Clinical insight in first episode psychosis: the role of metacognition

Abstract

Background

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.

Aims

To explore whether metacognitive ability and cognitive insight are associated with clinical insight while controlling for IQ, depression, and symptoms in FEP.

Methods

60 individuals with FEP completed measures for clinical insight, metacognitive ability, cognitive insight, positive and negative symptoms, depression, and IQ.

Results

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.

Discussion

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.

Keywords:

• First episode psychosis
• clinical insight
• cognitive insight
• metacognition
• positive symptoms
• IQ
• depression
• negative symptoms
• medication

Acknowledgments

We thank all participants for taking part in the study. This study was presented as a poster for SIRS conference 2019.

Disclosure statement

There are no conflicts of interest.

Author contribution

AW and PL developed the hypotheses for the study. AW collected the data. AW produced the manuscript with reviewing and editing from all authors (PL, KG, DF).

Data availability statement

Due to the sensitive nature of the questions during the study, participants were assured raw data would remain confidential and would not be shared. Requests to access the dataset should be directed to Abigail C. Wright: [email protected].

Notes

1 As this study involved re-contacting individuals from an early cohort study, one participant was above the 18-40 range.

2 Due to the way educational level, martial status, ethnicity, work status and accommodation status were measured and the assumptions of chi-square tests, we had to collapse the groups. Participants who preferred not to state their answer were removed from these chi-squared analyses.