Mental illness study to explore patients' self-assessments

July 12, 2018 by Stephen Fontenot, University of Texas at Dallas
Credit: University of Texas at Dallas

As the mental health community pursues new ways to improve the lives of the severely ill, a University of Texas at Dallas researcher is focusing on what can be learned from patients' answers to a simple question: "How do you think you are doing?"

Dr. Amy Pinkham, associate professor in the School of Behavioral and Brain Sciences, is the principal investigator of a new multi-university study of introspective accuracy and its effects on the daily functions of those with severe mental illness. The project recently received more than $2.8 million from the National Institutes of Health for its nearly four-year duration.

Pinkham explained introspective accuracy—how well you evaluate your own capabilities—in terms of a grocery trip.

"If you think you have a great memory, and you don't need a grocery list, but you get home and see that you forgot some things, that's a case of poor introspective accuracy," she said. "But if you have a bad memory and you know it, you do things to compensate. You're going to make that list, and you're going to have a better functional outcome when you return from the store."

Understanding Skills, Shortcomings

Pinkham emphasized that underestimates of a patient's own skills can be as important as overestimates, using the example of someone avoiding social interaction. Her recently published work in the Journal of Psychiatric Research illustrates that schizophrenia patients have a wide range of impairment to their social cognition, the mental processes that form the foundation for successful social interactions.

"If I think I'm awkward, I may not go introduce myself. I may not apply for a job that requires being social. I think I'm not going to be good at it," she said. "I might be denying myself an opportunity where I could succeed, or I'm creating problems for myself, based on underestimating my abilities."

Pinkham and her colleagues hypothesize that, alongside the range to which individuals with schizophrenia understand and accept their diagnoses, there is an analogous wide spectrum of understanding about their own skills and shortcomings.

"Individuals with schizophrenia—and other severe mental illnesses like bipolar disorder—often have difficulty in evaluating their memory, or their abilities to interact with people or judge others' emotional states," said Pinkham, who has published several studies that examine how impaired contributes to behavior in schizophrenia and related disorders.

"Sometimes, we all miss the mark in self-assessment, but we're realizing that the amount and direction in which we consistently miss that mark can have important implications for our functioning."

The study—a collaboration with sites at the University of Miami's Miller School of Medicine and the University of California, San Diego—will have 450 subjects, half diagnosed with schizophrenia or schizoaffective disorder, and half with bipolar disorder. The goal is to generate empirical evidence about the nature of these self-assessment impairments.

"Someone can be fully aware of their illness, but not grasp their other strengths and weaknesses," Pinkham said. "We want to learn how those abilities interact, how linked they are and how that contributes to functional ability. Once we better understand those things, we'll know if trying to improve self-awareness levels can, in turn, improve real-world function—if individuals can learn they need that metaphorical grocery list and adapt."

Comparing Assessments

Assessing daily functions—and, in turn, introspective accuracy—will be accomplished with the help of informants, in part because the reliability of the subjects' answers is a large part of what will be tested.

"We can't just ask them, 'How do you do in this area?'" Pinkham said. "We rely on informants enrolled in the study with each individual. These are people who know them well—either a professional like a social worker or psychiatrist, or a family member, who often has the most information about what someone does every day."

Informants will complete assessments about the individuals, which will be compared to the individuals' self-assessments. Self-assessments of ability also will be compared to actual performance on tests of other important constructs such as memory and emotion recognition.

"When we see discrepancies, we know someone is off," Pinkham said. "We think the size and direction of those discrepancies are going to be meaningful in terms of how well that person is actually doing."

The functionality assessment relies on activities that may sound very basic—tasks that, if not attended to, can undermine the quality of life of a mentally ill person.

"A daily life skills assessment involves simple tasks like paying your electric bill or refilling a prescription," Pinkham said. "Because we can't follow someone 24 hours a day, we can't get a truly complete, objective assessment. But we can get a good idea of someone's abilities by asking them to perform such tasks in the lab and asking their informants how they do in these areas."

While existing data establishes that mentally healthy people who are slightly depressed assess their skills and abilities more accurately than those who are not depressed—a concept called depressive realism—it's unknown whether that trend extends to the severely mentally ill.

"We don't know how psychotic symptoms play into that," Pinkham said. "This is crucial because overestimation and underestimation can call for different forms of treatment. Certain medicines are useful for people who overestimate, but not someone who is underestimating. The direction component is important."

As complex as severe mental illness is, Pinkham stresses that some of the most useful questions to ask are straightforward.

"Put most simply, we're asking, 'How much do you know about yourself?' That's all this is," she said. "And it might be that what you think about your own memory matters just as much as how good your memory actually is. We're trying to better explain these things so that we can improve how we address the needs of those with severe mental illness and make people's lives better."

Explore further: 20-year study finds little change in social functioning in people with psychosis

More information: Michal Hajdúk et al. Social cognitive impairments in individuals with schizophrenia vary in severity, Journal of Psychiatric Research (2018). DOI: 10.1016/j.jpsychires.2018.06.017

Related Stories

20-year study finds little change in social functioning in people with psychosis

March 21, 2018
Researchers have found that levels of social impairment in people with schizophrenia remained remarkably stable in the years after the first hospitalisation for psychosis.

People with schizophrenia account for more than one in ten suicide cases

June 22, 2018
A new CAMH and Institute for Clinical Evaluative Sciences (ICES) study shows that people with schizophrenia account for more than 1 in 10 cases of suicide in Ontario, and that young people are disproportionately affected.

Web-based treatments helping people with severe mental illness return to work

October 11, 2017
Patients living with severe mental illness are being helped to return to work courtesy of new research from Sydney's Westmead Institute for Medical Research.

Analysis finds schizophrenics have thinner cerebral cortex, on average

June 6, 2018
Individuals with schizophrenia, on average, have a thinner cerebral cortex, the largest part of the brain that controls higher intellectual functions and motor activity, compared to healthy people, according to an international ...

mHealth as effective as clinic-based intervention for people with serious mental illness

May 25, 2018
A mobile health (mHealth) intervention was found to be as effective as a clinic-based group intervention for people with serious mental illness in a new study published online today in Psychiatric Services.

Recommended for you

In depression the brain region for stress control is larger

September 20, 2018
Although depression is one of the leading psychiatric disorders in Germany, its cause remains unclear. A recent study at the Max Planck Institute for Human Cognitive and Brain Sciences (MPI CBS) in Leipzig, Germany, found ...

Quitting junk food produces similar withdrawal-type symptoms as drug addiction

September 20, 2018
If you plan to try and quit junk food, expect to suffer similar withdrawal-type symptoms—at least during the initial week—like addicts experience when they attempt to quit using drugs.

American girls read and write better than boys

September 20, 2018
As early as the fourth grade, girls perform better than boys on standardized tests in reading and writing, and as they get older that achievement gap widens even more, according to research published by the American Psychological ...

Mindfulness meditation: 10 minutes a day improves cognitive function

September 19, 2018
Practising mindfulness meditation for 10 minutes a day improves concentration and the ability to keep information active in one's mind, a function known as "working memory". The brain achieves this by becoming more efficient, ...

People can handle the truth (more than you think)

September 19, 2018
Most people value the moral principle of honesty. At the same time, they frequently avoid being honest with people in their everyday lives. Who hasn't told a fib or half-truth to get through an awkward social situation or ...

The 'real you' is a myth – we constantly create false memories to achieve the identity we want

September 19, 2018
We all want other people to "get us" and appreciate us for who we really are. In striving to achieve such relationships, we typically assume that there is a "real me". But how do we actually know who we are? It may seem simple ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.