Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles

A Latent Class Analysis

Paul H. Lysaker, Emily Gagen, Abigail Wright, Jenifer Vohs, Marina Kukla, Phillip T. Yanos, Ilanit Hasson-Ohayon

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)48-56
Number of pages9
JournalSchizophrenia Bulletin
Volume45
Issue number1
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Schizophrenia
Psychiatry
Neurobehavioral Manifestations
Aptitude
Hostility
Psychotic Disorders
Metacognition

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles : A Latent Class Analysis. / Lysaker, Paul H.; Gagen, Emily; Wright, Abigail; Vohs, Jenifer; Kukla, Marina; Yanos, Phillip T.; Hasson-Ohayon, Ilanit.

In: Schizophrenia Bulletin, Vol. 45, No. 1, 01.01.2019, p. 48-56.

Research output: Contribution to journalArticle

Lysaker, Paul H. ; Gagen, Emily ; Wright, Abigail ; Vohs, Jenifer ; Kukla, Marina ; Yanos, Phillip T. ; Hasson-Ohayon, Ilanit. / Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles : A Latent Class Analysis. In: Schizophrenia Bulletin. 2019 ; Vol. 45, No. 1. pp. 48-56.
@article{55e4814a01cf41adb05e926e64768564,
title = "Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis",
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.",
author = "Lysaker, {Paul H.} and Emily Gagen and Abigail Wright and Jenifer Vohs and Marina Kukla and Yanos, {Phillip T.} and Ilanit Hasson-Ohayon",
year = "2019",
month = "1",
day = "1",
doi = "10.1093/schbul/sby142",
language = "English (US)",
volume = "45",
pages = "48--56",
journal = "Schizophrenia Bulletin",
issn = "0586-7614",
publisher = "Oxford University Press",
number = "1",

}

TY - JOUR

T1 - Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles

T2 - A Latent Class Analysis

AU - Lysaker, Paul H.

AU - Gagen, Emily

AU - Wright, Abigail

AU - Vohs, Jenifer

AU - Kukla, Marina

AU - Yanos, Phillip T.

AU - Hasson-Ohayon, Ilanit

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85058894763&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058894763&partnerID=8YFLogxK

U2 - 10.1093/schbul/sby142

DO - 10.1093/schbul/sby142

M3 - Article

VL - 45

SP - 48

EP - 56

JO - Schizophrenia Bulletin

JF - Schizophrenia Bulletin

SN - 0586-7614

IS - 1

ER -