Abstract
Many studies up to date have implied that biases in the metacognition of memory, so called metamemory, contribute to the development and maintenance of positive symptoms in schizophrenia. However, no study exists which has longitudinally followed patients experiencing positive symptoms. The present article therefore reviews cross-sectional studies on retrospective metamemory abilities in participants within different stages of a schizophrenia spectrum disorder, with heterogeneous symptom severities, creating a pseudo-longitudinal overview. Summarized, a deterioration of these abilities correlating with psychosis development can be inferred. The reviewed publications indicate that metamemory biases can already be found in patients with an at-risk mental state for psychosis (ARMS). Patients in their first episode of psychosis (FEP) seem to be more severely impaired than ARMS-patients but similarly affected compared to chronic patients. The contribution of these biases to the pathogenesis of psychosis is discussed, giving consideration to relations with other cognitive- and metacognitive functions, neurochemical processes and neural correlates. It is hypothesized that the biases represent early cognitive markers of the beginning and persisting psychotic state. An early treatment program could help patients to ameliorate the general course of illness or even to prevent the risk of a transition to psychosis.
Highlights
Recent literature has demonstrated a reduced metacognitive capacity in patients with schizophrenia
Being aware of one’s cognitive functionality and cognitive errors is a necessary condition in order to adequately plan strategies for emerging tasks, evaluate their success and adapt one’s approach according to situational requirements
One example of a metacognitive ability is the metacognition of memory processes, named metamemory
Summary
Recent literature has demonstrated a reduced metacognitive capacity in patients with schizophrenia. Metamemory awareness rather corresponds to the monitoring and regulation of memory (Perfect and Schwartz, 2002) As it is Metamemory in the Psychosis Pathogenesis generally true for metacognition, metamememory abilities provide a foundation for the recognition of one’s memory competences, for the correction of beliefs about these competences if required, and for the adaption of strategies to meet the task requirements. Asking for introspective judgements about one’s current memory performance is a qualified strategy to assess metamemory awareness. For prospective metamemory judgements at the time of retrieval one may use Feeling of Knowing ratings (FOK; Bacon et al, 2001) which assess one’s certainty that an item will be recognized in an upcoming recognition task after it has not been recalled independently. CL ratings have been assessed in a variety of tasks, for example verbal recognition tasks (Kircher et al, 2007), verbal (Moritz et al, 2004; Laws and Bhatt, 2005; Bhatt et al, 2010; Eifler et al, 2015; Eisenacher et al, 2015; Hodgetts et al, 2015) or visual (Moritz et al, 2008; Peters et al, 2012, 2013) false memory tasks, source monitoring tasks (Moritz and Woodward, 2002, 2006a,b; Moritz et al, 2003, 2005; Doré et al, 2007; Garcia et al, 2012) or general knowledge tasks (Bacon et al, 2001)
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