Accuracy of immediate self-assessment of neurocognitive test performance: Associations with psychiatric diagnosis and longitudinal psychotic symptoms

J Psychiatr Res. 2022 Dec:156:594-601. doi: 10.1016/j.jpsychires.2022.10.069. Epub 2022 Nov 4.


Participants with schizophrenia (SCZ) and bipolar disorder (BD) have challenges in self-evaluation of their cognitive and functional abilities, referred to as introspective accuracy (IA). Although psychotic symptoms are commonly found to be uncorrelated with cognitive performance, many models of the development of delusions focus on failures in self-assessment and responses biases during momentary monitoring. We performed a single 4-test cognitive assessment on 240 participants (schizophrenia n = 126; bipolar disorder n = 114) and asked them to make a judgment about their performance immediately after completion of each task. We related performance and these judgments to results of Ecological Momentary Assessments (EMA) of the momentary occurrence of psychotic symptoms (Voices, paranoid ideas, other delusions) collected over up to 90 surveys over a 30 days prior to the single cognitive assessment. We examined test performance and the accuracy of self-assessment at that assessment, looking at diagnostic differences in performance and mis-estimation of performance. Participants with bipolar disorder had better cognitive performance, but there were no differences in mis-estimation. Analyses of the correlation between cognitive performance and self-assessment were all significant and better cognitive performance predicted reduced errors in self-assessment. Examination of the 30-day course of psychotic symptoms and IA could only be performed in participants with schizophrenia, revealing correlations between more common occurrences of all three psychotic symptoms and increased absolute values for IA errors. These data are consistent with theories of cognitive response biases and the formation of delusions.

Keywords: Bipolar disorder; Ecological momentary assessment; Introspective accuracy; Paranoia; Psychotic symptoms; Schizophrenia; Voices.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Humans
  • Mental Disorders*
  • Mental Status and Dementia Tests
  • Self-Assessment*