Which metacognitive components of insight in schizophrenia? The relationship between subjective and objective measures of metacognition and insight

C. Marucci 1, V. Santarelli 2, A. Collazzoni 1, D. Talevi 1, R. Rossi 3, A. Rossi 1, P. Stratta 2

1 Applied and Biotechnological Clinical Sciences Department (DISCAB) Section of Psychiatry and Clinical Psychology, University of L’Aquila, Italy; 2 Department of Mental Health, ASL 1, L’Aquila, Italy; 3 PhD Programme University of Tor Vergata, Roma, Italy


It has been well documented that metacognition is compromised in people with a diagnosis of schizophrenia. Recent theories, concerning the roots of poor insight in schizophrenia, have proposed that it may result, in part, from impairments in metacognition, the capacity to think about thinking. Metacognition is a complex construct including both objective and subjective elements not necessarily overlapping. Aim of this study is to investigate the relationship of these elements with insight.


Metacognitive abilities were assessed using both objective [i.e. Wisconsin Card Sorting Test (WCST), metacognitive adaptation] and subjective measures [Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS)] in 44 individuals with schizophrenia. The G12 item of the Positive and Negative Symptoms Scale (PANSS) was used for Insight evaluation. Functional performance was evaluated using Global Assessment of Functioning.


Table I shows the means of symptoms, insight, metacognition and functional ability in the studied sample. Table II shows Pearson r correlations between metacognitive evaluations and symptomatology, insight, cognitive and functional variables. No relationship was found between objective and subjective measures of metacognition. Subjective metacognition, but not the objective one was related to PANNS depressive score. Lack of Insight did not correlate with objective metacognition, but was significantly related to subjective metacognitive complaints and positive, negative, disorganized and excited PANNS symptoms. Global functioning was related only to the PANSS Positive Factor.


Subjective and objective metacognitive measures in schizophrenia could be considered as distinct domains, supporting the hypothesis of the independence of cognitive functioning in schizophrenia from its subjective measures. Our results support the hypothesis of the lack of insight as a complex psychopathological construct related to phenomenology, cognition and psychotic symptoms.

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