Integrated Program in Neuroscience, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Verdun, Canada.
Integrated Program in Neuroscience, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Verdun, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
Psychiatry Res. 2017 Dec;258:116-123. doi: 10.1016/j.psychres.2017.09.082. Epub 2017 Sep 28.
Poor clinical insight represents a major barrier to recovery in schizophrenia. Research suggests that higher-order social cognitive abilities such as theory of mind (TOM) and metacognition contribute to levels of clinical insight. However, few studies have examined whether social cognitive abilities other than TOM are related to clinical insight. Moreover, to date, no investigation has attempted to determine whether the contribution of metacognitive ability to clinical insight can be differentiated from the contribution of higher-order social cognition, despite their conceptual similarity. Therefore, the purpose of this study was to examine the relative contribution of different social cognitive abilities, as well as metacognition, to clinical insight in a large sample of 139 enduring schizophrenia patients, and controlling for established predictors of clinical insight. Hierarchical regression analyses were used to evaluate the portion of variance explained by 3 social cognitive abilities: emotion recognition, TOM, and affective empathy, and the metacognitive ability of self-reflectiveness. Clinical insight levels were assessed using the Schedule for the Assessment of Insight-Expanded version. Results indicated that affective empathy and self-reflectiveness are the strongest predictors of clinical insight. These results provide insights on the development of targeted interventions for improving clinical insight in this population.
较差的临床洞察力是精神分裂症康复的主要障碍。研究表明，较高阶的社会认知能力，如心理理论（Theory of Mind，TOM）和元认知，与临床洞察力水平相关。然而，很少有研究探讨除 TOM 之外的其他社会认知能力是否与临床洞察力相关。此外，迄今为止，尽管元认知能力和高阶社会认知能力在概念上相似，但尚无研究试图确定元认知能力对临床洞察力的贡献是否可以与高阶社会认知能力的贡献区分开来。因此，本研究旨在通过对 139 名持续性精神分裂症患者的大样本进行研究，考察不同社会认知能力（包括情绪识别、心理理论和情感同理心）以及元认知能力（自我反思）对临床洞察力的相对贡献，并控制临床洞察力的既定预测因素。采用层次回归分析来评估 3 种社会认知能力（情绪识别、心理理论和情感同理心）和元认知能力（自我反思）对临床洞察力的解释程度。使用精神分裂症临床洞察力评估量表-扩展版（Schedule for the Assessment of Insight-Expanded version）评估临床洞察力水平。结果表明，情感同理心和自我反思是临床洞察力的最强预测因素。这些结果为针对该人群提高临床洞察力的靶向干预措施的开发提供了思路。
