Metacognition strengthens the association between neurocognition and attenuated psychosis syndrome: Preliminary evidence from a pilot study among treatment-seeking versus healthy adolescents

Background: In a pilot study, we assessed the potential value of deficits at the metacognitive versus the neurocognitive level of functioning for identifying adolescents with attenuated psychotic syndrome (APS). Method: Twenty-two treatment-seeking adolescents with APS, 42 treatment-seeking comparisons, and 34 agematched healthy comparisons were evaluated using the Prodromal Questionnaire, the Structured Interview for Prodromal Syndromes, and the Mood and Anxiety Symptom Questionnaire. Neurocognitive and metacognitive functioning were assessed in two non-social (verbal memory and executive functioning) and two social (facial emotion perception and theory of mind) cognitive domains. In addition to the standard neurocognitive administration of the tasks, subjects were asked to rate their confidence level on each answer and to choose whether they wanted it "counted" toward their overall task performance score on the task. Choices were rewarded. Results: As hypothesized, APSamong treatment-seeking adolescentswasmore strongly associated with impaired neurocognition than with impaired metacognition. Likewise, as hypothesized, impaired metacognition was shown to significantly improve the APS prediction beyond the contribution of impaired neurocognition alone, even after controlling for general intellectual ability, negative symptoms, social functioning, and depression. Conclusions: These results suggest thatmetacognitive monitoring and control play a strengthening role in the association between neurocognition and APS. One possible explanation is thatmetacognition serves as an indicator of insight into the condition, accounting for differences in insight not explained by neurocognition alone. However, further research with larger samples that include non-treatment seeking individuals, establishedmeasures of insight, and follow-up data is required to assess this possibility. (C) 2018 Elsevier B.V. All rights reserved.