Comparing the Effects of Atypical Antipsychotic Polypharmacy on Metacognitive Function in Schizophrenia: Considering AI-assisted Interventions as a Future Direction—a Pilot Study

Abstract

Metacognitive impairments are central to schizophrenia and strongly linked to limited insight and poor functional outcomes. While atypical antipsychotics effectively reduce positive symptoms, their influence on metacognition remains unclear. This pilot study explores how different antipsychotic regimens may affect metacognitive belief patterns, while also considering artificial intelligence (AI) only as a future direction for augmenting cognitive interventions. Twelve participants (eight with schizophrenia, four healthy controls) were assessed using the Metacognitions Questionnaire-30 (MCQ-30). Patients were prescribed either clozapine with amisulpride or two-drug combinations selected from risperidone, aripiprazole, and quetiapine. Between-group comparisons were conducted using one-way ANOVA with post hoc tests. Effect sizes and post hoc power analyses were calculated. No significant differences emerged in cognitive confidence or cognitive self-consciousness. However, patients receiving dual-drug combinations from risperidone, aripiprazole, and quetiapine reported stronger positive beliefs about worry and greater perceptions of thought dangerousness. These trends suggest that certain multi-drug regimens may intensify maladaptive metacognitive beliefs. This study provides preliminary observations that antipsychotic polypharmacy may influence metacognitive functioning in schizophrenia. While AI was not applied here, future research could examine whether digital tools may one day support metacognitive awareness and regulation alongside pharmacological care.