Koren Danny, Seidman Larry J, Poyurovsky Michael, Goldsmith Morris, Viksman Polina, Zichel Suzi, Klein Ehud
Psychology Department, University of Haifa, Haifa 31905, Israel.
Schizophr Res. 2004 Oct 1;70(2-3):195-202. doi: 10.1016/j.schres.2004.02.004.
The aim of the present study was to explore the neuropsychological basis of insight in first-episode schizophrenia, by evaluating its differential and joint links with cognitive vs. metacognitive performance. Thirty first-episode patients were assessed with the Scale of Unawareness of Mental Disorder (SUMD) and a metacognitive version of the Wisconsin Card Sorting Test (WCST). In addition to the standard administration of the WCST, subjects were also asked to rate their level of confidence in the correctness of each sort (prior to getting the feedback), and to choose whether they wanted each sort to be "counted" toward their overall performance score on the test. Each "volunteered" sort received a bonus of 10 cents if correct, but an equal penalty if wrong. Insight into illness had higher correlations with free-choice metacognitive indices derived from confidence ratings and volunteered sorts than with the conventional scores from the WCST. Moreover, prediction of poor insight was significantly improved when adding the new, free-choice metacognitive measures to the conventional WCST measures, but not the other way around. These preliminary results suggest that metacognition is an important mediator between basic cognitive deficits and poor insight, and might be even more relevant to poor insight than cognitive deficits per se.
本研究的目的是通过评估洞察力与认知能力和元认知能力表现的差异及联合联系，来探究首发精神分裂症洞察力的神经心理学基础。对30名首发患者进行了精神障碍自知力量表（SUMD）和威斯康星卡片分类测验（WCST）的元认知版本评估。除了标准的WCST测试外，还要求受试者对每次分类的正确性评定其信心水平（在得到反馈之前），并选择他们希望每次分类是否计入测试的总体表现分数。如果每次“自愿”分类正确可得10美分奖励，错误则扣除同样分数。与WCST的传统得分相比，对疾病的洞察力与从信心评定和自愿分类得出的自由选择元认知指标具有更高的相关性。此外，将新的自由选择元认知测量指标添加到传统的WCST测量指标中时，对洞察力差的预测有显著改善，但反之则不然。这些初步结果表明，元认知是基本认知缺陷与洞察力差之间的重要中介因素，可能比认知缺陷本身与洞察力差的关系更为密切。
