Metacognitive profiles in individuals with a first episode of psychosis and their relation to social functioning and perceived social support

Minor

Schizophrenia Research: Cognition

et al. 2020

105

137

Bleuler suggested that fragmentation of thought, emotion and volition were the unifying feature of the disorders he termed schizophrenia. In this paper we review research seeking to measure some of the aspects of fragmentation related to the experience of the self and others described by Bleuler. We focus on work which uses the concept of metacognition to characterize and quantify alterations or decrements in the processes by which fragments or pieces of information are integrated into a coherent sense of self and others. We describe the rationale and support for one method for quantifying metacognition and its potential to study the fragmentation of a person's sense of themselves, others and the relative place of themselves and others in the larger human community. We summarize research using that method which suggests that deficits in metacognition commonly occur in schizophrenia and are related to basic neurobiological indices of brain functioning. We also present findings indicating that the capacity for metacognition in schizophrenia is positively related to a broad range of aspects of psychological and social functioning when measured concurrently and prospectively. Finally, we discuss the evolution and study of one therapy that targets metacognitive capacity, Metacognitive Reflection and Insight Therapy (MERIT) and its potential to treat fragmentation and promote recovery.

Section: Metacognition In Schizophreniamentioning

confidence: 99%

Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments

Minor

Schizophrenia Research: Cognition

et al. 2020

105

137

“…Metacognition is an extensive mental activity that involves contemplation of one's own thinking or others' mental state. Metacognitive deficits have been reported in all phases of schizophrenia (5)(6)(7) and are related to poor treatment outcomes. Metacognitive training (MCT), a novel and widely used group intervention for patients with schizophrenia, may enhance patients' self-awareness and insights into these cognitive distortions to alleviate the positive symptoms of psychosis, especially paranoid ideation (8).…”

Section: Introductionmentioning

confidence: 99%

Metacognitive Training Modulates Default-Mode Network Homogeneity During 8-Week Olanzapine Treatment in Patients With Schizophrenia

Shan

Liao

et al. 2020

Front. Psychiatry

Background: Previous studies have revealed the efficacy of metacognitive training for schizophrenia. However, the underlying mechanisms of metacognitive training on brain function alterations, including the default-mode network (DMN), remain unknown. The present study explored treatment effects of metacognitive training on functional connectivity of the brain regions in the DMN.Methods: Forty-one patients with schizophrenia and 20 healthy controls were scanned using resting-state functional magnetic resonance imaging. Patients were randomly assigned to drug plus psychotherapy (DPP) and drug therapy (DT) groups. The DPP group received olanzapine and metacognitive training, and the DT group received only olanzapine for 8 weeks. Network homogeneity (NH) was applied to analyze the imaging data, and pattern classification techniques were applied to test whether abnormal NH deficits at baseline might be used to discriminate patients from healthy controls. Abnormal NH in predicting treatment response was also examined in each patient group.Results: Compared with healthy controls, patients at baseline showed decreased NH in the bilateral ventral medial prefrontal cortex (MPFC), right posterior cingulate cortex (PCC)/ precuneus, and bilateral precuneus and increased NH in the right cerebellum Crus II and bilateral superior MPFC. NH values in the right PCC/precuneus increased in the DPP group after 8 weeks of treatment, whereas no substantial difference in NH value was observed in the DT group. Support vector machine analyses showed that the accuracy, sensitivity, and specificity for distinguishing patients from healthy controls were more than 0.7 in the NH values of the right PCC/precuneus, bilateral ventral MPFC, bilateral superior MPFC, and bilateral precuneus regions. Support vector regression analyses showed that high NH levels at baseline in the bilateral superior MPFC could predict symptomatic improvement of positive and negative syndrome scale (PANSS) after 8 weeks of DPP treatment. No correlations were found between alterations in the NH values and changes in the PANSS scores/cognition parameters in the patients. Conclusion:This study provides evidence that metacognitive training is related to the modulation of DMN homogeneity in schizophrenia.

“…The findings from both studies might be related to patients' impairments in self-reflective processes (including metacognition, self-referential, and internal source-monitoring). More precisely, patients' difficulties with identifying their involuntary memories per se (Study 2) are likely to be caused by patients' metacognitive deficits (47)(48)(49)(50). The lower proportion of external cues and higher proportion of internal cues in the patient group, compared to the control group in Study 1, might be related to an aberrant salience of inner stimuli (40,41).…”

Section: Discussionmentioning

confidence: 98%

“…This finding likely reflects patients' difficulties in scanning and monitoring their stream of consciousness in order to report only involuntary memories (and not spontaneous future projections, personal reflections or prospective memories, for instance), as instructed. This relates to patients' metacognitive deficits (47)(48)(49)(50) or internal sourcemonitoring deficits (51), that is, their poorer ability to distinguish between different internal sources of mental representation, such as memories from imagined events (52,53).…”

Section: Discussionmentioning

confidence: 99%

Involuntary Autobiographical Memories in Schizophrenia: Characteristics and Conditions of Elicitation

et al. 2020

Involuntary autobiographical memories are mental representations of personally experienced past events that come to mind spontaneously, with no preceding attempt to recall them. They have been showed to be more frequent and more emotional in the psychosis continuum. Although schizophrenia is strongly associated with thought disorders, including cognitive intrusions of thought, images, semantic knowledge, research on patients' involuntary autobiographical memories is limited. We undertook two studies to compare involuntary and voluntary remembering in schizophrenia and the conditions in which involuntary memories occurs in those patients, both in daily life (n = 40), using a diary method, and in an experimental context (n = 50). Overall, results showed that the conditions of elicitation of involuntary memories differ in patients, as patients were more sensitive to memory triggers, especially internal triggers, in comparison to controls. Relatedly, patients' involuntary memories-mostly related to mundane events with low emotional load-were experienced more frequently. Although patients' involuntary and voluntary memories were less clear, more poorly contextualized and associated with a lower belief in occurrence than those of controls, patients considered them as more central to the self, in comparison to controls. The results are discussed in relation to patients' self-reflective impairments.