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

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 r 2 = 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.

Brain structural correlates of functional capacity in first-episode psychosis

“…No statistically significant differences were observed between FEP and healthy controls on any demographic variables (all p values > 0.05, see Table 1). In the FEP group, the mean UPSA score was 68.41 (SD = 19.18, N = 34), which is slightly lower than previous FEP studies in which their mean scores were 74.7 51 and 77.5 6 .…”

“…The UPSA is an instrument to assess the capacity to complete everyday tasks across 5 domains: finance, communication, comprehension and planning, transportation, and household chores. The UPSA has been assessed for reliability and validated in schizophrenia 56 and employed in FEP before 3,6,51,57 . Of the 39 FEP participants, 34 completed the UPSA.…”

Brain Structural Correlates of Metacognition in First-Episode Psychosis

“…Impaired metacognition has been consistently identified in both FEP and patients with chronic schizophrenia, and impacts functional capacity 4 , affecting work function 5 , quality of life 6 and social function 7 . Evidence also suggests that metacognition might mediate relationships between neurocognitive abilities and functional capacity 8 and predict functional outcome 9 ; various therapeutic strategies have emerged specifically targeting metacognitive deficits 3,10 . Determining the neural correlates of metacognition, and how these relate to neuropathological mechanisms in schizophrenia, would help optimise these strategies.…”

Persons with first episode psychosis have distinct profiles of social cognition and metacognition

“…Poor metacognition has been linked to poor outcome 55 . Specifically, the JTC bias has been associated to an increased presence of delusions 26 , worse neuropsychological functioning, and lower IQ 27 – 29 .…”