Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes

Juliet Silberstein, Philip D. Harvey

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Introduction: Individuals with schizophrenia present across a spectrum of symptomatology. Disability remains a debilitating reality across varying disease presentations and remains pervasive despite psychiatric medications. Cognition (neuro/social cognition) and negative symptoms have emerged as the strongest predictors of real-world disability, but account for <50% of the variance in outcomes. Methods: Our attempts to determine what accounts for the remaining 50% of variance has shown that poor introspective accuracy (IA) may be the most potent predictor of functional outcomes 25% of individuals with schizophrenia. We define IA as the adequacy of self-assessments of ability, skills, performance, or decisions. We suggest that IA is a progression of metacognition and can extend beyond cognition to include misestimation of prior and likely future performance in social or other adaptively relevant situations. Results: Additionally, IA is bidirectional and self-orientated. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures or neurocognitive skills and has found that IA of social cognition accounts unique variance in real-world disability above social cognitive performance. Discussion: We argue that impaired IA, affecting 25–50% of patients with schizophrenia, in the absence or minimal presence of other impairments might be the most powerful predictor of functional outcomes.

Original languageEnglish (US)
Pages (from-to)28-39
Number of pages12
JournalCognitive Neuropsychiatry
Issue number1
StatePublished - Jan 2 2019


  • Schizophrenia
  • metacognition
  • neurocognition
  • social cognition

ASJC Scopus subject areas

  • Cognitive Neuroscience
  • Psychiatry and Mental health


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