Department of Psychology, University of Sussex, Falmer, Brighton BN1 9QH, UK.
R&D department, Sussex Partnership NHS Foundation Trust.
Schizophr Bull. 2017 Jul 1;43(4):824-832. doi: 10.1093/schbul/sbw128.
Neurocognitive and functional outcome deficits have long been acknowledged in schizophrenia and neurocognition has been found to account for functional disability to a greater extent than psychopathology. Much of the variance in functional outcome however still remains unexplained and metacognition may mediate the relationship between neurocognition, functional capacity, and self-reported social and occupational function.
Eighty first episode psychosis participants were recruited and completed measures of neurocognition (memory, executive function, and intelligence quotient), metacognition (Beck Cognitive Insight Scale, Metacognitive Awareness Interview), psychopathology (PANSS), and both functional capacity (UPSA) and real-life social and occupational function (The Time Use Survey). Path analyses investigated the relationships between variables through structural equation modeling.
A series of path models demonstrated that metacognition partially mediates the relationship between neurocognition and functional capacity, and fully mediates the relationship between functional capacity and social and occupational function.
The present study findings identify that metacognition may be critical to translating cognitive and functional skills into real-world contexts, and this relationship is found at early stages of illness. Understanding how individuals translate cognitive and functional skills into the real-world (the competence-performance gap) may offer valuable guidance to intervention programs. This finding is important to models of recovery as it suggests that intervention programs that focus on enhancing metacognition abilities may have a greater impact than traditional rehabilitation programs focusing on cognitive abilities, on social and occupational outcomes.
精神分裂症患者的神经认知和功能结果缺陷由来已久，神经认知被发现比精神病理学更能导致功能障碍。然而，功能结果的大部分差异仍然无法解释，元认知可能在神经认知、功能能力以及自我报告的社会和职业功能之间的关系中起中介作用。
招募了 80 名首发精神病患者，并完成了神经认知（记忆、执行功能和智商）、元认知（贝克认知洞察力量表、元认知意识访谈）、精神病理学（PANSS）以及功能能力（UPSA）和现实生活中的社会和职业功能（时间使用调查）的测量。路径分析通过结构方程模型研究了变量之间的关系。
一系列路径模型表明，元认知部分中介了神经认知和功能能力之间的关系，并且完全中介了功能能力和社会及职业功能之间的关系。
本研究结果表明，元认知可能是将认知和功能技能转化为现实世界情境的关键，这种关系在疾病早期就存在。了解个体如何将认知和功能技能转化为现实世界（能力-表现差距），可能为干预计划提供有价值的指导。这一发现对于康复模式很重要，因为它表明，与专注于认知能力的传统康复计划相比，专注于增强元认知能力的干预计划可能对社会和职业结果产生更大的影响。
