title: Metacognitive functioning predicts positive and negative symptoms over 12 months in first episode psychosis.
abstract: The negative symptoms of schizophrenia are a major source of impairment and distress but both pharmacological and psychological treatment options provide only modest benefit. Developing more effective psychological treatments for negative symptoms will require a more sophisticated understanding of the psychological processes that are implicated in their development and maintenance. We extended previous work by demonstrating that metacognitive functioning is related to negative symptom expression across the first 12 months of first episode psychosis (FEP). Previous studies in this area have either been cross-sectional or have used much older participants with long-standing symptoms. In this study, forty-five FEP participants were assessed three times over 12 months and provided data on PANSS rated symptoms, premorbid adjustment, metacognitive functioning, and DUP. Step-wise linear regression showed that adding metacognition scores to known predictors of negative symptoms (baseline symptom severity, gender, DUP, and premorbid academic and social adjustment) accounted for 62% of the variance in PANSS negative symptom scores at six months and 38% at 12 months. The same predictors also explained 47% of the variance in positive symptoms at both six and 12 months. However, exploration of the simple correlations between PANSS symptom scores and metacognition suggests a stronger univariate relationship between metacognition and negative symptoms. Overall, the results indicate that problems with mental state processing may be important determinants of negative symptom expression from the very early stages of psychosis. These results provide further evidence that metacognitive functioning is a potentially relevant target for psychological interventions.
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. Electronic address: hamish.mcleod@glasgow.ac.uk.
authors.forename: Hamish J
authors.initials: HJ
authors.lastname: McLeod
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. Electronic address: andrew.gumley@glasgow.ac.uk.
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Gumley
authors.affiliation: NHS Grampian, Psychiatry Research Group, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK; University of Aberdeen, Psychiatry Research Group, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK. Electronic address: angus.macbeth@abdn.ac.uk.
authors.forename: Angus
authors.initials: A
authors.lastname: Macbeth
authors.affiliation: Section of Clinical & Health Psychology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK. Electronic address: M.Schwannauer@ed.ac.uk.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwannauer
authors.affiliation: Roudebush VA Medical Center, Indiana University School of Medicine, USA; Department of Psychiatry, Indiana University School of Medicine, USA. Electronic address: plysaker@iupui.edu.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lysaker
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D062706:Prodromal Symptoms; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D012919:Social Behavior; D013997:Time Factors; D055815:Young Adult
keywords: First episode psychosis; Metacognition; Negative symptoms