A cognitive model of diminished expression in schizophrenia: The interface of metacognition, cognitive symptoms and language disturbances.
A cognitive model of diminished expression in schizophrenia: The interface of metacognition, cognitive symptoms and language disturbances.
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DOI：
10.1016/j.jpsychires.2020.09.008
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发表时间：
2020-12
影响因子：
4.8
通讯作者：
Lysaker PH
中科院分区：
文献类型：
--
作者：
García-Mieres H;Lundin NB;Minor KS;Dimaggio G;Popolo R;Cheli S;Lysaker PH
阴性症状对药物治疗的抵抗激发了人们对理解导致其形成和持续的心理因素的兴趣。然而，人们对强化和维持表达减少的负面症状领域的心理过程知之甚少。先前的研究表明，较高水平的表达减少与元认知能力的缺陷有关。我们提出了一个更复杂的模型，当元认知自我反射的损伤、高阶语言结构的改变和认知症状相互作用，从而干扰人们以他人可以识别的方式理解和表达情绪的能力时，表达减少就会发生。患有精神分裂症谱系障碍的个体（N = 201）提供了详细描述他们的生活故事和对精神疾病的反思的个人叙述。自我反射率用元认知评估量表（meta - cognitive Assessment scale -缩写）进行测量，情境模型通过计算语言指数的自动化程序Coh-Metrix 3.0从参与者的个人叙述中提取。用阳性和阴性证候量表测量表达减弱和认知症状。结构方程模型（SEM）检验了自我反射率是否介导认知症状和情境模型对表达减少的影响。扫描电镜结果显示，自我反射率在一定程度上介导了情境模型对表达减少的影响（β =−）。073, p = 0.008，±95% CI[- 0.126, - 0.019])。完全介导认知症状对表达减少的影响（β = 0.099, p = 0.001，±95% CI[0.038, 0.160]）。总之，结果表明，自我反思、语言衔接和认知症状可能是治疗精神病表达减少的有效干预目标。
The 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.
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