Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Assessment of 3-Dimensional Wisdom in Schizophrenia

Schizophr Res; ePub 2019 Feb 14; Van Patten, et al

A recent investigation suggests that wisdom, especially reflective wisdom, may be associated with better cognitive performance and better physical and mental health in people with schizophrenia (PwS). Furthermore, it is conceivable that interventions to enhance wisdom may have broad cognitive and mental and physical health benefits in individuals with chronic psychotic disorders. In the current study, researchers administered a widely used, validated 3-dimensional wisdom scale that includes 3 interrelated dimensions: cognitive, reflective, and affective. They examined group differences in wisdom, as well as relationships between wisdom and sociodemographics, clinical symptoms, neurocognitive and functional performance, and mental and physical health in 65 stable adult outpatients with chronic schizophrenia or schizoaffective disorder and 96 non-psychiatric comparison participants (NPCPs). They found:

  • PwS had lower wisdom scores than NPCPs and that wisdom moderated relationships between diagnostic group and neurocognitive and functional performance; PwS with higher levels of wisdom demonstrated better cognitive performance than did PwS with lower levels of wisdom.
  • In addition, wisdom was positively correlated with performances on multiple neurocognitive tasks in PwS, but not in NPCPs.
  • Reflective wisdom—representing accurate/unbiased introspection and perspective-taking—correlated with all mental health variables in PwS.

Van Patten R, Lee EE, Daly R, Twamley E, Tu XM, Jeste DV. Assessment of 3-dimensional wisdom in schizophrenia: Associations with neuropsychological functions and physical and mental health. [Published online ahead of print February 14, 2019]. Schizophr Res. doi:10.1016/j.schres.2019.01.022.


Wisdom is a psychological characteristic that often increases with age and that has multiple positive effects on health and well-being. The authors of this study note that while there is a dearth of literature on wisdom in people with schizophrenia, the body of evidence on the related construct of social cognition in schizophrenia includes components of wisdom frameworks and has shared neurobiological underpinnings, such as emotion regulation, theory of mind, and prosocial attitudes. These findings suggest that wisdom and cognitive functioning overlap considerably, with greater wisdom being associated with better neurocognitive and functional status. This report is an excellent reminder of the importance of going beyond symptoms and impairments as a clinical focus in schizophrenia. It appears likely that additional and new efforts to assess and enhance positive traits, such as wisdom and resilience, can improve recovery and quality of life in those with schizophrenia.—Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.