Metacognitive knowledge and experience in recently diagnosed patients with bipolar disorder

ABSTRACT

Introduction. Metacognition, which refers to an individual’s ability to assess their own cognitive ability or performance, is poorly understood in bipolar disorder. This study was conducted to evaluate two aspects of metacognitive ability in recently diagnosed patients with bipolar disorder: (a) metacognitive knowledge, pertaining to awareness of one’s own general cognitive functioning; and (b) metacognitive experience, referring to awareness of one’s cognitive performance on a specific, online cognitive task. Method. Participants consisted of 50 clinically euthymic patients recently diagnosed with Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM–IV) bipolar I disorder who were within three months of resolution of their first manic episode, and a comparison group of 38 demographically similar healthy volunteers. To assess metacognitive knowledge, participants provided a general rating of their estimated cognitive ability prior to completing a neuropsychological battery, and self-ratings were compared to actual ability based on a composite score of overall cognitive functioning. To assess metacognitive experience, subjects provided a postdiction rating of their perceived memory performance after completing a list learning verbal memory test, and self-ratings were compared to actual memory performance. Measures of both relative and absolute accuracy of ratings were obtained. Results. Results indicated that patients showed diminished accuracy in rating their general cognitive ability, implying deficits in metacognitive knowledge. In contrast, patients were accurate in rating their online memory performance, suggesting intact metacognitive experience. Conclusions. Findings suggest that in patients with bipolar disorder, intact task-specific cognitive self-appraisals may fail to generalize to or to modify inaccurate global cognitive self-appraisals. Further research using more comprehensive metacognitive tasks is warranted in bipolar disorder.

KEYWORDS:

• Awareness
• Metacognition
• Unawareness
• Verbal learning
• Memory
• Metamemory

Acknowledgements

The data for this manuscript were generated from the Systematic Treatment Optimization Program for Early Mania.

Disclosure statement

Lakshmi N. Yatham has been a member of advisory board, received research grants, and been a speaker for Astrazeneca, Janssen, Lilly, GSK, Bristol Myers Squibb, Novartis, Servier, Lundbeck, Merck, and Pfizer. Ivan J. Torres has served as a consultant for Lundbek Canada. The remaining authors report no financial interests or other potential conflicts of interest.

Additional information

Funding

This work was supported by Astrazeneca Canada [grant number DC9900205]; and the Canadian Institute of Health [research grant number MOP-115166].