Associations of symptoms, neurocognition, and metacognition with insight in schizophrenia spectrum disorders
Abstract
Many persons with schizophrenia experience poor insight and, as a result, are at risk for treatment non-adherence and numerous negative outcomes. However, to date, the etiology of poor insight has not yet been fully elucidated. One recent theory concerning the roots of poor insight in schizophrenia has proposed that it may result, in part, from impairments in metacognition, or the capacity to think about thinking. The present study thus aims to examine whether metacognition is associated with insight even after controlling for the effects of psychiatric symptomatology and neurocognition. In this study, 95 adults with a schizophrenia spectrum disorder were assessed on measures of insight (i.e., awareness of symptoms, treatment needs, and illness consequences), psychiatric symptoms (i.e., positive symptoms, negative symptoms, and general psychopathology), neurocognitive functions (i.e., executive function, memory, and attention), and metacognitive capacities (i.e., self-reflectivity and theory of mind). Univariate correlations followed by stepwise multiple regressions, which controlled for symptoms and neurocognition, indicated that both self-reflectivity and theory of mind were significantly linked with awareness of symptoms; theory of mind was linked with awareness of treatment needs; and self-reflectivity was linked with awareness of illness consequences. Importantly, these findings suggest that metacognitive capacities may be related to insight independent of concurrent psychiatric symptoms and neurocognitive deficits. Moreover, awareness of different facets of the illness may require contributions from different components of metacognition. Future research should investigate how existing metacognitive skill training programs could potentially be tailored, or modified, to help persons with schizophrenia to develop and enhance insight.
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Poor clinical insight is associated with negative symptoms.
“Literature supporting this includes studies correlating poor clinical insight with overall symptom severity [43][44][45] , positive symptoms 46,47 , negative symptoms 44,48,49 , disorganization symptoms 46,47,50-52 , and excitement symptoms 46,47,53 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [48]
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Halaj, A., Seow, T. X. F., & David, A. S. (2026) · Schizophrenia Research · doi:10.1016/j.schres.2026.09.028
- Authors
- Chan, K. K. S.
- Affiliations
- Education University of Hong Kong (HK)
- Corresponding author
- Chan, Kevin K.S.
- ORCID
- Chan, Kevin K.S.
- Venue
- Comprehensive Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 65
- Pages
- 63-69
- ISSN
- 0010-440X (ISSN-L)
- OpenAlex
- W2201399786
- Cited by
- 27
- References
- 51
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 2 · 2018: 5 · 2017: 4 · 2016: 1
- FWCI
- 2.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Comprehensive Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- The Hong Kong Institute of Education (RG27/2013-2014R)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- insight, schizophrenia spectrum disorders, metacognition, self-reflectivity, theory of mind, neurocognitive function, executive function, medication adherence
- MeSH terms
- Metacognition, Adult, Attention, Awareness, Cognition, Female, Humans, Male, Memory, Middle Aged, Neuropsychological Tests, Problem Solving, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Thinking, Executive Function
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