Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia-Spectrum Disorders: Relationship to Metacognitive Deficits

Joshua E Mervis; Kelsey A Bonfils; Samuel E Cooper; Courtney Wiesepape; Paul H Lysaker

doi:10.1093/schizbullopen/sgab034

Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia-Spectrum Disorders: Relationship to Metacognitive Deficits

Schizophr Bull Open. 2021 Jul 20;2(1):sgab034. doi: 10.1093/schizbullopen/sgab034. eCollection 2021 Jan.

Authors

Joshua E Mervis^{1

2}, Kelsey A Bonfils³, Samuel E Cooper⁴, Courtney Wiesepape^{2

5}, Paul H Lysaker^{2

6}

Affiliations

¹ Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
² Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
³ School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA.
⁴ Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA.
⁵ Department of Psychology, Indiana State University, Terre Haute, IN, USA.
⁶ Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.

Abstract

People diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.

Keywords: executive function; insight; metacognition; psychosis; psychotic disorders; schizophrenia; self-certainty; self-reflection; self-reflectivity; social cognition.