Abu-Akel Ahmad, Heinke Dietmar, Gillespie Steven M, Mitchell Ian J, Bo Sune
School of Psychology, University of Birmingham.
Psychiatric Research Unit, Region Zealand.
J Abnorm Psychol. 2015 Nov;124(4):1102-1109. doi: 10.1037/abn0000096. Epub 2015 Sep 14.
Psychopathy and metacognitive difficulties have been associated with the occurrence of violence in schizophrenia. However, evidence suggests that nonschizophrenic psychopaths match or even outperform healthy controls on tests of metacognition. We hypothesize that the metacognitive difficulties associated with schizophrenia may be ameliorated by comorbid psychopathy. To this end, metacognition (using the Metacognition Assessment Scale-Abbreviated [MAS-A]) and psychopathy (using the Hare Psychopathy Checklist-Revised [PCL-R]) are assessed in 79 patients with schizophrenia with a history of criminal offending. Piecewise regression reveals that the association between metacognition and psychopathy changes from a negative to a positive association at a breakpoint corresponding to a score of 24 on the PCL-R. This score is within the range of the cut-off point used for the diagnosis of psychopathy in Europe, which corresponds to a score of 26 on the PCL-R. The patients scoring above 24 on the PCL-R demonstrated better overall metacognitive abilities, suggesting that these patients constitute a specific group in which schizophrenia has an attenuated impairing effect on metacognition. However, this effect was absent for the Mastery subscale of the MAS-A, which refers to the ability to use one's own mental states to solve social and psychological dilemmas. Our results suggest that the relative preservation of metacognitive abilities in schizophrenic patients with extreme levels of psychopathy may contribute to their offending behavior as it may enable them to understand how to manipulate and extort their victims. However, enhancing the Mastery domain of metacognition in these patients may attenuate this offending behavior.
精神病态与元认知困难一直被认为与精神分裂症患者的暴力行为有关。然而，有证据表明，在元认知测试中，非精神分裂症的精神病态者表现与健康对照组相当，甚至更优。我们假设，共病的精神病态可能会改善与精神分裂症相关的元认知困难。为此，我们对79名有犯罪史的精神分裂症患者进行了元认知（使用简化版元认知评估量表[MAS-A]）和精神病态（使用修订版哈瑞精神病态量表[PCL-R]）评估。分段回归分析显示，在PCL-R评分为24分时，元认知与精神病态之间的关联从负相关转变为正相关。这个分数在欧洲用于诊断精神病态的临界值范围内，相当于PCL-R评分为26分。PCL-R评分高于24分的患者总体元认知能力更好，这表明这些患者构成了一个特殊群体，在这个群体中精神分裂症对元认知的损害作用减弱。然而，MAS-A的掌握分量表（该分量表指利用自身心理状态解决社会和心理困境的能力）并未出现这种效果。我们的研究结果表明，精神病态程度极高的精神分裂症患者元认知能力的相对保留可能导致他们的犯罪行为，因为这可能使他们懂得如何操纵和敲诈受害者。然而，提高这些患者元认知的掌握领域能力可能会减少这种犯罪行为。
