Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain.
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain.
Psychopathology. 2022;55(2):104-115. doi: 10.1159/000521915. Epub 2022 Feb 17.
Insight in schizophrenia spectrum disorders (SSD) is associated with outcomes. Although the neurocognitive basis of insight is widely accepted, the specific contribution of decision-making (Jumping to Conclusions [JTC]), Cognitive Insight (CI), and Theory of Mind (ToM) to insight remains unclear.
The sample included N = 77 SSD outpatients aged 18-64 years from a randomized controlled trial of metacognitive training. Assessments included JTC-Beads Task, CI-Beck Cognitive Insight Scale, ToM-Hinting Task, and the Emotions Recognition Test Faces.
hierarchical multivariable linear regression models tested their contribution to total insight (TI) and three insight dimensions - illness recognition (IR), symptom relabelling (SR), and treatment compliance (TC) - measured with the Schedule for the Assessment of Insight - Expanded version, whilst adjusting for potential confounders.
Bivariate analyses showed that CI was associated with TI (R2 change = 0.214; p < 0.001), IR (R2 change = 0.154; p = 0.003), and SR (R2 change = 0.168; p = 0.003), while JTC predicted IR (R2 change = 0.790; p = 0.020). Multivariable regression models showed that CI predicted TI (R2 change = 0.116; p = 0.036) and SR (R2 change = 0.166, p = 0.011), whereas JTC was linked with IR (R2 change = 0.710; p = 0.026). ToM was not linked with any insight score. No cognitive variable was associated with treatment compliance.
Results supported the (meta)cognitive model of insight in SSD. JTC and CI emerged as the main (meta)cognitive processes underlying insight. Metacognitive interventions may therefore improve insight in SSD, although these therapies alone may fail to address treatment compliance.
精神分裂症谱系障碍（SSD）的洞察力与结局相关。尽管神经认知基础的洞察力被广泛接受，但决策（仓促结论[JTC]）、认知洞察力（CI）和心理理论（ToM）对洞察力的具体贡献仍不清楚。
本样本包括来自认知训练随机对照试验的 N = 77 名 18-64 岁的 SSD 门诊患者。评估包括 JTC-珠子任务、CI-贝克认知洞察力量表、ToM-暗示任务和面部情绪识别测试。
分层多变量线性回归模型测试了它们对总洞察力（TI）和三个洞察力维度-疾病识别（IR）、症状重新标记（SR）和治疗依从性（TC）的贡献，使用扩展版的洞察力评估时间表进行测量，同时调整了潜在的混杂因素。
双变量分析显示，CI 与 TI（R2 变化= 0.214；p < 0.001）、IR（R2 变化= 0.154；p = 0.003）和 SR（R2 变化= 0.168；p = 0.003）相关，而 JTC 预测 IR（R2 变化= 0.790；p = 0.020）。多变量回归模型显示，CI 预测 TI（R2 变化= 0.116；p = 0.036）和 SR（R2 变化= 0.166，p = 0.011），而 JTC 与 IR 相关（R2 变化= 0.710；p = 0.026）。ToM 与任何洞察力得分均无关。没有认知变量与治疗依从性相关。
结果支持 SSD 中的（元）认知洞察力模型。JTC 和 CI 成为洞察力的主要（元）认知过程。因此，元认知干预可能会改善 SSD 中的洞察力，尽管这些治疗方法本身可能无法解决治疗依从性问题。
