Metacognition in non-psychotic help-seeking adolescents: associations with prodromal symptoms, distress and psychosocial deterioration.

Objective: To explore the notion that difficulties in metacognitive functioning are a core pre-psychotic feature of emerging schizophrenia and its spectrum.

Method: Seventy-eight help-seeking, non-psychotic adolescents (age 13-18) were assessed with the Prodromal Questionnaire (PQ), the Structured Interview for Prodromal Syndromes (SIPS), two scales of social and role functioning, and a metacognitive version of two non-social (verbal memory and executive functioning) and two social (facial emotion perception and Theory of Mind) cognition tasks. In addition to the standard administration of the tasks, subjects were also asked to rate their level of confidence in the correctness of each answer, and to choose whether they wanted it to be "counted" toward their overall performance score on the task. Each "volunteered" response received a bonus of 5 cents if correct, but an equal penalty if wrong.

Results: Levels of cognitive and metacognitive functioning were not significantly different between subjects at high versus low risk. However, the prediction of psychosocial functioning reached significance when adding the novel metacognitive measures to the conventional measures of cognitive and social-cognitive abilities.

Discussion: These results challenge the robustness of the link between neurocognitive deficits and risk for schizophrenia. However, they suggest that metacognition plays an important moderating role in the association between neurocognition and functional outcome before acute onset of the illness.