Hostile attribution bias in schizophrenia-spectrum disorders: narrative review of the literature and persisting questions.

BACKGROUND: Social cognition is often aberrant or impaired in psychotic disorders and related to functional outcomes. In particular, one core social cognitive bias - hostile attribution bias - is proposed to be implicated in paranoia, anxiety, mood disturbances and interpersonal conflict outcomes. However, questions remain about this domain's specificity to psychosis and its relationship to general functional outcomes. AIMS: The present paper offers a descriptive and critical review of the literature on hostile attribution bias in psychotic disorders, in order to examine (1) its impact on persecutory symptoms in schizophrenia-spectrum disorders, (2) impact on other related psychopathology among those experiencing psychosis and (3) relationship to functioning. METHODS: Twenty-eight studies included in this review after parallel literature searches of PsycINFO and PubMed. RESULTS: Evidence from these studies highlighted that hostile attribution bias is elevated in schizophrenia, and that it is related to anxiety, depression and interpersonal conflict outcomes. CONCLUSION: While results suggest that hostile attributions are elevated in schizophrenia and associated with symptoms and functioning, there exist numerous persisting questions in the study of this area, including identifying which measures are most effective and determining how it presents: as a state or trait-like characteristic, via dual processes, and its situational variation.

A systematic search and critical review of studies evaluating psychometric properties of patient-reported outcome measures for schizophrenia.

Measurement-based care (MBC) involves the regular administration of outcome assessments to track and evaluate treatment progress and requires psychometrically sound instruments. While there are widely used patient-reported outcome measures (PROMs) for several psychiatric disorders and symptom categories (e.g., depression, anxiety), there is less consensus about self-report assessments for measurement-based care of schizophrenia. The present review provides an initial guide to this area by reporting on psychometric studies that introduce or evaluate PROMs designed for the ongoing treatment of schizophrenia. Out of an initial database of 6,153 articles, and review of 141 full-text articles, an analysis of 21 articles examining 12 measures is presented in this review. Findings suggest robust options exist for clinical and research institutions aiming to assess symptom outcomes in schizophrenia, with most measures showing strengths in internal consistency, test-retest reliability, and a number of measures with evidence of convergent or criterion validity. While there exist heterogeneous options, multiple measures demonstrated promising psychometric strengths. Future work validating consistent psychometric validity could involve measures which could be valuable in context of MBC for schizophrenia.

Meaning, integration, and the self in serious mental illness: Implications of research in metacognition for psychiatric rehabilitation.

OBJECTIVE: It has been established that recovery is a common outcome for adults diagnosed with serious mental illness which involves objective and subjective phenomenon. While considerable work has examined objective aspects of recovery, it remains difficult to know how to quantify the processes which support more subjective aspects of recovery related to sense of self. This article explores the potential of recent research on metacognition to offer new avenues to measure the processes which make a sense of self available within the flow of life. METHOD: Emerging definitions of metacognition using an integrative model of metacognition are reviewed. Research is presented suggesting adults diagnosed with serious mental illness are often confronted by metacognitive deficits which interfere with their ability to make sense of their psychiatric challenges and effectively direct their own recovery. FINDINGS: Metacognitive capacity may be a quantifiable phenomenon which contributes to certain aspects of recovery related to meaning making, agency and self-direction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Promoting metacognitive capacity may be a previously unrecognized active element of existing rehabilitative interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reflection and Recovery from Psychosis during the Time of COVID-19: Adaptation in Psychotherapy in the United States / La reflexión y la recuperación de la psicosis durante el COVID-19: adaptación en la psicoterapia de EE UU

In response to the coronavirus (COVID-19) pandemic several adaptations have allowed us to continue to provide one form of recovery-oriented psychotherapy to persons with psychosis: Metacognitive Insight and Reflection Therapy (MERIT). These successful adaptations have included the incorporation of patients' experience of the pandemic and the exploration of challenges from temporary changes in therapy platforms to deepen reflections about patients' self-experience, their experience of intersubjectivity and their own agentic responses to psychosocial challenges

En respuesta a la pandemia del coronavirus (COVID-19) varias adaptaciones han permitido que sigamos facilitando una de las formas de psicoterapia orientada a la recuperación de las personas que padecen psicosis: la terapia de percepción metacognitiva y reflexión (MERIT). Estas adaptaciones satisfactorias incluyen la incorporación de la experiencia de los pacientes de la pandemia y el uso de los desafíos que plantean los cambios temporales en las plataformas terapéuticas con objeto de profundizar en la reflexión sobre la autoexperiencia de los pacientes, su experiencia en intersubjetividad y sus propias respuestas a los desafíos psicosociales

Dynamic relationships between emotional distress, persecutory ideation, and metacognition in schizophrenia.

OBJECTIVE: Determine whether metacognitive capacity (i.e., a range of abilities that involve recognition, reflection, and integration of mental states) influences the relationships between emotional distress and persecutory ideation (PI). METHODS: The present study examined emotional distress, metacognition and PI in a sample (n = 337) of individuals with schizophrenia or schizoaffective disorder and clinician-rated PI. Pearson and partial correlations were used to examine relationships between variables, as well as between-subjects analysis of variances to compare groups characterized based on emotional distress and persecutory ideation scores. RESULTS: While emotional distress and PI are associated with one another, metacognition is negatively associated with PI and positively associated with emotional distress. Subgroup comparisons demonstrated that individuals with high emotional distress and low PI had significantly higher metacognitive capacity than those elevated in PI or reduced in both emotional distress and PI. CONCLUSIONS: Findings suggest metacognitive capacity may relate to improved awareness of distress and reduced PI.

Metacognition in schizophrenia disorders: Comparisons with community controls and bipolar disorder: Replication with a Spanish language Chilean sample.

Metacognition refers to the activities which allow for the availability of a sense of oneself and others in the moment. Research mostly in North America with English-speaking samples has suggested that metacognitive deficits are present in schizophrenia and are closely tied to negative symptoms. Thus, replication is needed in other cultures and groups. The present study accordingly sought to replicate these findings in a Spanish speaking sample from Chile. Metacognition and symptoms were assessed among 26 patients with schizophrenia, 26 with bipolar disorder and 36 community members without serious mental illness. ANCOVA controlling for age and education revealed that the schizophrenia group had greater levels of metacognitive deficits than the bipolar disorder and community control groups. Differences in metacognition between the clinical groups persisted after controlling for symptom levels. Spearman correlations revealed a unique pattern of associations of metacognition with negative and cognitive symptoms. Results largely support previous findings and provide added evidence of the metacognitive deficits present in schizophrenia and the link to outcome cross culturally. Implications for developing metacognitively oriented interventions are discussed.

Social cognition in schizophrenia: factor structure, clinical and functional correlates.

BACKGROUND: Social cognition is consistently impaired in people with schizophrenia, separable from general neurocognition, predictive of real-world functioning and amenable to psychosocial treatment. Few studies have empirically examined its underlying factor structure. AIMS: This study (1) examines the factor structure of social cognition in both a sample of individuals with schizophrenia-spectrum disorders and non-clinical controls and (2) explores relationships of factors to neurocognition, symptoms and functioning. METHOD: A factor analysis was conducted on social cognition measures in a sample of 65 individuals with schizophrenia or schizoaffective disorder, and 50 control participants. The resulting factors were examined for their relationships to symptoms and functioning. RESULTS: Results suggested a two-factor structure in the schizophrenia sample (social cognition skill and hostile attributional style) and a three-factor structure in the non-clinical sample (hostile attributional style, higher-level inferential processing and lower-level cue detection). In the schizophrenia sample, the social cognition skill factor was significantly related to negative symptoms and social functioning, whereas hostile attributional style predicted positive and general psychopathology symptoms. CONCLUSIONS: The factor structure of social cognition in schizophrenia separates hostile attributional style and social cognition skill, and each show differential relationships to relevant clinical variables in schizophrenia.

Development of the brief inventory of perceived stress.

OBJECTIVES: To provide a measure of perceived stress that is psychometrically superior to existing instruments and novel in dimensionality. DESIGN: At 4-week intervals over 48 weeks, patients with multiple sclerosis (N = 138) completed 26 items from the Perceived Stress Scale (PSS) and the Perceived Stress Questionnaire (PSQ). RESULTS: Extant factor analytic models of the PSS fit poorly. A new measure using nine PSS and PSQ items, the Brief Inventory of Perceived Stress (BIPS), demonstrated good fit, construct validity, and stability with 3 factors: Lack of Control, Pushed, and Conflict and Imposition. CONCLUSIONS: Items commonly used to measure perceived stress may have a more sophisticated underlying structure than previously thought. The BIPS's multidimensionality and longitudinal stability offer potential benefits in conceptualization and outcome prediction.