Three-Year Follow-Up Study Exploring Metacognition and Function in Individuals With First Episode Psychosis.

Abigail C Wright,Geoff Davies,David Fowler,Kathryn Greenwood

doi:10.3389/fpsyt.2019.00182

Abstract

Introduction: Research has demonstrated that functional outcome in psychosis is predicted by factors such as neurocognition, functional capacity, symptoms and, more recently, metacognition. Metacognitive ability has been demonstrated to mediate between neurocognition and functional outcome in First Episode Psychosis (FEP). Whether metacognition also predicts longer-term recovery in first episode psychosis is unknown. This study assessed whether neurocognition, functional capacity and metacognitive ability in FEP predicted functional outcome three years later.Methods: Eighty individuals with First Episode Psychosis were re-contacted after an average 3 years (range: 26–45 month follow-up) from baseline. Twenty-six participants (33%) completed completed measures of neurocognition, metacognition, functional capacity, functional outcome (hours spent in structured activity per week) and psychopathology at baseline and at follow-up.Results: Individual regression analyses demonstrated neurocognition, functional capacity, and metacognitive ability at baseline significantly predicted functional outcome at three years. However, when baseline functional outcome was controlled, only metacognitive ability was a significant predictor of change in functional outcome from baseline to follow-up, p < 0.001. This model explained 72% (adjusted r2 = 0.69) of the variance in functional outcome at follow-up. Negative symptoms did not change the model.Discussion: This study demonstrated that better metacognitive ability significantly predicted improvement in functioning in FEP across a 3-year period. This highlights the potential value of clinical interventions that focus on improving metacognitive ability at first point of illness to maximize recovery.

Highlights

Research has demonstrated that functional outcome in psychosis is predicted by factors such as neurocognition, functional capacity, symptoms and, more recently, metacognition
Missing data was considered as “Missing Completely At Random” (MAR), as missing data was not associated with data within the study
There were no significant differences on cognition, functional capacity, functional outcome, symptoms, and metacognitive ability for those who participated in follow-up and those who did not

Summary

Introduction

Research has demonstrated that functional outcome in psychosis is predicted by factors such as neurocognition, functional capacity, symptoms and, more recently, metacognition. Metacognitive ability has been demonstrated to mediate between neurocognition and functional outcome in First Episode Psychosis (FEP). Whether metacognition predicts longer-term recovery in first episode psychosis is unknown. This study assessed whether neurocognition, functional capacity and metacognitive ability in FEP predicted functional outcome three years later. Clinical recovery after an experience of psychosis was previously considered poor [3], recent research has demonstrated that around 50% of individuals with psychosis had favorable outcomes after long follow-up periods [4,5,6] and this has been demonstrated with First Episode Psychosis (FEP) [7, 8]. Birchwood et al [11] named this the critical-period, highlighting the importance of early and targeted interventions to prevent further decline [12,13,14]

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Discussion

Conclusion