title: Deficits in metacognitive capacity distinguish patients with schizophrenia from those with prolonged medical adversity.
abstract: Research has suggested that many with schizophrenia experience decrements in synthetic metacognition, or the abilities to form integrated representations of oneself and others and then utilize that knowledge to respond to problems. Although such deficits have been linked with functional impairments even after controlling for symptoms and neurocognition, it is unclear to what extent these deficits can distinguish persons with schizophrenia from others experiencing significant life adversity but without psychosis. To explore this issue we conducted logistic regression analysis to determine whether assessment of metacognition could distinguish between 166 participants with schizophrenia and 51 adults with HIV after controlling for social cognition and education. Metacognition was assessed with the Metacognitive Assessment Scale Abbreviated (MAS-A), and social cognition with the Bell Lysaker Emotion Recognition Test. We observed that the MAS-A total score was able to correctly classify 93.4% of the schizophrenia group, with higher levels of metacognition resulting in increased likelihood of accurate categorization. Additional exploratory analyses showed specific domains of metacognition measured by the MAS-A were equally able to predict membership in the schizophrenia group. Results support the assertion that deficits in the abilities to synthesize thoughts about oneself and others into larger representations are a unique feature of schizophrenia.
authors.affiliation: Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA; Indiana University School of Medicine Indianapolis, IN, USA. Electronic address: plysaker@iupui.edu.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lysaker
authors.affiliation: Indiana University School of Medicine Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Vohs
authors.affiliation: Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Hamm
authors.affiliation: Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Kukla
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Minor
authors.affiliation: Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands; Department of Clinical and Experimental Psychopathology, Rijksuniversiteit Groningen, The Netherlands.
authors.forename: Steven
authors.initials: S
authors.lastname: de Jong
authors.affiliation: Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Rozanne
authors.initials: R
authors.lastname: van Donkersgoed
authors.affiliation: Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands; Department of Clinical and Experimental Psychopathology, Rijksuniversiteit Groningen, The Netherlands.
authors.forename: Marieke H M
authors.initials: MH
authors.lastname: Pijnenborg
authors.affiliation: Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA.
authors.forename: Jerillyn S
authors.initials: JS
authors.lastname: Kent
authors.affiliation: Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Matthews
authors.affiliation: Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Ringer
authors.affiliation: University of Indianapolis, School of Psychological Science, Indianapolis, IN, USA.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Leonhardt
authors.affiliation: Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA; Indiana University School of Medicine Indianapolis, IN, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Francis
authors.affiliation: Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Buck
authors.affiliation: Centro di Terapia Metacognitiva Interpersonale, Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Dimaggio
mesh_terms: D003071:Cognition; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011581:Psychological Tests; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D012938:Social Perception; D056345:Theory of Mind; D013850:Thinking
keywords: Adversity; HIV+; Metacognition; Schizophrenia; Social cognition; Theory of mind