Department of Psychiatry, Richard L. Roudebush VA Medical Center, 116A, 1481 W. 10th Street, Indianapolis, IN, 46202, United States.
Psychotherapy and Social Rehabilitation Department, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia; Mental-Health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
J Psychiatr Res. 2021 Aug;140:1-6. doi: 10.1016/j.jpsychires.2021.05.030. Epub 2021 May 23.
Schizophrenia is increasingly understood as an interactive network of disturbances in different elements of self-awareness. In this study we have examined the relationship between disturbances in two forms of awareness: cognitive insight and clinical insight by exploring whether their relationship is mediated by a third form of larger awareness: metacognition.
Participants were 41 outpatients with schizophrenia and 37 outpatients with early episode psychosis gathered in Moscow, Russia. Metacognition was assessed with the Metacognition Assessment Scale - Abbreviated. Verbal memory and positive symptoms were assessed for use as additional mediators.
Mediation analyses revealed that after accounting for the effects of positive symptoms and verbal memory, the relationship between the self-reflection domain of cognitive insight and clinical insight was significantly mediated by overall metacognitive capacity. Further, positive symptoms were a significant mediator between the cognitive insight self-reflection domain and clinical insight. Neither metacognition nor positive symptoms or verbal memory were found to mediate the relationship of the cognitive insight domain of self-certainty with clinical insight.
Decrements in some forms of ability to reflect upon one's thinking may reduce the ability to form complex and integrated ideas of oneself and others, leading to less coherent and complete accounts of the experience of schizophrenia.
精神分裂症越来越被理解为自我意识不同元素中一系列相互作用的紊乱。在这项研究中，我们通过探索认知洞察和临床洞察力两种形式的意识紊乱是否由更大的第三种意识形式——元认知来介导，从而检验了这两种意识紊乱之间的关系。
参与者为 41 名莫斯科的精神分裂症门诊患者和 37 名首发精神病门诊患者。元认知通过元认知评估量表-简化版进行评估。言语记忆和阳性症状用于作为额外的中介进行评估。
中介分析显示，在考虑阳性症状和言语记忆的影响后，认知洞察的自我反思领域与临床洞察力之间的关系显著由整体元认知能力所介导。此外，阳性症状是认知洞察的自我反思领域与临床洞察力之间的重要中介。元认知、阳性症状和言语记忆都不能介导自我确信认知洞察领域与临床洞察力之间的关系。
某些形式的自我思维反思能力的下降可能会降低形成对自己和他人的复杂和综合观念的能力，导致对精神分裂症体验的描述不完整。
