Metacognition in schizophrenia spectrum disorders: methods of assessment and associations with neurocognition, symptoms, cognitive style and function.

Deficits in metacognitive capacity in schizophrenia can be conceptualized as existing along a spectrum from more discrete to more synthetic activities. While each represents an equally important focus of study, synthetic metacognitive activities may be more difficult to measure given they are more a matter of assessing complexity of thought rather than concrete accuracy; and therefore have received less attention. This review summarizes research on synthetic metacognition using a paradigm in which metacognitive capacity is rated within personal narratives. Results across the work reviewed here provides evidence that these deficits are detectable in patients with schizophrenia and that deficits are related to, but not reducible to, symptom severity and poorer neurocognitive function. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to a range of mental activities including reasoning style, learning potential and insight. These deficits may also play a role in long term outcome via their impact on the ability to function in work settings and to think about and sustain social connections.