Identifying Latent Groups of Individuals with First Episode Psychosis Based on Social Relationships: A Reconsideration of Social Functioning

First episode psychosis (FEP) occurs at an important developmental time for adolescents and young adults when social relationships are of particular importance. The concept of social functioning in psychosis has frequently utilized concepts from the chronic serious mental illness (SMI) literature and as such, can lack emphasis on these relationships as being critical components of an individual’s illness and recovery. Ascertaining potential patterns of social functioning in FEP individuals can help guide treatment and identify important ways in which individuals differ in this area. The current study used latent class analysis (LCA) to identify subgroups of FEP individuals presenting for treatment at three coordinated specialty care clinics (n=134). Groups were identified based on satisfaction with social relationships and frequency of in-person and electronic communication with peers, family, and significant others. Groups were further characterized using demographic and clinical features. Linear and multinomial logistic regression models were utilized to determine the potential predictive relationships between duration of untreated psychosis (DUP), class membership, and for a subset of the sample, 6-month outcomes. Treatment goals set at baseline were also examined for their potential relationship to 6-month outcomes. LCA resulted in three classes: Class 1 (Dissatisfied) demonstrated the least satisfaction with their social relationships, reported the least frequent contact with others and greatest degree of symptom severity, particularly with regard to depression and avolition. Class 2 (Satisfied) reported the greatest degree of satisfaction and reported frequent contact with peers and family, as well as the lowest degree of symptom severity. Class 3 (In-Between) reported mixed satisfaction and dissatisfaction as well as some contact with peers and family and moderate levels of symptoms. DUP was not found to be a significant predictor of class membership or of 6-month outcomes. Neither class membership nor treatment goals were predictive of 6-month outcomes. Results are consistent with previous efforts in this area, and they extend the findings of other studies that have based classification on premorbid adjustment. Nuanced approaches to defining social functioning in FEP are indicated, as are varied approaches to treatment based on objective and subjective indicators of social interactions and social relationships.Doctor of Philosoph

The Performance of Empathic Expression Rating Scale: A Role-Play Assessment Of Empathy For Individuals With Schizophrenia

Social cognitive deficits are well documented in people with schizophrenia; this includes deficits in empathy, or the ability to both understand and share the emotions of another person. However, current measures of empathy are generally inappropriate for this population. The present study evaluated the psychometric properties of a role-play measure of empathy called the Performance of Empathic Expression Rating Scale (PEERS) in a sample of 60 individuals with schizophrenia and 51 healthy controls. The ratings assess a person’s ability to interact empathically with a confederate in an emotional situation. The PEERS demonstrated acceptable internal consistency, inter-rater reliability, and discriminant validity. Patients performed significantly worse than controls, but most of these differences were explained by social skill ability. The PEERS was also related to some aspects of a self-report measure of empathy and a theory of mind task. Implications for the future use of this assessment will be discussed.Master of Art

Metacognition in schizophrenia disorders: Comparisons with community controls and bipolar disorder: Replication with a Spanish language Chilean sample

Metacognition refers to the activities which allow for the availability of a sense of oneself and others in the moment. Research mostly in North America with English-speaking samples has suggested that metacognitive deficits are present in schizophrenia and are closely tied to negative symptoms. Thus, replication is needed in other cultures and groups. The present study accordingly sought to replicate these findings in a Spanish speaking sample from Chile. Metacognition and symptoms were assessed among 26 patients with schizophrenia, 26 with bipolar disorder and 36 community members without serious mental illness. ANCOVA controlling for age and education revealed that the schizophrenia group had greater levels of metacognitive deficits than the bipolar disorder and community control groups. Differences in metacognition between the clinical groups persisted after controlling for symptom levels. Spearman correlations revealed a unique pattern of associations of metacognition with negative and cognitive symptoms. Results largely support previous findings and provide added evidence of the metacognitive deficits present in schizophrenia and the link to outcome cross culturally. Implications for developing metacognitively oriented interventions are discussed

Metacognitive approaches to the treatment of psychosis: a comparison of four approaches

In light of increasing interest in metacognition and its role in recovery from psychosis, a range of new treatments focused on addressing metacognitive deficits have emerged. These include Metacognitive Therapy, Metacognitive Training, metacognitive insight and reflection therapy, and metacognitive interpersonal therapy for psychosis. While each of these treatments uses the term metacognitive, each differs in terms of their epistemological underpinnings, their structure, format, presumed mechanisms of action, and primary outcomes. To clarify how these treatments converge and diverge, we first offer a brief history of metacognition as well as its potential role in an individual's response to and recovery from complicated mental health conditions including psychosis. We then review the background, practices, and supporting evidence for each treatment. Finally, we will offer a framework for thinking about how each of these approaches may ultimately complement rather than contradict one another and highlight areas for development. We suggest first that each is concerned with something beyond what people with psychosis think about themselves and their lives. Each of these four approaches is interested in how patients with severe mental illness think about themselves. Each looks at immediate reactions and ideas that frame the meaning of thoughts. Second, each of these approaches is more concerned with why people make dysfunctional decisions and take maladaptive actions rather than what comprised those decisions and actions. Third, despite their differences, each of these treatments is true to the larger construct of metacognition and is focused on person's relationships to their mental experiences, promoting various forms of self-understanding which allow for better self-management. Each can be distinguished from other cognitive and skills-based approaches to the treatment of psychosis in their emphasis on sense-making rather than learning a new specific thing to say, think, or do in a given situation

Reflection and Recovery from Psychosis during the Time of COVID-19: Adaptation in Psychotherapy in the United States

In response to the coronavirus (COVID-19) pandemic several adaptations have allowed us to continue to provide one form of recovery-oriented psychotherapy to persons with psychosis: Metacognitive Insight and Reflection Therapy (MERIT). These successful adaptations have included the incorporation of patients’ experience of the pandemic and the exploration of challenges from temporary changes in therapy platforms to deepen reflections about patients’ self-experience, their experience of intersubjectivity and their own agentic responses to psychosocial challenges

Metacognitive deficits and social functioning in schizophrenia across symptom profiles: A latent class analysis

Functional deficits are a hallmark of schizophrenia spectrum disorders, but much debate still exists over why and how they originate. One model suggests that disturbances in social functioning are a result of metacognitive deficits or a failure to integrate information to form more complex ideas of themselves and others. It is unclear if this social dysfunction is present across different symptom presentations. We examined the relationship of metacognition, symptoms, and social functioning among a sample of adults with schizophrenia spectrum disorders (N ¼ 334). A latent class analysis produced a four-class model. Groups were classified as follows: diffuse symptoms/moderately impaired social functioning (Class 1), positive and hostility symptoms/mildly impaired social functioning (Class 2), minimal symptoms/good social functioning (Class 3), and negative and cognitive symptoms/severely impaired social functioning (Class 4). Class 3 demonstrated better overall metacognitive capacity than both Classes 1 and 4 but did not differ significantly from Class 2. Classes 2 and 3 both demonstrated better interpersonal functioning than Classes 1 and 4. Together, these findings provide support for models of poor functioning that stem from fragmentation of an individual’s experience, leading to diminished abilities to form meaningful connections with others. Additional interpretations, limitations, and research implications are discussed

Social cognition in schizophrenia: factor structure, clinical and functional correlates

Social cognition is consistently impaired in people with schizophrenia, separable from general neurocognition, predictive of real-world functioning, and amenable to psychosocial treatment. Few studies have empirically examined its underlying factor structure

Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis

Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT’s capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed

Neuroplastic Changes Following Social Cognition Training in Schizophrenia: A Systematic Review

Social cognitive impairment is a key feature of schizophrenia and social cognition training (SCT) is a promising tool to address these deficits. Neurobiological dysfunction in schizophrenia has been widely researched, but neuronal changes induced by SCT have been scarcely explored. This review aims to assess the neuroplastic effects of SCT in patients with schizophrenia spectrum disorders. PubMed and Web of Science databases were searched for clinical trials testing the effects of SCT in functional and structural brain measurements of adult patients with schizophrenia or schizoaffective disorders. A total of 11 studies were included: five used fMRI, two used EEG and ERP, one used ERP only, two used MEG and one study used MRI. Data extracting and processing regarding sociodemographic and clinical variables, intervention characteristics, neuroimaging procedures, neuroplastic findings, effect sizes and study quality criteria was completed by two raters. Results indicate a wide range of structural and functional changes in numerous regions and circuits of the social brain, including early perceptual areas, the limbic system and prefrontal regions. Despite the small number of trials currently available, evidence suggests that SCT is associated with neuroplastic changes in the social brain and concomitant improvements in social cognitive performance. There is a lack of extensive knowledge about the neural mechanisms that underlie social cognitive enhancement after treatment, but the reported findings may shed light on the neural substrates of social cognitive impairment in schizophrenia and how improved treatment procedures can be developed and applied.info:eu-repo/semantics/publishedVersio

Metacognitive deficits and social functioning in schizophrenia across symptom profiles: A latent class analysis

Functional deficits are a hallmark of schizophrenia spectrum disorders, but much debate still exists over why and how they originate. One model suggests that disturbances in social functioning are a result of metacognitive deficits or a failure to integrate information to form more complex ideas of themselves and others. It is unclear if this social dysfunction is present across different symptom presentations. We examined the relationship of metacognition, symptoms, and social functioning among a sample of adults with schizophrenia spectrum disorders (N ¼ 334). A latent class analysis produced a four-class model. Groups were classified as follows: diffuse symptoms/moderately impaired social functioning (Class 1), positive and hostility symptoms/mildly impaired social functioning (Class 2), minimal symptoms/good social functioning (Class 3), and negative and cognitive symptoms/severely impaired social functioning (Class 4). Class 3 demonstrated better overall metacognitive capacity than both Classes 1 and 4 but did not differ significantly from Class 2. Classes 2 and 3 both demonstrated better interpersonal functioning than Classes 1 and 4. Together, these findings provide support for models of poor functioning that stem from fragmentation of an individual’s experience, leading to diminished abilities to form meaningful connections with others. Additional interpretations, limitations, and research implications are discussed