Social, metacognition deficits in schizophrenia predict dysfunction type

By Ingrid Grasmo, medwireNews Reporter

Research findings suggest that deficits in social cognition and metacognition among individuals with schizophrenia represent different forms of dysfunction and symptomatology.

The findings published in Acta Psychiatrica Scandinavica show that difficulties in making discrete judgments about the thoughts and feelings of others and problems forming larger integrated representations of themselves and others are separate entities linked to different outcomes.

"An understanding of whether metacognitive and social cognitive processes are distinct could be of considerable importance as it may point to methods of assessing specific deficits, as well as the development of treatment that might address each of these difficulties separately," say Paul Lysaker (Indiana University School of Medicine, Indianapolis, USA) and co-authors.

In total, 95 patients with a schizophrenia spectrum disorder underwent three assessments of social cognition that evaluated the ability to identify emotions and intentions, and two metacognitive tasks requiring them to form more integrated and flexible representations of themselves and others.

Additional assessment of symptoms, social functioning and neurocognition revealed that low scores on the social cognition factor were linked to negative symptoms, poorer education, and suboptimal performance on an index of premorbid intellectual function.

The researchers say this finding suggests that negative symptoms represent a partial expression of underlying difficulties in the awareness of other individuals' mental state, resulting in diminished affect or avolition.

By contrast, low scores on the metacognitive awareness component were significantly linked to disorganized symptoms, frequency of social contacts, the capacity for relatedness, and flexibility in abstract thought.

The team notes that deficits in these two factors may amplify one another, with disorganized symptoms reflecting the breakdown of a metacognitive strategy for managing social situations perceived as difficult or ambiguous by the individual.

Despite not having a control group of patients without psychosis and the inability to infer causality, differences in social cognition and metacognition combined were found to account for 62% of the variance in patient outcomes.

Lysaker and team say the study findings highlight the importance of assessing patients for weaknesses in their ability to form integrated representations of the self and the ability to successfully perceive discrete mental phenomena.

"The underlying mechanisms of action for many successful integrative rehabilitation and psychotherapy interventions may involve addressing these deficits and further study of their interrelationship that may elucidate more clearly how to best assist persons with schizophrenia to recover," conclude the researchers.

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