assumption that recent hospitalization is a barrier to work-related self-efficacy.