Metacognition and reflexivity in patients with schizophrenia

Many patients with schizophrenia demonstrate a lack of insight into their disorder and often do not complain about their cognitive impairments. This might be due to generally reduced metacognitive abilities.

Twenty-seven patients with a DSM IV diagnosis of schizophrenia and 19 healthy control subjects performed 2 separate tasks tapping into metacognitive functions. In the first experiment the participants encoded words. In the following recognition part they judged their level of subjective confidence in the correctness of their answer. In the second experiment reaction time was measured, whilst judgments were made about personality trait adjectives describing the subjects themselves or other familiar people.

Although the recognition rate in the first experiment was equal between the groups, the patients showed a significantly reduced ability to correctly judge their memory performance. There was no correlation between metamemory and psychopathology nor insight measures. The patients further needed significantly more time to characterize themselves compared to the healthy participants. The response rates for self-characterization correlated with the ability to recognize symptoms as part of a disorder but did not correlate with psychopathology.

Metacognitive faculties seem to be, at least in part, a separable cognitive entity. Patients with schizophrenia demonstrate impaired metacognitive capacities, independent of current symptoms or memory performance.