The role of metacognitive profiles in social functioning and social network evolution in schizophrenia

An individual’s capacity to develop adequate metacognitive theories plays an important role in social interactions and social functioning. Through metacognition, a person is able to read several aspects of a social situation and respond appropriately. Accordingly, research on social functioning, social networks, and metacognition consistently show impairments in individuals with schizophrenia. Although research has traditionally focused on the influence of individual skills, metacognitive abilities can be considered individually, or globally. However, different aspects of metacognition may not be predictive of every individual domain of social functioning, evolution of a satisfying and supportive social network, and social aspects of substance use. Therefore, the overall goal of this project was to contribute to the knowledge of the influence of metacognitive profiles on social functioning and the social context of individuals with schizophrenia, with a special interest in the implications of substance misuse. The first study investigated whether distinct metacognitive profiles exist within a population of individuals with a first psychotic episode, and to determine how such profiles influence individual domains of social functioning and perceived social support. Cluster analysis revealed three distinct metacognitive profiles: (1) overall better abilities; (2) poor abilities on thinking of one’s own and other’s mind, but better Mastery; and (3) overall poorer abilities. Analyses showed significant differences between profiles only for self-reported intimacy and independent living abilities, with the second profile showing better abilities than the third. Profiles did not simply represent consistently higher or lower functioning across subscales. Although mastery was predictive of social functioning, the ability to think in an increasingly complex manner of one’s self and others did not seem to improve functioning in individuals with a first episode of psychosis. Early interactions in particular are thought to influence the development of this ability. Interactions with others continue to be important to personal reflection and the further development of metacognitive skills. Therefore, given the influence of metacognition on social interactions, the second study explored whether metacognitive abilities played a role in the evolution of social networks in persons who develop schizophrenia and comorbid substance misuse. Social networks were charted from childhood to the present and were anchored to general (elementary, school, high school, first hospitalization, etc) and personal milestones (moving to a new city, changing school, onset of substance misuse, hardships, etc). Qualitative aspects were also investigated. Two distinct social network evolution profiles were identified. Profiles were stable over time in their reactions to life transition and differed on metacognitive abilities. Profile 1 was associated with better metacognitive abilities. It varied on the onset, conclusion, and the diversity of relationships. Profile 2 was associated with poorer metacognitive abilities. Networks completely changed at transitions but remained static and homogeneous between transitions. The presence of long-term, mutually supportive relationships, and the pursuit of personal interests contributing to friendship formation was present in the first but not the second profile, which evolved towards a network of substance users in adolescence, and isolation following the onset of illness.

Keyphrases: Schizophrenia, Psychosis, Social network, Social functioning, Substance misuse