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Item A pilot randomized controlled trial comparing a novel compassion and metacognition approach for schizotypal personality disorder with a combination of cognitive therapy and psychopharmacological treatment(BMC, 2023-02-20) Cheli, Simone; Cavalletti, Veronica; Lysaker, Paul H.; Dimaggio, Giancarlo; Petrocchi, Nicola; Chiarello, Francesca; Enzo, Consuelo; Velicogna, Francesco; Mancini, Francesco; Goldzweig, Gil; Psychiatry, School of MedicineBackground: Schizotypal personality disorder is characterized by a pervasive pattern of maladaptive behavior that has been associated with the liability for schizophrenia. Little is known about effective psychosocial interventions. This pilot non-inferiority randomized controlled trial aimed to compare a novel form of psychotherapy tailored for this disorder and a combination of cognitive therapy and psychopharmacological treatment. The former treatment - namely, Evolutionary Systems Therapy for Schizotypy-integrated evolutionary, metacognitively oriented, and compassion focused approaches. Methods: Thirty-three participants were assessed for eligibility, twenty-four randomized on a 1:1 ratio, nineteen included in the final analysis. The treatments lasted 6 months (24 sessions). The primary outcome was change across nine measurements in personality pathology, the secondary outcomes were remission from diagnosis and pre-post changes in general symptomatology and metacognition. Results: Primary outcome suggested a non-inferiority of the experimental treatment in respect to control condition. Secondary outcomes reported mixed results. There was no significant difference in terms of remission, but experimental treatment showed a larger reduction of general symptomatology (η2 = 0.558) and a larger increase in metacognition (η2 = 0.734). Conclusions: This pilot study reported promising results about the effectiveness of the proposed novel approach. A confirmatory trial on large sample size is needed to provide evidence about relative effectiveness of the two treatment conditions.Item Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems(Public Library of Science, 2019-12-17) Hickson, Meredith R.; Conroy, Andrea L.; Bangirana, Paul; Opoka, Robert O.; Idro, Richard; Ssenkusu, John M.; John, Chandy C.; Pediatrics, School of MedicineBackground Acute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown. Methods We conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity. Results AKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children <6 years of age. Conclusions AKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.Item Adapting Writing Center Pedagogy for Composition Classrooms: A Metacognitive Approach(2012-05-04) Gellin, Laura M.; Fox, Stephen L.; Buchenot, Andre; Hogue, Teresa MolinderWhile a writing center tutor may view her role as a coach, a commentator, and a counselor, the tutor actually serves as scaffolding, a temporary, supportive replacement of the processes more experienced writers can manage alone without a tutor, namely, the metacognitive processes of self-assessing, self-monitoring, and self-motivating. Metacognition then becomes the essential factor in adapting writing center practices into the composition classroom. By re-conceptualizing the three roles of a writing center tutor and re-visioning the classroom into a more “pure” learning space, tutor-teachers improve students’ writing skills, increase their engagement, and redirect students’ focus toward the writing process rather than the grade. To demonstrate the efficacy of this adapted writing center approach in the composition classroom, I created an authentic, challenging project in which the pre-project activities, task design, work process, and reflection assignment enact my proposed theory. By adopting this approach, tutor-teachers ultimately empower students and design compositional tasks that act as a catalyst for transforming the way students understand themselves as writers and as students.Item Associations between Cortical Thickness and Metamemory in Alzheimer’s Disease(Springer, 2022) Duran, Tugce; Woo, Ellen; Otero, Diana; Risacher, Shannon L.; Stage, Eddie; Sanjay, Apoorva B.; Nho, Kwangsik; West, John D.; Phillips, Meredith L.; Goukasian, Naira; Hwang, Kristy S.; Apostolova, Liana G.; Neurology, School of MedicineMetacognitive deficits affect Alzheimer's disease (AD) patient safety and increase caregiver burden. The brain areas that support metacognition are not well understood. 112 participants from the Imaging and Genetic Biomarkers for AD (ImaGene) study underwent comprehensive cognitive testing and brain magnetic resonance imaging. A performance-prediction paradigm was used to evaluate metacognitive abilities for California Verbal Learning Test-II learning (CVLT-II 1-5) and delayed recall (CVLT-II DR); Visual Reproduction-I immediate recall (VR-I Copy) and Visual Reproduction-II delayed recall (VR-II DR); Rey-Osterrieth Complex Figure Copy (Rey-O Copy) and delayed recall (Rey-O DR). Vertex-wise multivariable regression of cortical thickness was performed using metacognitive scores as predictors while controlling for age, sex, education, and intracranial volume. Subjects who overestimated CVLT-II DR in prediction showed cortical atrophy, most pronounced in the bilateral temporal and left greater than right (L > R) frontal cortices. Overestimation of CVLT-II 1-5 prediction and DR performance in postdiction showed L > R associations with medial, inferior and lateral temporal and left posterior cingulate cortical atrophy. Overconfident prediction of VR-I Copy performance was associated with right greater than left medial, inferior and lateral temporal, lateral parietal, anterior and posterior cingulate and lateral frontal cortical atrophy. Underestimation of Rey-O Copy performance in prediction was associated with atrophy localizing to the temporal and cingulate areas, and in postdiction, with diffuse cortical atrophy. Impaired metacognition was associated to cortical atrophy. Our results indicate that poor insight into one's cognitive abilities is a pervasive neurodegenerative feature associated with AD across the cognitive spectrum.Item Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia- Spectrum Disorders: Relationship to Metacognitive Deficits(Oxford University Press, 2021-07-20) Mervis, Joshua E.; Bonfils, Kelsey A.; Cooper, Samuel E.; Wiesepape, Courtney; Lysaker, Paul H.; Psychiatry, School of MedicinePeople diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.Item A cognitive model of diminished expression in schizophrenia: The interface of metacognition, cognitive symptoms and language disturbances(Elsevier, 2020-12) García-Mieres, Helena; Lundin, Nancy B.; Minor, Kyle S.; Dimaggio, Giancarlo; Popolo, Raffaele; Cheli, Simone; Lysaker, Paul H.; Psychology, School of ScienceThe resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. However, little is understood about the psychological processes that reinforce and sustain the negative symptoms domain of diminished expression. Prior research has shown that higher levels of diminished expression relate to deficits in metacognitive capacity. We propose a more complex model in which diminished expression occurs when impairments in metacognitive self-reflectivity, alterations in higher-order language structure, and cognitive symptoms interact and thus interfere with persons' ability to understand and express emotions in ways others can recognize. Individuals with schizophrenia-spectrum disorders (N = 201) provided personal narratives detailing their life story and reflections about their mental illness. Self-reflectivity was measured with the Metacognition Assessment Scale-Abbreviated, and situation models were extracted from participants' personal narratives via Coh-Metrix 3.0, an automated program that calculates language indices. Diminished expression and cognitive symptoms were measured with the Positive and Negative Syndrome Scale. Structural equation models (SEM) examined whether self-reflectivity mediated the impact of cognitive symptoms and situation models on diminished expression. Results of the SEM revealed that self-reflectivity partially mediated the impact of situation models on diminished expression (β = -.073, p = .008, ±95% CI [-0.126, -0.019]). and fully mediated the influence of cognitive symptoms in diminished expression (β = 0.099, p = .001, ±95% CI [0.038, 0.160]). In conclusion, results suggest that self-reflectivity, linguistic cohesion, and cognitive symptoms may be useful targets for intervention in efforts to treat diminished expression in psychosis.Item Disorganized Speech and Metacognition in Schizophrenia: Differential Relations and a Comparison of Behavioral Speech Measures(2021-08) Myers, Evan J.; Minor, Kyle S.; Salyers, Michelle P.; Lysaker, Paul H.Disorganized speech is a core feature of schizophrenia. It is a key component of formal thought disorder (FTD). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. In this study, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and emerging automated analysis methods. Positive and Negative Syndrome Scale (PANSS) and Indiana Psychiatric Illness Interviews (IPII) were conducted; the IPII was coded for disorganized speech using the Communication Disturbances Index (CDI) and Coh-Metrix multidimensional indices. Metacognition was rated using the Metacognition Assessment Scale. We compared FTD (n = 16; PANSS conceptual disorganization ≥ 3) and non-FTD (n = 29; PANSS conceptual disorganization < 3) groups on metacognition and examined CDI and Coh-Metrix’s ability to account for variance in metacognition. We hypothesized that the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. Analyses indicated metacognition did not differ between groups and neither measure accounted for significant variance in metacognition. Results also showed that the CDI was able to distinguish the groups. Overall, results suggest little relationship between FTD and metacognition. Findings also indicate that trained rater measures of disorganized speech may have clinical utility in classifying FTD. Future research examining these constructs should address important limitations of this study by ensuring adequate levels of FTD in the study sample and by assessing neurocognition.Item The Independent Relationships of Metacognition, Mindfulness, and Cognitive Insight to Self-Compassion in Schizophrenia(Wolters Kluwer, 2020-01) Hochheiser, Jesse; Lundin, Nancy B.; Lysaker, Paul H.; Psychiatry, School of MedicineThe debilitating nature of psychosis may be exacerbated by societal stigma and feelings of social isolation over and above positive (e.g., hallucinations) and negative (e.g., flat affect) symptoms. Thus, recovery may be facilitated by increasing self-compassion, the ability to respond with a nonjudgmental attitude of kindness toward oneself as a result of connecting with one's own inadequacies and suffering. We conducted a stepwise regression in individuals with schizophrenia-spectrum disorders (n = 92) to determine the unique contributions of cognitive variables in predicting self-compassion, such as metacognition (the ability to form complex and integrated ideas about oneself and others), mindfulness, and cognitive insight. Results indicated that increased metacognitive awareness of others and mindfulness uniquely predicted greater self-compassion (i.e., self-kindness), whereas increased cognitive insight predicted greater lack of self-compassion (i.e., self-judgment). These findings suggest the potential for mindfulness and metacognitive interventions to increase positive self-compassion and promote recovery in psychosis.Item Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments(Wiley, 2018-02) Lysaker, Paul H.; Pattison, Michelle L.; Leonhardt, Bethany L.; Phelps, Scott; Vohs, Jenifer L.; Medicine, School of MedicinePoor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.Item Making Meaning in the Presence of Sub-threshold Psychotic Symptoms: An Investigation of Metacognitive Capacity in Psychometric Schizotypy(2016-04-15) Davis, Beshaun J.; Minor, Kyle Stuart; Lysaker, Paul H.; Salyers, Michelle Pensec; McGrew, John H.; Grahame, Nicholas J.Schizophrenia is a complex and debilitating mental disorder characterized by a myriad of symptoms that affect multiple aspects of functioning. Metacognition, or the ability to form complex notions of oneself and others, has been evidenced to be deficient in schizophrenia. As such, one burgeoning line of research has sought to elucidate the role of metacognitive capacity on functional outcome across the schizophrenia spectrum. Although there is a substantial body of evidence about the role of metacognition in clinical manifestations of the disorder, few studies to date have explored whether similar deficits can be seen in individuals at risk for schizophrenia. One such at risk group is that of schizotypy wherein individuals demonstrate attenuated trait-like characteristics resembling less severe versions of those seen in psychosis. The aim of the current study was to investigate metacognitive capacities in this group. To that end, 67 participants were recruited (schizotypy = 34, control = 33) and two primary hypotheses were developed: 1) Individuals with schizotypy will exhibit significantly worse metacognition than a non-schizotypy group; and 2) Metacognition will account for additional variance above and beyond social cognition in predicting social functioning. Contrary to our hypotheses, group differences a metacognition and its subdomains were not significant. Further, inconsistent with studies in chronic schizophrenia, metacognition did not significantly predict social functioning. Our findings suggest that metacognition is preserved in schizotypy.