The Importance of Metamemory Functioning to the Pathogenesis of Psychosis

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.

Dopamine is a double-edged sword: Enhancing memory retrieval performance at the expense of metacognition

“…Moreover, the improved retrieval performance observed here is consistent with previous rat studies reporting memory facilitation after acute systemic haloperidol administration in the retrieval phase (Chugh et al, 1991;Sara, 1986). Finally, our findings might help to explain the presence of episodic memory (Scimeca and Badre, 2012) and metamemory (Eisenacher and Zink, 2017) impairments in dopamine-related diseases as well as offer new perspectives for the treatment of memory disorders.…”

Dopamine is a double-edged sword: dopaminergic modulation enhances memory retrieval performance but impairs metacognition

“…These opposing findings are in agreement with recently demonstrated dissociable brain mechanisms underlying recognition performance and memory confidence in non-human primates [60], as well as with long-established behavioral dissociations between memory accuracy and confidence in human cognitive studies (e.g., [61][62][63][64]). Beyond this dissociation, our findings might help to explain the presence of episodic memory [65] and metamemory [66] impairments in dopamine-related diseases, as well as offer new perspectives for the treatment of memory disorders.…”

Self-Awareness of Psychopathology and Brain Volume in Patients With First Episode Psychosis

“…These results suggest that rSTG volume has significant implications for self-reporting memory. Since the PRMQ assesses a patient’s own amnesia experience, high scores imply high awareness of memory impairment (108). In addition, PRMQ is used to measure cognitive functions, as well as the broader neurobehavioral changes that are likely to occur alongside compromised functioning, such as loss of insight (109–111).…”