Relationships between neuropsychological performance, insight, medication adherence, and social metacognition in schizophrenia.
Schizophrenia Research. 2023-02-01; 252: 48-55
DOI: 10.1016/j.schres.2022.12.037
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1. Schizophr Res. 2023 Feb;252:48-55. doi: 10.1016/j.schres.2022.12.037. Epub
2023 Jan 7.
Relationships between neuropsychological performance, insight, medication
adherence, and social metacognition in schizophrenia.
Roux P(1), Faivre N(2), Urbach M(3), Aouizerate B(4), Brunel L(5), Capdevielle
D(6), Chereau I(7), Dubertret C(8), Dubreucq J(9), Fond G(10), Lançon C(11),
Leignier S(9), Mallet J(12), Misdrahi D(13), Pires S(7), Schneider P(14),
Schurhoff F(5), Yazbek H(6), Zinetti-Bertschy A(14), Passerieux C(3),
Brunet-Gouet E(3).
Author information:
(1)Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles,
Service Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie, Le
Chesnay, France; Université Paris-Saclay, Université Versailles
Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, 94807 Villejuif,
France. Electronic address: .
(2)Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000 Grenoble,
France.
(3)Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles,
Service Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie, Le
Chesnay, France; Université Paris-Saclay, Université Versailles
Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, 94807 Villejuif,
France.
(4)Fondation Fondamental, Créteil, France; Department of Adult Psychiatry,
Charles Perrens Hospital, F-33076 Bordeaux, France; Laboratory of Nutrition and
Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, France.
(5)Fondation Fondamental, Créteil, France; INSERM U955, Translational Psychiatry
Team, AP-HP Mondor University Hospital, DHU Pe-PSY, Schizophrenia Expert Center,
40 rue de Mesly, 94000 Creteil, France.
(6)Fondation Fondamental, Créteil, France; University Department of Adult
Psychiatry, Hospital La Colombière, CHU Montpellier, France; INSERM, Univ
Montpellier, Neuropsychiatry: Epidemiological and Clinical Research,
Montpellier, France; University of Montpellier, Montpellier, France.
(7)Fondation Fondamental, Créteil, France; CHU Clermont-Ferrand, Service de
Psychiatrie B, Université Clermont Auvergne, Clermont-Ferrand, France.
(8)Fondation Fondamental, Créteil, France; AP-HP, Department of Psychiatry,
Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of
Psychiatry and Neuroscience of Paris, Paris Descartes University, France;
Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France.
(9)Fondation Fondamental, Créteil, France; Psychosocial Rehabilitation Reference
Centre, Alpes Isère Hospital, Grenoble, France.
(10)Fondation Fondamental, Créteil, France; La Conception Hospital, AP-HM,
Aix-Marseille Univ, School of Medicine – La Timone Medical Campus, EA 3279:
CEReSS – Health Service Research and Quality of Life Center, 27 Boulevard Jean
Moulin, 13005 Marseille, France.
(11)Fondation Fondamental, Créteil, France; Ste Marguerite Hospital, AP-HM,
Aix-Marseille Univ, School of Medicine – La Timone Medical Campus, EA 3279:
CEReSS – Health Service Research and Quality of Life Center, 27 Boulevard Jean
Moulin, 13005 Marseille, France.
(12)Fondation Fondamental, Créteil, France; University Department of Adult
Psychiatry, Hospital La Colombière, CHU Montpellier, France.
(13)Fondation Fondamental, Créteil, France; Department of Adult Psychiatry,
Charles Perrens Hospital, F-33076 Bordeaux, France; University of Bordeaux, CNRS
UMR 5287-INCIA, Bordeaux, France.
(14)Fondation Fondamental, Créteil, France; University Hospital of Strasbourg,
Department of Psychiatry, University of Strasbourg, Strasbourg, France; Inserm
U1114, Strasbourg, France.
BACKGROUND: Social metacognition is still poorly understood in schizophrenia,
particularly its neuropsychological basis and its impact on insight and
medication adherence. We therefore quantified social metacognition as the
agreement between objective and subjective mentalization and assessed its
correlates in a sample of individuals with schizophrenia spectrum disorders.
METHODS: Participants consisted of 143 patients with schizophrenia or
schizoaffective disorders who underwent a metacognitive version of a
mentalization task, an extensive neuropsychological battery, and a clinical
evaluation to assess their insight into illness and medication adherence. We
studied potential interactions between confidence judgments and several
neuropsychological and clinical variables on mentalization accuracy with
mixed-effects multiple logistic regressions.
RESULTS: Confidence judgments were closely associated with mentalization
accuracy, indicative of good social metacognition in this task. Working memory,
visual memory, and reasoning and problem-solving were the three
neuropsychological dimensions positively associated with metacognition. By
contrast, the two measures of medication adherence were associated with poorer
metacognition, whereas no association was found between metacognition and
clinical insight. The multiple regression model showed a significant positive
impact of better working memory, older age at onset, longer duration of
hospitalization, and worse medication adherence on social metacognition.
CONCLUSIONS: We discuss possible mechanisms underlying the apparent association
between social metacognition and working memory. Adherence should be monitored
when remediating social metacognition, and psychoeducation should be given to
patients with a high level of awareness of their capacity to mentalize.
Copyright © 2023 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.schres.2022.12.037
PMID: 36623435 [Indexed for MEDLINE]
Conflict of interest statement: Declaration of competing interest None.