Self-Assessment in Schizophrenia: Accuracy of Evaluation of Cognition and Everyday Functioning
Self-Assessment in Schizophrenia: Accuracy of Evaluation of Cognition and Everyday Functioning
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DOI：
10.1037/neu0000175
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发表时间：
2015-09-01
期刊：
影响因子：
2.4
通讯作者：
Harvey, Philip D.
中科院分区：
文献类型：
--
作者：
Gould, Felicia;McGuire, Laura Stone;Harvey, Philip D.
目的：自我评估缺陷，通常被称为自知力受损或对疾病缺乏意识，在精神分裂症患者中得到很好的确立。有多个层次的意识，包括对症状、功能缺陷、认知障碍的意识，以及持续监测认知和功能表现的能力。本研究旨在评估意识各方面对精神分裂症患者日常功能水平的比较预测价值。方法：对214例精神分裂症患者进行多方面功能自评。我们还收集了高接触临床医生对日常功能进行评分的信息，并检查了自我评估对预测现实世界功能结果的重要性。基于表现的认知、功能能力和元认知表现的测量对日常功能的相对影响也被研究了。结果：对能力的错误估计是对真实世界功能的最强预测因子，并且超过了认知表现、功能能力表现和基于元认知监控的绩效评估的影响。自我评估以外的其他因素的相对贡献因被检查的日常功能领域而异，但在所有情况下，解释的预测性差异都较小。结论：这些结果强调了错误估计一个人目前的功能和相对能力水平所造成的功能影响。这些发现与以洞察力为重点的治疗和补偿策略的使用是一致的，这些策略旨在提高多个功能领域的自我意识。
Objective: Self-assessment deficits, often referred to as impaired insight or unawareness of illness, are well established in people with schizophrenia. There are multiple levels of awareness, including awareness of symptoms, functional deficits, cognitive impairments, and the ability to monitor cognitive and functional performance in an ongoing manner. The present study aimed to evaluate the comparative predictive value of each aspect of awareness on the levels of everyday functioning in people with schizophrenia. Method: We examined multiple aspects of self-assessment of functioning in 214 people with schizophrenia. We also collected information on everyday functioning rated by high contact clinicians and examined the importance of self-assessment for the prediction of real-world functional outcomes. The relative impact of performance-based measures of cognition, functional capacity, and metacognitive performance on everyday functioning was also examined. Results: Misestimation of ability emerged as the strongest predictor of real-world functioning and exceeded the influences of cognitive performance, functional capacity performance, and performance-based assessment of metacognitive monitoring. The relative contribution of the factors other than self-assessment varied according to which domain of everyday functioning was being examined, but, in all cases, accounted for less predictive variance. Conclusion: These results underscore the functional impact of misestimating one's current functioning and relative level of ability. These findings are consistent with the use of insight-focused treatments and compensatory strategies designed to increase self-awareness in multiple functional domains.