title: Self-assessment in schizophrenia: Accuracy of evaluation of cognition and everyday functioning.
abstract: OBJECTIVE
  Self-assessment deficits, often referred to as impaired insight or unawareness of illness, are well established in people with schizophrenia. There are multiple levels of awareness, including awareness of symptoms, functional deficits, cognitive impairments, and the ability to monitor cognitive and functional performance in an ongoing manner. The present study aimed to evaluate the comparative predictive value of each aspect of awareness on the levels of everyday functioning in people with schizophrenia.
  
  
  METHODS
  We examined multiple aspects of self-assessment of functioning in 214 people with schizophrenia. We also collected information on everyday functioning rated by high contact clinicians and examined the importance of self-assessment for the prediction of real-world functional outcomes. The relative impact of performance-based measures of cognition, functional capacity, and metacognitive performance on everyday functioning was also examined.
  
  
  RESULTS
  Misestimation of ability emerged as the strongest predictor of real-world functioning and exceeded the influences of cognitive performance, functional capacity performance, and performance-based assessment of metacognitive monitoring. The relative contribution of the factors other than self-assessment varied according to which domain of everyday functioning was being examined, but, in all cases, accounted for less predictive variance.
  
  
  CONCLUSIONS
  These results underscore the functional impact of misestimating one's current functioning and relative level of ability. These findings are consistent with the use of insight-focused treatments and compensatory strategies designed to increase self-awareness in multiple functional domains.
authors: Department of Psychiatry, University of Miami Miller School of Medicine.
authors: Felicia
authors: F
authors: Gould
authors: Department of Psychiatry, University of Miami Miller School of Medicine.
authors: Laura Stone
authors: LS
authors: McGuire
authors: Department of Psychiatry, University of Miami Miller School of Medicine.
authors: Dante
authors: D
authors: Durand
authors: Department of Psychiatry, University of Miami Miller School of Medicine.
authors: Samir
authors: S
authors: Sabbag
authors: Department of Psychiatry, University of Miami Miller School of Medicine.
authors: Carlos
authors: C
authors: Larrauri
authors: Department of Psychiatry, University of California, San Diego.
authors: Thomas L
authors: TL
authors: Patterson
authors: Department of Psychiatry, University of California, San Diego.
authors: Elizabeth W
authors: EW
authors: Twamley
authors: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine.
authors: Philip D
authors: PD
authors: Harvey
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000339:Affect; D003071:Cognition; D003072:Cognition Disorders / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance; D012559:Schizophrenia; D012565:Schizophrenic Psychology; D012647:Self-Assessment
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