Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes

Abstract

Introduction. Individuals with schizophrenia present across a spectrum of symptomatology. Disability remains a debilitating reality across varying disease presentations and remains pervasive despite psychiatric medications. Cognition (neuro/social cognition) and negative symptoms have emerged as the strongest predictors of real-world disability, but account for <50% of the variance in outcomes. Methods. Our attempts to determine what accounts for the remaining 50% of variance has shown that poor introspective accuracy (IA) may be the most potent predictor of functional outcomes 25% of individuals with schizophrenia. We define IA as the adequacy of self-assessments of ability, skills, performance, or decisions. We suggest that IA is a progression of metacognition and can extend beyond cognition to include misestimation of prior and likely future performance in social or other adaptively relevant situations. Results. Additionally, IA is bidirectional and self-orientated. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures or neurocognitive skills and has found that IA of social cognition accounts unique variance in real-world disability above social cognitive performance. Discussion. We argue that impaired IA, affecting 25–50% of patients with schizophrenia, in the absence or minimal presence of other impairments might be the most powerful predictor of functional outcomes.

Introspective accuracy for substance use across a year of treatment for first episode psychosis

“…IA has been recently studied in schizophrenia research to assess targets that are highly relevant to recovery like functioning, social cognition, and neurocognition, generally finding poor IA is associated with poor outcomes ( Halverson et al, 2019 ; Pinkham et al, 2018b ; Silberstein and Harvey, 2019 ; Springfield and Pinkham, 2020 ). IA regarding substance use is likely to play a role in functional recovery through understanding one's potential to get well ( Harvey and Pinkham, 2015 ; Silberstein and Harvey, 2019 ). This in turn could increase and individual's engagement with their treatment through identifying goals or celebrating accomplishments.…”

Autistic Symptoms and Social Cognition Predict Real-World Outcomes in Patients With Schizophrenia

“…In addition, recent data demonstrate that social cognition has an important influence on functional outcomes in patients with schizophrenia, and may indeed be a central factor in determining real-world outcomes (27)(28)(29), particularly when combined with consideration of both social cognitive ability and selfassessments of that ability (30). Despite the identification of these contributors, a good portion of the variance in functional outcomes remains unaccounted for (31), suggesting that the search for determinants of outcomes should continue. Given that greater ASD symptoms in schizophrenia have been independently linked to poorer social cognition and poorer functioning, it is necessary to evaluate the importance of these factors when examined concurrently with each other and with other known predictors (e.g., cognitive impairment, etc.).…”

Functional outcomes and subjective recovery of jumping to conclusions in schizophrenia

“…Such conflicting relationships may be related to subjective overestimation ( Sanchez and Dunning, 2020 ). For instance, the person with schizophrenia is prone to over- or underestimation ( Silberstein et al, 2018 ; Silberstein and Harvey, 2019 ). Particularly, the tendency to overestimate has been associated with low functional outcome and low social cognition, including JTC ( Perez et al, 2020 ; Silberstein et al, 2018 ).…”