Metacognitive Abilities within Personal Narratives of Inpatients with Schizophrenia: Associations with Clinical Insight and Drug Compliance

Fatma Hussein ,Heba Shafik ,Rasha Salah Eweida

doi:10.7176/jep/10-1-13

Abstract

Psychiatric nurses face many challenges in providing effective care for patients with schizophrenia who have poor insight. The understanding of metacognitive functions in schizophrenia may form a richer idea of why some patients deny illness and decline treatment, and may allow for further consideration of effective psychiatric care. This study aimed to assess the metacognitive abilities within personal narratives among inpatients with schizophrenia and to investigate its relationship with clinical insight and drug compliance. The study followed a cross- sectional descriptive correlational research design. It was conducted on 65 male inpatients with schizophrenia, at El-Maamoura Hospital for Psychiatric Medicine in Alexandria, Egypt. Indiana Psychiatric Illness Interview was used to elicit a narrative of self and illness, the narratives of the study subjects were rated using the metacognitive assessment scale concurrently with the assessment of clinical insight and drug compliance. The results revealed a statistical significant positive correlation between metacognitive abilities, clinical insight and drug compliance. It was concluded that poor insight and drug non-compliance might be significantly improved when considering the metacognitive measures. Recommendations encompassed that metacognitive assessment should be integrated in psychiatric care of inpatients with schizophrenia. A form of integrative psychotherapeutic intervention that could promote insight and drug compliance through stimulating metacognitive abilities should be developed in patients with schizophrenia. Replication of the study is also required on more diverse and larger groups of patients. Keywords: Metacognitive abilities, Narratives, Schizophrenia, Clinical Insight, Drug compliance. DOI : 10.7176/JEP/10-1-13

Highlights

Poor insight is a core feature of schizophrenia, it is a complex and controversial phenomenon that is highly prevalent, occurring in 57 to 98 percent of patients with schizophrenia (Lehrer& Lorenz 2014)
Patients with schizophrenia experience poor insight, and as a result they are at high risk for non-adherence to medication which is the most challenging aspect of treating psychotic patients in clinical setting (Higashi et al 2013)
To understand the cognitive mechanisms of insight in patients with schizophrenia, attention should be drawn to the metacognitive abilities in their personal experience of mental illness

Summary

Introduction

Poor insight is a core feature of schizophrenia, it is a complex and controversial phenomenon that is highly prevalent, occurring in 57 to 98 percent of patients with schizophrenia (Lehrer& Lorenz 2014). It is a barrier to treatment adherence, and a significant contributor to poor functional outcomes and prognosis in individuals with schizophrenia spectrum disorders (Novick et al 2015). By examining the relationship between insight and drug adherence over time, Zhou et al (2017) found that poor www.iiste.org insight was predictive of medication discontinuation at one‐year follow‐up (Zhou et al 2017). Czobor et al (2015) postulated that poor insight predicted less adherence at 6 and 12 months follow‐up in drug trials conducted in first‐episode psychosis, while Abdel et al (2016) found that insight predicted levels of post‐discharge adherence (Czobor et al 2015 & Abdel Aziz et al 2016)

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Results

Conclusion