Koren Danny, Poyurovsky Michael, Seidman Larry J, Goldsmith Morris, Wenger Sigal, Klein Ehud M
Psychology Department, University of Haifa, Technion Medical School, Haifa, Israel.
Biol Psychiatry. 2005 Mar 15;57(6):609-16. doi: 10.1016/j.biopsych.2004.11.029.
This study was designed to explore the neuropsychological basis of competence to consent to treatment in first-episode schizophrenia by evaluating its differential and joint links with cognitive versus metacognitive performance.
Twenty-one first-episode patients were assessed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) 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 "ventured" sort received a bonus of 10 cents if correct but an equal penalty if wrong.
Compromised capacity to consent was more strongly related to deficits at the metacognitive level than to cognitive deficits per se. Moreover, prediction of competence to consent 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 plays a fundamental role in capacity to consent, which might be at least equally important for decision-making competence as cognitive deficits per se.
本研究旨在通过评估首发精神分裂症患者同意治疗能力与认知和元认知表现的差异及联合联系，探索其同意治疗能力的神经心理学基础。
对21名首发患者进行了麦克阿瑟治疗能力评估工具（MacCAT-T）和威斯康星卡片分类测验（WCST）的元认知版本评估。除了WCST的标准施测外，还要求受试者对每次分类的正确性（在得到反馈之前）进行信心评级，并选择是否希望每次分类被计入其在测试中的总体表现得分。如果每次“冒险”分类正确可得10美分奖励，错误则扣相同分数。
同意能力受损与元认知水平的缺陷相关性更强，而非与认知缺陷本身相关。此外，当将新的、自由选择的元认知测量方法添加到传统WCST测量方法中时，同意能力的预测显著改善，但反之则不然。
这些初步结果表明，元认知在同意能力中起基本作用，这对决策能力可能至少与认知缺陷本身同样重要。
