61.1 Introspective Accuracy as a Predictor of Real-World Outcomes

摘要

>Background: Although cognitive performance and functional capacity are potent predictors of achievement in everyday activities, much like social cognition is a predictor of social functioning, other mediating factors are important. These mediators include self-efficacy, motivation, and, importantly, introspective accuracy. In this presentation, we discuss the role of introspective accuracy as a predictor of real world outcomes in residential, vocational, and social domains in samples of people with schizophrenia. >Methods: Two separate studies were conducted. Both studies included self-reports and informant ratings of everyday functioning as well as performance-based assessments of cognitive performance and functional capacity. In the first study, patients with schizophrenia (n = 214) were asked to self-evaluate their cognitive performance and these assessments were compared to informant ratings to yield a difference score. In the second study, patients (n = 53) were asked to self-assess their social cognitive abilities, which were also compared to informant ratings on the same scale. In the second study, patients also performed several tests of social cognition and in one of the tests they were asked to provide confidence ratings for the quality of their performance, which were examined across correct and incorrect responses. >Results: In the first study, discrepancies between self-reported and informant-rated cognitive abilities were the strongest predictor of everyday activities and vocational functioning: more important than cognitive test performance and functional capacity. In the second study, self-reports of everyday social functioning were correlated with self-reported social cognition ability but not with actual performance on tests of social cognition. Social cognitive test performance was correlated with informant reports of both social functioning and social cognitive ability. Finally, and most important, impaired self-assessment of social cognitive ability, indexed by higher levels of confidence while making incorrect responses on social cognitive tests, was correlated with poorer informant-rated social outcomes. >Conclusion: Problems in the ability to evaluate competence in neurocognitive and social cognitive domains directly contribute to domain-specific deficits in everyday functioning. These contributions are substantial and impairment in self-assessment of competence appears very similar in its nature across neurocognitive and social cognitive domains. Identification of a neurobiological basis of these impairments may lead to treatment developments.