Martiadis Vassilis, Pessina Enrico, Raffone Fabiola, Iniziato Valeria, Martini Azzurra, Scognamiglio Pasquale
Department of Mental Health, Community Mental Health Center DS 25, ASL Napoli 1 Centro, Naples, Italy.
Department of Mental Health, Community Mental Health Center, ASL Cuneo 2, Alba, Italy.
Front Psychiatry. 2023 Apr 13;14:1155321. doi: 10.3389/fpsyt.2023.1155321. eCollection 2023.
Metacognition refers to the cognitive ability to control, monitor and modulate cognitive processes thus guiding and orienting behavior: a continuum of mental activities that ranges from more discrete ones, such as the awareness of the accuracy of others' judgment, to more integrated activities, such as the knowledge of cognitive processes. Metacognition impairment in schizophrenia, which is considered a core feature of the illness, has become a growing research field focusing on a wide range of processes including reasoning, autobiographical memory, memory biases, cognitive beliefs and clinical insight. There is a well-established relationship between metacognition and schizophrenia symptoms severity, as well as between impaired metacognitive functioning and specific symptomatic sub-domains, such as positive symptoms, negative symptoms, or disorganization. The development of specific cognitive-derived psychotherapies for metacognitive deficits in schizophrenia has been ongoing in the last years. Although sharing a metacognitive feature, these treatments focus on different aspects: false or unhelpful beliefs for metacognitive therapy; cognitive biases for metacognitive training; schematic dysfunctional beliefs for cognitive behavioral therapy (CBT) for psychoses; metacognitive knowledge and sense of identity for MERIT; interpersonal ideas or events triggering delusional thinking for MIT-P. This article reviews the instruments designed to assess metacognitive domains and functions in individuals with schizophrenia, providing mental health professionals with an overview of the heterogeneous current scenario ranging from self-administered scales to semi-structured interviews, which are supported by a variety of theoretical frameworks. Future directions may address the need for more specific and refined tools, also able to follow-up psychotherapeutic-induced improvements.
元认知是指控制、监测和调节认知过程从而引导和定向行为的认知能力：这是一个连续的心理活动，范围从较为离散的活动，如对他人判断准确性的意识，到更为综合的活动，如对认知过程的了解。精神分裂症中的元认知损害被认为是该疾病的一个核心特征，已成为一个不断发展的研究领域，关注包括推理、自传体记忆、记忆偏差、认知信念和临床洞察力等广泛的过程。元认知与精神分裂症症状严重程度之间存在既定的关系，以及元认知功能受损与特定症状子领域之间的关系，如阳性症状、阴性症状或紊乱症状。近年来，针对精神分裂症元认知缺陷的特定认知衍生心理治疗一直在发展。尽管这些治疗都具有元认知特征，但它们关注的是不同方面：元认知治疗关注错误或无用的信念；元认知训练关注认知偏差；精神病认知行为疗法（CBT）关注图式功能失调信念；MERIT关注元认知知识和身份感；MIT-P关注引发妄想思维的人际观念或事件。本文回顾了旨在评估精神分裂症患者元认知领域和功能的工具，为心理健康专业人员提供了一个从自我管理量表到半结构化访谈的异质当前情况概述，这些都有各种理论框架的支持。未来的方向可能需要更具体和精细的工具，这些工具还能够跟踪心理治疗引起的改善情况。
