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Themenschwerpunkt

Metakognitive und sozial-kognitive Defizite bei Schizophrenien. Funktionelle Bedeutung und Behandlungsstrategien

Published Online:February 28, 2015https://doi.org/10.1024/1661-4747/a000165

Abstract

Die Gruppe der Schizophrenien umfasst heterogene psychopathologische Syndrome, die oft mit neurokognitiven Störungen und niedrigem psychosozialen Funktionsniveau assoziiert sind. Empirische Studien legen nahe, dass viele mit Schizophrenie assoziierte Symptome auf Störungen der sozialen Kognition bzw. metakognitive Störungen zurückgeführt werden können. Diese Konzepte beziehen sich auf die Fähigkeit, soziale Signale wahrnehmen und interpretieren, eigene und psychische Zustände Anderer reflektieren und dieses Wissen flexibel in sozialen Interaktionen und zur Problemlösung einsetzen zu können. Der vorliegende Artikel gibt eine Übersicht über sozial-kognitive und metakognitive Defizite bei Schizophrenien und wie über das Training dieser Kernkompetenzen das psychosoziale Funktionsniveau von Patienten mit Schizophrenie verbessert werden kann. Bei Schizophrenien sind soziale Kognition und Metakognition eng mit dem psychosozialen Funktionsniveau verbunden, zum Teil jedoch auch abhängig von neurokognitiven Fähigkeiten. Sozial-kognitives bzw. metakognitives Training kann zur Verbesserung des psychosozialen Funktionsniveaus beitragen, möglicherweise aber in Abhängigkeit vom Lernpotential und der Motivation der Patienten. Zukünftige Studien sollten untersuchen, welche Subtypen innerhalb des Schizophrenie-Spektrums am ehesten von sozial-kognitivem und metakognitivem Training profitieren können und welche Gruppen ggf. zusätzlich neurokognitives Training benötigen, um das psychosoziale Funktionsniveau zu verbessern.


Metacognitive and social cognitive deficits in schizophrenia. Impact on functioning and treatment strategies

The group of schizophrenias concerns heterogeneous psychopathological syndromes that are often associated with neurocognitive impairment and poor functional outcome. Research suggests that many symptoms associated with schizophrenia can be interpreted as a result of poor social cognition and “metacognition”, two related concepts that refer to the ability to recognise and interpret social signals, to reflect upon mental states of oneself and others, and to flexibly entertain this knowledge in social interaction and problem-solving. The present article reviews the evidence for social cognitive and metacognitive deficits in schizophrenia and whether training in these domains may improve poor social functioning. In schizophrenia social cognition and metacognition are intrinsically linked with social functioning, yet partly dependent on neurocognition. In addition, there is some evidence to suggest that social and metacognitive training can improve social functioning, possibly depending on patients' learning potential and motivation. Future studies may aim at resolving the question which syndromal subgroups within the schizophrenia phenotype benefit best from social and metacognitive training, and which groups may need additional neurocognitive training to improve social functioning.

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