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精神分裂症谱系障碍中症状、神经认知和元认知与洞察力的关联。

Associations of symptoms, neurocognition, and metacognition with insight in schizophrenia spectrum disorders.

作者信息

Chan Kevin K S

机构信息

Department of Psychological Studies and Centre for Psychosocial Health, The Hong Kong Institute of Education, Hong Kong.

出版信息

Compr Psychiatry. 2016 Feb;65:63-9. doi: 10.1016/j.comppsych.2015.09.009. Epub 2015 Oct 13.

Abstract

Many persons with schizophrenia experience poor insight and, as a result, are at risk for treatment non-adherence and numerous negative outcomes. However, to date, the etiology of poor insight has not yet been fully elucidated. One recent theory concerning the roots of poor insight in schizophrenia has proposed that it may result, in part, from impairments in metacognition, or the capacity to think about thinking. The present study thus aims to examine whether metacognition is associated with insight even after controlling for the effects of psychiatric symptomatology and neurocognition. In this study, 95 adults with a schizophrenia spectrum disorder were assessed on measures of insight (i.e., awareness of symptoms, treatment needs, and illness consequences), psychiatric symptoms (i.e., positive symptoms, negative symptoms, and general psychopathology), neurocognitive functions (i.e., executive function, memory, and attention), and metacognitive capacities (i.e., self-reflectivity and theory of mind). Univariate correlations followed by stepwise multiple regressions, which controlled for symptoms and neurocognition, indicated that both self-reflectivity and theory of mind were significantly linked with awareness of symptoms; theory of mind was linked with awareness of treatment needs; and self-reflectivity was linked with awareness of illness consequences. Importantly, these findings suggest that metacognitive capacities may be related to insight independent of concurrent psychiatric symptoms and neurocognitive deficits. Moreover, awareness of different facets of the illness may require contributions from different components of metacognition. Future research should investigate how existing metacognitive skill training programs could potentially be tailored, or modified, to help persons with schizophrenia to develop and enhance insight.

摘要

许多精神分裂症患者自知力较差,因此存在治疗依从性差及出现众多负面后果的风险。然而,迄今为止,自知力差的病因尚未完全阐明。最近有一种关于精神分裂症自知力差根源的理论提出,它可能部分源于元认知障碍,即思考思维的能力受损。因此,本研究旨在探讨即使在控制了精神症状学和神经认知的影响之后,元认知是否与自知力相关。在这项研究中,对95名患有精神分裂症谱系障碍的成年人进行了评估,评估内容包括自知力(即对症状、治疗需求和疾病后果的认识)、精神症状(即阳性症状、阴性症状和一般精神病理学)、神经认知功能(即执行功能、记忆和注意力)以及元认知能力(即自我反思和心理理论)。先进行单变量相关性分析,然后进行控制症状和神经认知的逐步多元回归分析,结果表明自我反思和心理理论均与症状意识显著相关;心理理论与治疗需求意识相关;自我反思与疾病后果意识相关。重要的是,这些发现表明元认知能力可能与自知力相关,且独立于并发的精神症状和神经认知缺陷。此外,对疾病不同方面的认识可能需要元认知的不同组成部分的参与。未来的研究应该调查现有的元认知技能培训项目如何能够潜在地进行调整或修改,以帮助精神分裂症患者发展和提高自知力。

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