The relationship of metacognition and neurocognitive profile in obsessive compulsive disorder (OCD) presenting with autogenous and reactive features

Aim: In this study, it was aimed to investigate neurocognitive features and metacognitions in OCD patients with autogenous and reactive features that provide a new subgrouping for OCD. Thus, it is aimed to investigate whether this subtype, which has been done within the scope of cognitive theory, is differentiated metacognitively and neurobiologically. It is also aimed to investigate the relationship between metacognition and neurocognitive processes that are thought to interact with each other in both OCD patients and OCD subgroups. Method: From January 2016 to December 2016, 67 patients who applied to the psychiatry outpatient clinic of the Karadeniz Technical University Medical Faculty and accepted to participate in the study from the patients who were diagnosed with OCD according to the DSM-5 diagnostic criteria and who met inclusion criteria were taken into the study. These patients were divided into groups with 27 autogenous obsessions and 40 reactive obsessions to the contents of primer obsessions. 67 patients matched with these patients in terms of gender, age and educational level were included in the study as control group. Metacognition Questionnaire-30 (MCQ-30), Stroop Test, Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT) and Auditory Verbal Learning Test (AVLT) were used in our study. Results: In our study, the groups consisting of OCD, autogenous, reactive and healthy individuals were found to be similar in terms of their age, educational level, gender and marital status. Insight was found lower in the patients with autogenous obsessions than reactive group. In terms of metacognition, the mean score of the MCQ-30 positive beliefs about worry subscale of patients with reactive obsessions was higher than the autogenous group. When the OCD patients were compared with the control group, it was found that the OCD group had higher scores on MCQ-30 negative beliefs about uncontrollability of thoughts, beliefs about need to control thoughts, and cognitive self-consciousness than the control group. In terms of neurocognitive test performances, about TMT-A, B, B-A, Stroop test performance, immediate memory, verbal learning, delayed recall and recognition in AVLT, total correct, total errors, perseverative errors, nonperseverative errors, conceptual level responses, learning to learn score in WCST, the patients in the autogenous and reactive groups showed similar performance compared to the control group but these patients were found to perform worse than the control group. Compared with the control group, all of the OCD patients had similar characteristics to the autogenous and reactive groups in the TMT, Stroop Test and AVLT, while the autogenous and reactive group in the WCST additionally had worse performance than the control group at trials to complete first category and failure to maintain set score. When the relationship between metacognition and neurocognitive performance was examined, it was found that there was a moderate correlation in the negative direction between the MCQ cognitive confidence subscale and immediate memory, verbal learning and recognition scores at AVLT in the group with autogenous obsessions. Conclusion: Based on the data of this study, it was found that there was no difference between the groups except for the positive beliefs about worry subscale among the OCD subtypes with autogenous and reactive obsessions, although metacognitive structures differed between OCD and healthy individuals. This may indicate that similar metacognitive pathologies play a role in OCD subtypes. In terms of neurocognitive functions, the fact that healthy subjects differ from OCD but that there is no difference between autogenous and reactive groups may indicate that similar neurobiological pathologies play a role in subtypes. Due to limited number of patients with autogenous obsessions in current study, any future research with greater sample size will be helpful to explain the metacognitions and cognitive functions in OCD with autogenous and reactive obsessions.