Negative mood states as a correlate of cognitive performance and self-assessment of cognitive performance in bipolar disorder versus schizophrenia

Introduction: Mood states have been reported to manifest a cross-sectional correlation with self-assessment ac-curacy across functional domains and psychiatric conditions. Ecological momentary assessment (EMA) provides a strategy to examine the momentary course and correlates of mood states. This study tested the association of moods assessed longitudinally with accuracy of immediate self-assessments of cognitive test performance in participants with schizophrenia and bipolar disorder.Methods: 240 well-diagnosed participants with schizophrenia and bipolar disorder completed a subset of tests from the MATRICS Consensus Cognitive Battery and an immediate self-assessment of cognitive performance. Differences between actual and self-reported performance were used to index the accuracy of self-assessment. Daily smartphone EMA, 3x per day for 30 days, sampled participants acute accent momentary moods (sad, happy, relaxed, anxious), aggregated into positive affect and negative affect (NA). Results: Bipolar participants had better cognitive performance, but both samples had equivalent mis-estimation. Repeated-measures analyses found that NA did not manifest significant variability over time either between or within participants in the two diagnostic groups. Within-group analyses found that higher average NA was associated with greater mis-estimation and poorer cognitive performance in participants with bipolar disorder, but not in those with schizophrenia.Conclusion: Negative moods had a significant association with impairments in self-assessment of cognitive per-formance in participants with bipolar disorder. Our study did not confirm previous cross-sectional findings of more accurate self-assessment associated with greater NA in schizophrenia. These findings suggest that cross-sectional assessments, particularly self-reports, may lead to different results than aggregated data from longi-tudinal evaluations.