Emma Claire Palmer

Social Disadvantage: Cause or Consequence of Impending Psychosis?

Background: An association between social disadvantage and established psychosis is well documented in the literature, but there remains a lack of data on the social circumstances of patients before they became ill. We investigated whether social disadvantage at, and prior to, first contact with psychiatric services, is associated with psychosis. Method: We collected information on social disadvantage in childhood and adulthood from 278 cases presenting with their first episode of psychosis to the South London and Maudsley National Health Service Foundation Trust and from 226 controls recruited from the local population. Three markers of childhood social disadvantage and 3 markers of disadvantage in adulthood were analyzed. Results: Long term separation from, and death of, a parent before the age of 17 years were both strongly associated with a 2- to 3-fold-increased odds of psychosis. Cases were also significantly more likely to report 2 or more markers of adult social disadvantage than healthy controls (OR = 9.03) at the time of the first presentation with psychosis, independent of a number of confounders. When we repeated these analyses for long-standing adult social disadvantage, we found that the strength of the association decreased but still remained significant for 1 year (OR = 5.67) and 5 years (OR = 2.57) prior to the first contact. Conclusions: Social disadvantage indexes exposure to factors operating prior to onset that increase the risk of psychosis, both during childhood and adulthood.

Effects of age on metacognitive efficiency.

Highlights • Metacognitive ability refers to the mapping between one’s beliefs and behaviours.• We separately quantified task performance and metacognition for perception and memory.• We identify a decline in metacognition with age across the adult lifespan.• Changes of metacognition with age were not explained by executive function.• Combined with adolescent data the lifespan profile of metacognition is an inverted-U.

The relationship between cognitive insight and depression in psychosis and schizophrenia: A review and meta-analysis

Lack of insight is a commonly observed problem in patients with psychosis and schizophrenia. Clinical insight in patients has been associated with low mood. Cognitive insight is a recently defined concept, relating to the ability to self-reflect and the degree to which patients are over-confident regarding their interpretations of illness-related experiences, and is related to clinical insight. We therefore sought to investigate whether there is a positive relationship between cognitive insight and mood. A literature search identified 17 relevant papers published between 2004 and 2014. Our analysis indicated that there was a small but significant positive correlation between the composite index (CI) of the Beck Cognitive Insight Scale (BCIS) and depression scores, but this was driven by a significant positive relationship between depression and the BCIS self-reflection (SR) sub-scale, where low mood was related to higher SR scores. There was no significant relationship between the self-certainty sub-scale and depression. Post-hoc analysis indicated that different depression scales did not significantly affect the relationship with SR. Our results support the idea that cognitive insight is significantly related to mood in schizophrenia, and the effect size is similar to that between clinical insight and mood. Potential applications of this knowledge into treatment and rehabilitation are discussed and a model of cognitive insight is proposed.

More work on lack of awareness and insight in healthy people and psychiatric patients will assist model building

Abstract We comment on the work of Mograbi and Morris and their newly developed Cognitive Awareness Model in terms of metacognition and awareness of disability in health aging, dementia, and psychosis. It is suggested that further research comparing implicit awareness of disability and objective metacognitive processes would be useful for theory development, as well as further understanding cognitive models of insight in the clinical domain.