Comparison of Cognitive Attentional Syndrome and Generic and Psychosis-Specific Metacognitive Beliefs in Remitted Patients with Schizophrenia, Schizoaffective Disorder, and Bipolar Disorder Type I with Psychotic Features with Healthy Controls

Positive metacognitive beliefs about psychotic experiences are linked to hallucinations and delusions, while negative beliefs are associated with distress in response to psychotic experiences. This study compared metacognitive beliefs and processes in patients with schizophrenia (SCH), bipolar disorder type-1 with psychotic features (BDP), and schizoaffective disorder (SAD), against healthy controls (HCS), to identify any differences. The study included 50 patients each with SCH, BDP, and SAD, and 80 HCS. Metacognitive processes and beliefs were assessed using the Metacognition Questionnaire (MCQ-30), Cognitive Attentional Syndrome-1 (CAS-1) Scale, Measure of Common Responses to Unusual Experiences (MCRUE), Beliefs About Voices Questionnaire (BAVQ) and Beliefs About Paranoia Scale (BAPS). No significant differences were found between patient groups for CAS-1, MCQ-30, BAPS, MCRUE total and subscale scores, and BAVQ Benevolence and Engagement subscale mean scores. BAVQ total and Malevolence subscale mean scores were significantly higher in the BDP group compared to SCH and SAD. The BDP group also had significantly higher BAVQ Resistance subscale mean scores than the SCH group (p < 0.05). CAS-1 total and subscale scores for Dysfunctional Coping, Perseverative Thinking, and Metacognitive Strategies were significantly lower in HCS (p < 0.05). HCS also had lower scores on MCQ-30 Uncontrollability and Danger, Need to Control Thoughts subscales, BAPS Negative Beliefs About Paranoia, and MCRUE Threat Monitoring and Avoidance subscales. Conversely, BAVQ total and subscale mean scores were higher in the HCS group (p < 0.05). Patients with SCH, SAD, and BDP had higher positive and negative metacognitive beliefs compared to HCS, but no significant differences were found among the patient groups themselves. Identifying metacognitive deficits in these disorders is crucial for enhancing metacognitive capacity and initiating timely clinical interventions aimed at improving social skills and independent living.