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Schizophrenia and Metacognition: An Investigation of Course of Illness and Metacognitive Beliefs Within a First Episode Psychosis

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Abstract

The Self Regulatory Executive Function (S-REF) model implicates maladaptive metacognitive beliefs and processes in the predisposition and/or maintenance of positive psychotic symptoms. In the model, metacognitive beliefs guide cognitive and behavioural responses to cognitive experiences. This study tested for relationships between course of illness and levels of specific metacognitions in schizophrenia spectrum disorders. A large cohort of people with first episode psychosis (n = 578) recruited as part the OPUS trial (1998–2000) were tested. Information about course of illness (remitted, episodic or continually psychotic) and metacognitive belief ratings were collected. Data obtained from 367 participants revealed that levels of maladaptive metacognitive beliefs varied as a function of course of illness and distinguished between remitted patients and non-patients. Metacognitive beliefs explained 17 % additional variance displayed in course of illness in a multinomial regression analysis when controlling for other causal factors. In addition, beliefs concerning Need to Control thoughts (RR 1.13, 95 % CI 1.03–1.22, p < 0.01) predicted a continually psychotic course of illness. Elevations in metacognitive beliefs were associated with the severity and duration of psychotic symptoms, consistent with the S-REF model. Moreover, metacognition was a better predictor of course of illness than anxiety and depression. If these associations are shown to be causal, clinical interventions that modify metacognitive beliefs may also impact on positive symptoms and course of illness within schizophrenia.

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Acknowledgments

The authors would like to acknowledge the important contributions of Heidi Jensen, Lasse Randers and Lars Morså in the data collection phase of this study. A special thanks to all the participants that gave their time to make this study possible. The study was funded by unconditional grants from Lundbeck, Tryg Foundation and region Mid-Jutland research fund for psychiatric research.

Conflict of Interest

Stephen F. Austin, Ole Mors, Merete Nordentoft, Carsten R. Hjorthøj, Rikke G Secher, Morten Hesse, Roger Hagen, Marcantonio Spada, and Adrian Wells declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. This manuscript is original to the authors and the results have not been published or presented before. This manuscript is not under consideration for publication anywhere else and it has been approved by all co-authors and the centers where the study was undertaken (Center for Psychiatric Research, Risskov and Psychiatric Research Unit, Copenhagen).

Animal Rights

No animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Centre for Psychiatric Research, Aarhus University, Åarhus, Denmark

    Stephen F. Austin & Ole Mors

  2. Copenhagen Research Unit, University of Copenhagen, Copenhagen, Denmark

    Stephen F. Austin, Merete Nordentoft, Carsten R. Hjorthøj & Rikke G. Secher

  3. Centre for Drug and Alcohol Research, Aarhus University, Åarhus, Denmark

    Morten Hesse

  4. Department for Psychology, Norwegian University of Science and Technology, Trondheim, Norway

    Roger Hagen

  5. Department of Psychology, London South Bank University, London, UK

    Marcantonio Spada

  6. Department of Clinical Psychology, University of Manchester, Manchester, UK

    Adrian Wells

  7. Psychiatric Research Unit, Psychiatric Centre North Zealand, University of Copenhagen, Dyrehavevej 48, 3400, Hillerød, Denmark

    Stephen F. Austin

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  1. Stephen F. Austin
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Correspondence to Stephen F. Austin.

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Austin, S.F., Mors, O., Nordentoft, M. et al. Schizophrenia and Metacognition: An Investigation of Course of Illness and Metacognitive Beliefs Within a First Episode Psychosis. Cogn Ther Res 39, 61–69 (2015). https://doi.org/10.1007/s10608-014-9633-9

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  • DOI: https://doi.org/10.1007/s10608-014-9633-9

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