Specific Self-Defining Memories May Improve Functioning in First Episode Psychosis

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Self-defining memories predicted functioning in first episode psychosis, independent of metacognition.
Self-defining memories predicted functioning in first episode psychosis, independent of metacognition.

At the first episode of psychosis, patients had less integrated self-defining memories than healthy controls, indicating a deficit in these functional skills early in the disease process. The link between self-defining memories and clinical outcomes as well as the effect they have on functionality is described in a study published in Schizophrenia Bulletin.

Researchers of this cross-sectional study evaluated 71 patients with first episode psychosis and 57 healthy controls using a self-defining memories questionnaire, a functional outcome survey, a functional capacity skills evaluation, a syndrome symptoms scale, neurocognition measurements, and metacognition assessments.

Between the 2 cohorts, researchers found a significant difference between integrated memories and nonintegrated memories, with 82% of the first episode psychosis cohort and 42% of the healthy controls having a nonintegrated memory (P <.001). Neurocognition did not predict integration but did account for 14.8% of specificity variation. Metacognition also did not predict integration but did account for 28.7% of the specificity variation.

After controlling for confounding variables, specificity was a predictor for functional outcome and accounted for 70.4% of the functional outcome score variation (P <.001). When a specific self-defining memory was reported, the mean time spent in a structured activity increased to 43.3 hours per week from 14.92 hours per week when a nonspecific self-defining memory was reported.

Metacognition mediated the relationship between the self-defining memory and functional outcome (β=0.48; 95% CI, 0.36-0.6; P <.001) while specificity partially mediated the relationship between the self-defining memory and functional capacity (β=0.25; 95% CI, 0.04-0.46; P =.021). Significant pathways were found between self-defining memory and both metacognition (β=0.62, P <.001) and specificity (β=0.41, P =.013), as well as between functional outcome and both metacognition (β=0.58, P <.01) and specificity (β=0.4, P <.001).

Future studies need to compute complex mediation models by using a larger sample size, further evaluate the role depression plays in functional outcomes, include unambiguous directions on the self-defining questionnaire to include the meaning behind the memory, and assess intervention schemes to increase function through self-defining memory therapy.

The researchers concluded that the specificity of self-defining memories predicts functional outcome, and those with “a specific [self-defining memory] were more likely to utilize their real-life functional skills to partake in structured activities.”

Reference

Wright AC, Davies G, Fowler D, Greenwood KE. Self-defining memories predict engagement in structured activity in first episode psychosis, independent of neurocognition and metacognition [published online November 2, 2018]. Schizophr Bull. doi: 10.1093/schbul/sby155

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