Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
J Ment Health. 2023 Feb;32(1):78-86. doi: 10.1080/09638237.2021.1922629. Epub 2021 May 17.
Poor clinical insight has been commonly reported in those with First Episode Psychosis (FEP) and thought to be influenced by a range of factors, including neurocognition and symptoms. Clinical insight may be compromised as a result of alterations in higher-level reflective processes, such as metacognitive ability and cognitive insight.
To explore whether metacognitive ability and cognitive insight are associated with clinical insight while controlling for IQ, depression, and symptoms in FEP.
60 individuals with FEP completed measures for clinical insight, metacognitive ability, cognitive insight, positive and negative symptoms, depression, and IQ.
Higher levels of metacognitive ability were associated with better clinical insight, even when controlling for IQ, depression, positive and negative symptoms, and medication. Integration subscale of metacognitive ability was most strongly associated with clinical insight. Cognitive insight was associated with clinical insight when controlling for covariates. However, when including metacognitive ability and cognitive insight in the predictive model, only metacognitive ability was significantly related to clinical insight.
Metacognitive ability, specifically the ability to describe one's evolving mental state to provide a coherent narrative, was significantly related to clinical insight, independent of covariates, and may be a potentially important target for intervention in FEP.
首次发作精神病（FEP）患者的临床洞察力通常较差，据认为这受到多种因素的影响，包括神经认知和症状。临床洞察力可能会因为高级反思过程的改变而受到影响，例如元认知能力和认知洞察力。
在控制 FEP 中的智商、抑郁和症状的情况下，探讨元认知能力和认知洞察力是否与临床洞察力相关。
60 名 FEP 患者完成了临床洞察力、元认知能力、认知洞察力、阳性和阴性症状、抑郁和智商的测量。
较高的元认知能力水平与更好的临床洞察力相关，即使在控制智商、抑郁、阳性和阴性症状以及药物治疗的情况下也是如此。元认知能力的整合子量表与临床洞察力的相关性最强。认知洞察力在控制协变量的情况下与临床洞察力相关。然而，当将元认知能力和认知洞察力纳入预测模型时，只有元认知能力与临床洞察力显著相关。
元认知能力，特别是描述自己不断变化的心理状态以提供连贯叙述的能力，与临床洞察力显著相关，独立于协变量，并且可能是 FEP 干预的一个潜在重要目标。
