Metacognition in bipolar disorder: A systematic review

Abstract

Objective: To perform a systematic review investigating metacognition in bipolar disorder (BD). Secondary objectives include exploring clinical and sociodemographic correlates of metacognition in BD, how metacognition varies according to affective state, establishing a comparison with other mental disorders, and investigating whether metacognitive interventions in BD are effective or not. Methods: A systematic review of the scientific literature on metacognition in BD patients was carried out. Original clinical studies on the subject were searched in the Medline, ISI, PsycINFO and SciELO databases. The search terms included were: “metacognition” OR “metacognitive” OR “metamemory” AND “bipolar” OR “mania” OR “manic”. Results: A total of nine articles were selected. Metacognition appears to be more impaired in BD than in controls, but less impaired than in schizophrenia. There seems to be no difference between bipolar and unipolar depression regarding metacognitive capacity. Higher educational level and longer duration of illness seem to be associated with better metacognitive capacity, while higher severity of BD symptoms is linked to worse metacognition. Metacognitive training in BD patients is a promising clinical perspective. Conclusion: Studies on metacognition in BD are scarce, but the existing literature indicates potential clinical and sociodemographic factors associated with poorer metacognition in the disorder, also suggesting that metacognitive therapeutic interventions may be clinically relevant for the management of BD.