Disorganization and disintegration in schizophrenia: Metacognitive capacity across levels of conceptual disorganization.

Disorganized speech can disrupt effective communication in schizophrenia-spectrum disorders (SSDs). Recent work has tied disorganized speech to deficits in metacognitive capacity, or one's capacity to integrate experiences to form complex mental representations. Specifically, recent work has shown that metacognitive deficits may emerge only at higher levels of disorganized speech, suggesting a possible exponential relationship. The present study investigated this relationship in a large sample of 485 adult outpatients with SSDs. We aimed to: 1) broadly characterize the nature of the relationship between metacognitive capacity and disorganized speech; and 2) compare metacognitive capacity across levels of conceptual disorganization. We employed ANOVAs, Tukey's HSD post hoc tests, and curve estimation analyses to answer these questions. Results provide mixed evidence that the relationship between metacognitive capacity and conceptual disorganization is exponential. Critically, we found that as levels of conceptual disorganization increase, there are small, clinically relevant decreases in metacognitive capacity, especially in metacognitive mastery. These findings have clinical implications for tailoring metacognitive interventions for patients with high levels of disorganized speech. Our results highlight the need for including participants with extreme disorganized speech and using multidimensional measures of disorganized speech in future studies.