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People with serious mental illness have challenged self-awareness, including momentary monitoring of performance. A core feature of this challenge is in the domain of using external information to guide behavior, an ability that is measured very well by certain problem-solving tasks such as the Wisconsin Card Sorting Test (WCST) . We used a modified WCST to examine correct sorts and accuracy decisions regarding the correctness of sort. Participants with schizophrenia (n = 99) or bipolar disorder (n = 76) sorted 64 cards and then made judgments regarding correctness of each sort prior to feedback. Time series analyses examined the course of correct sorts and correct accuracy decisions by examining the momentary correlation and lagged correlation on the next sort. People with schizophrenia had fewer correct sorts, fewer categories, and fewer correct accuracy decisions (all p<.001). Positive response biases were seen in both groups. After an incorrect sort or accuracy decision, the groups were equally likely to be incorrect on the next sort or accuracy decision. Following correct accuracy decisions, participants with bipolar disorder were significantly (p=.003) more likely to produce a correct sort or accuracy decision. These data are consistent with previous studies implicating failures to consider external feedback for decision making. Interventions aimed at increasing consideration of external information during decision making have been developed and interventions targeting use of feedback during cognitive test performance are in development., Competing Interests: Declaration of competing interest Dr. Raeanne C. Moore is a co-founder of KeyWise AI, Inc. and a consultant for NeuroUX. Dr. Harvey has received consulting fees or travel reimbursements from Alkermes, Boehringer Ingelheim, Karuna Therapeutics, Minerva Neuroscience, Roche Pharma, and Sunovion Pharma. He receives royalties from the Brief Assessment of Cognition in Schizophrenia, which is owned by WCG-Endpoint Solutions and is part of the MATRICS Consensus Battery. He is chief scientific officer of iFunction, Inc. Dr. Pinkham has served as a consultant for Roche Pharma. The other authors have no potential Biomedical Conflicts of Interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: Schizophrenia participants generate self-reports of their competencies that differ from objective information. They may base their reports on momentary moods or experiences rather than objective data. Theories of delusion formation implicate overconfidence during self-assessment as a cause., Methods: Ecological momentary assessment (EMA) was used to sample activities and experiences in 101 participants with schizophrenia up to 3 times a day for 30 days. Each survey asked where and with whom they were, what they were doing, and moods and psychotic symptoms they were experiencing. Self-reports and observer ratings of competence in work and everyday activities were collected., Results: Being home was associated with self-reports of better functioning in activities and work skills (p<.001) and being alone correlated with better self-reported functioning in activities (p<.001). Participants who reported more occurrences of hearing voices, paranoid ideation, and other psychotic symptoms reported their functioning as better (p<.001)., Implications: Schizophrenia was marked by a disconnect between momentary activities and self-assessments. Being home more was associated with better self-reported functioning on tasks that are only performed away from home. Psychotic  symptoms were associated with overestimation, consistent with previous theories positing that overconfidence and suspension of plausibility assessment may be associated with psychotic experiences., (Copyright © 2022. Published by Elsevier B.V.)

Objective: Individuals with severe mental illnesses (SMI), including schizophrenia spectrum illnesses and affective disorders, may be at increased risk for negative mental health outcomes related to the COVID-19 pandemic. This study compared the severity of pre-pandemic symptoms and affective experiences to current symptoms to evaluate this possibility., Methods: 148 individuals with SMI (92 with schizophrenia spectrum illnesses and 56 with affective disorders) were recruited from ongoing ecological momentary assessment studies that sampled day-to-day experiences and symptom severity prior to the pandemic. Participants completed a one-time phone survey that queried these same experiences/symptoms between April and June of 2020., Results: Severity of affective experiences and psychotic symptoms remained stable across time, as did sleep duration. Well-being and the number of substances used increased during the early months of the pandemic. Increases in well-being were associated with being female and spending less time alone pre-pandemic. Patterns of stability/change did not differ according to diagnostic category., Conclusions: At this relatively early stage, individuals with SMI are not reporting a worsening of symptoms or affective experiences and instead appear to be resilient in the face of the pandemic. Continued assessment is needed to determine whether this resilience will persist as the pandemic progresses., (Copyright © 2020 Elsevier B.V. All rights reserved.)