Effectiveness of a specific cueing method for improving autobiographical memory recall in patients with schizophrenia

The positive dimension of schizotypy is associated with self-report measures of autobiographical memory and future thinking but not experimenter-scored indices

ABSTRACTThe ability to remember our past and to imagine the future are critical to our sense of self. Previous research has indicated that they are disrupted in schizophrenia. However, it is unclear (i) whether this is found when examining experimenter-scored indices of content and/or participants' self-report of phenomenological characteristics, and (ii) how these abilities might be related to symptoms. This study sought to address these questions by taking a dimensional approach and measuring positive and negative schizotypal experiences in healthy people (n = 90). Participants were given cue words. For some, they remembered an event from the past and for others they generated an event in the future. No significant relationships were found with any aspect of schizotypy when participants' descriptions were scored by the experimenter according to a standardised episodic content measure. In contrast, several significant positive correlations were observed for past memory and future thinking when examining the positive dimension of schizotypy and participants' ratings, particularly to sensory characteristics of the experience and mental pre- or reliving. These results indicate enhanced subjective experiences of autobiographical memory and future thinking in those who report delusional and hallucinatory-like occurrences, which might be linked to mental imagery or metacognitive alterations.

Improving autobiographical memory in schizophrenia using wearable cameras: A single-case experimental study

Autobiographical memory (AM) impairments influence both sense of identity and social functioning of patients with schizophrenia. However, cognitive remediation methods addressing these difficulties do not sufficiently consider the heterogeneity of this disorder and frequently face methodological limitations. The aim of the present study was to evaluate the efficacy of a method using a wearable camera (NarrativeClip®), through an alternating treatments design across two types of AM training. In parallel, repeated measures were used to appreciate the efficacy, specificity, and generalizability of the programme's benefits. Three patients were invited to wear the camera during 24 personal events. Ten of these events memories were trained by visual cueing (wearable camera condition), 10 others by verbal cueing (written diary condition) and 4 were not trained (control condition). Using pictures collected by the wearable camera seemed particularly relevant, since it promoted more detailed recalls than the diary method, from the first training session and until the end of a one-year follow-up. In addition, the repeated measures performed revealed (1) the efficacy (improvement in AM capacities after participating in the programme), (2) specificity (persistence of working memory deficits), and (3) generalizability (improvement in measures of episodic memory) of our cognitive remediation programme's effects.

Autobiographical memory in chronic schizophrenia: A follow-up study

Chronic schizophrenia is a very disabling disease and patient's social integration remains difficult. One important aspect is autobiographical memory (AM) as it is impaired in schizophrenia and highly correlated to patient's outcome, since its closely linked to self and identity. Reduced specificity and lack of details are characteristics of patients' AM, but its longitudinal course in schizophrenia remains unclear. We examined 21 patients who underwent our protocol twice with an interval of 7 years. AM was assessed using a semi-structured interview, covering four periods of life and addressing semantic knowledge and autobiographical episodes as well as their details. The results can be divided into three parts, separating semantic memories, specific autobiographical memories and details describing the latter. While a significant deterioration of semantic AM over time could be revealed, the specificity of the free recalled autobiographical episodes remained rather stable - albeit on a low level. In contrast, unique events were remembered with significantly less details at follow-up than at the first examination. While floor-effects given a relatively small number of unique events have to be considered, semantic AM and episodic details seem to be a valuable target for AM remediation given their further deterioration over time.

Autobiographical memory impairment in chronic schizophrenia: Significance and clinical correlates

Previous studies of autobiographical memory (AM) in schizophrenia yielded a reduction of specificity, richness of details and conscious recollection, which indicate both, quantitative and qualitative AM changes. However, their associations with psychopathological symptoms and neuropsychological deficits were not resolved. Therefore, we sought to investigate AM with respect to psychopathology and neuropsychology in patients with chronic schizophrenia to rule out the influence of different courses of the disease. AM of four lifetime periods was examined in 75 patients and 50 healthy controls by using a semi-structured interview. The recalled episodes were rated for memory specificity. Subsequently, one single event of each period of life was rated for details and experiential aspects of reliving (originality, vividness/visual imagery, emotional re-experiencing and emotional valence). When contrasted with healthy controls, patients recalled a significantly reduced number of episodes and personal semantic facts; moreover, memory specificity of AM was significantly lower in patients than controls. While the richness of details calculated for single events showed only minor, non-significant group differences, vividness and emotional re-experiencing were significantly less pronounced in the patient group. Along with this, AM performance correlated significantly with negative symptoms including apathy as well as verbal memory and executive functions. Our results underline the significance of overgenerality as a key feature of AM in schizophrenia as well as a dissociation between intact number of details of single events and reduced vividness and emotional re-experiencing. The extent of negative symptoms including apathy and impairments of verbal memory/executive functions may explain AM deficits in chronic schizophrenia.

Effect of non-pharmacological interventions on source memory processes in the early course of psychosis: A systematic review

People with a psychotic disorder suffer from major cognitive impairments which prevent their functional recovery. Source memory impairments have been shown to be associated with psychotic symptoms and even to precede their onset. Source memory has thus been hypothesized as a cognitive precursor of psychosis. However, few interventions targeting source memory are included in current therapeutic approaches for early psychosis.

AIM

This systematic review aimed to identify non-pharmacological interventions for early psychosis which have impacted source memory processes.

METHODS

Studies were selected from nine databases when they included: (a) a non-pharmacological intervention involving a sample of patients with early-onset psychotic disorder or subclinical psychotic symptoms; and (b) effects on source memory processes, measured directly or inferred through an episodic memory task.

RESULTS

Thirteen studies were identified, including two cognitive remediation programs and one repetitive transcranial magnetic stimulation treatment that reported beneficial effects on source memory.

CONCLUSIONS

Relevant intervention strategies for source memory impairments were identified. This review points up a need to further develop interventions targeting theoretically defined source memory concepts and assess their effects with specific and valid tasks. Recommendations regarding underlying mechanisms which could have a beneficial impact on source memory may provide guidance for the future development of early psychosis interventions.

Early life adversity and the specificity of autobiographical memory amongst people with schizophrenia

BACKGROUND

People with schizophrenia diagnoses are thought to have difficulty retrieving memories of specific autobiographical events because of attempts to avoid the negative affect associated with previous adversity. We provide the first investigation of the association between early adversity (e.g., childhood abuse) and autobiographical memory problems amongst people with and without schizophrenia.

METHOD

Participants with diagnoses of schizophrenia (n = 79) and participants without diagnoses (n = 41) completed the Maltreatment and Abuse Chronology of Exposure (MACE) interview schedule and a cued recall task.

RESULTS

Participants exposed to greater number of, and more severe, childhood adversity retrieved fewer specific autobiographical memories. However, participants with schizophrenia retrieved fewer specific memories than control participants without diagnoses irrespective of the presence, severity or number of adversities they experienced.

CONCLUSIONS

Adversity contributes towards autobiographical memory difficulty but adversity does not explain why people with schizophrenia differ from diagnoses-free people in their autobiographical memory abilities.

Unraveling the role of retrieval deficits in autobiographical memory impairment in schizophrenia: A comparison of involuntary and voluntary autobiographical memories

Patients with schizophrenia show severe autobiographical memory impairment, thought to reflect retrieval deficits caused by executive dysfunction. However, prior research has focused exclusively on strategic (voluntary) retrieval, and ignored involuntary retrieval resulting from automatic and associative processes, involving minimal cognitive control. We report two studies with patients diagnosed with schizophrenia (Ns = 40 and 50 respectively) comparing their impairment in involuntary versus voluntary autobiographical memory. We use two different methodologies, not previously used in schizophrenia research: a naturalistic study involving real-life data and an experimental setup. Both studies consistently showed that involuntary and voluntary autobiographical memories were similarly impaired in schizophrenia. The absence of interaction effects between group and retrieval suggests that schizophrenic patients did not benefit from memory tasks involving little retrieval effort. These findings suggest that autobiographical memory impairment in schizophrenia are not caused by problems with self-initiated voluntary retrieval, but instead likely reflect encoding or binding deficits.

Eavesdropping on Autobiographical Memory: A Naturalistic Observation Study of Older Adults' Memory Sharing in Daily Conversations

The retrieval of autobiographical memories is an integral part of everyday social interactions. Prior laboratory research has revealed that older age is associated with a reduction in the retrieval of autobiographical episodic memories, and the ability to elaborate these memories with episodic details. However, how age-related reductions in episodic specificity unfold in everyday social contexts remains largely unknown. Also, constraints of the laboratory-based approach have limited our understanding of how autobiographical semantic memory is linked to older age. To address these gaps in knowledge, we used a smartphone application known as the Electronically Activated Recorder, or “EAR,” to unobtrusively capture real-world conversations over 4 days. In a sample of 102 cognitively normal older adults, we extracted instances where memories and future thoughts were shared by the participants, and we scored the shared episodic memories and future thoughts for their make-up of episodic and semantic detail. We found that older age was associated with a reduction in real-world sharing of autobiographical episodic and semantic memories. We also found that older age was linked to less episodically and semantically detailed descriptions of autobiographical episodic memories. Frequency and level of detail of shared future thoughts yielded weaker relationships with age, which may be related to the low frequency of future thoughts in general. Similar to laboratory research, there was no correlation between autobiographical episodic detail sharing and a standard episodic memory test. However, in contrast to laboratory studies, episodic detail production while sharing autobiographical episodic memories was weakly related to episodic detail production while describing future events, unrelated to working memory, and not different between men and women. Overall, our findings provide novel evidence of how older age relates to episodic specificity when autobiographical memories are assessed unobtrusively and objectively “in the wild.”

Cognitive Intervention Targeting Autobiographical Memory Impairment in Patients With Schizophrenia Using a Wearable Camera: A Proof-of-Concept Study

Autobiographical memory (AM) impairment in schizophrenia affects the richness of detail in personal memories and is one of the major predictors of patients' social functioning. Despite the empirical evidence attributing these difficulties to a defective encoding process, cognitive remediation interventions targeting AM in schizophrenia often focus on the remote past, making it difficult to address the consequences of poor encoding. Our study evaluated the efficacy of an innovative approach using a wearable camera (NarrativeClip®) in reinforcing the encoding of recent daily life events in patients with schizophrenia. Seventeen patients with schizophrenia and 15 control participants wore the camera during four consecutive days. Then, memories of events experienced during these days were reinforced using different types of retrospective, i.e. interventions designed to promote a re-encoding of the event. We evaluated two types of retrospective using the camera pictures: a simple visual retrospective and a visual retrospective associated with a specific event-cueing (VisR+EC). These two techniques were compared to a verbal retrospective and to the absence of retrospective. Our results showed that the VisR+EC allowed patients to retrieve as many details as the control group at a two-week interval. However, patients' memories remained impaired when a simple visual or a verbal retrospective was used. Our study provides encouraging results to foster the use of a wearable camera in individualized cognitive remediation programs for AM impairment in schizophrenia.

The Effects of Exposure to Recent Autobiographical Events on Declarative Memory in Amnestic Mild Cognitive Impairment: A Preliminary Pilot Study

BACKGROUND

Individuals with amnestic Mild Cognitive Impairment (aMCI) are at heightened risk of developing Alzheimer's dementia. In recent years, much attention has been given to the search for new interventions to slow down the progression of cognitive decline of these patients. Wearable digital camera devices are one form of new technology that captures images of one's life events, so they constitute a promising method to be used as a means to stimulate recent autobiographical memory.

OBJECTIVE

This preliminary study investigates the ability of a new cognitive intervention based on exposure to recent autobiographical memory captured by wearable cameras to improve episodic memory in patients with aMCI.

METHODS

Seventeen subjects wore a wearable camera while they went about their daily activities. The images captured were converted into eight different 3-minute films containing the most relevant information of each event. The intervention involved eight individualized weekly sessions during which patients were exposed to a different autobiographical event each week. Besides, several specific questions were formulated within each session. Clinical questionnaires assessing cognitive reserve, premorbid intelligence, depression, and anxiety were administered at baseline. Measures of objective episodic memory were applied at baseline and at post-treatment.

RESULTS

Significant improvements were observed at post-treatment in memory measures, and significant associations were found between memory change scores and age and cognitive reserve. Anyway, these associations did not reach statistical significance after adjusting for multiple comparisons.

CONCLUSION

The present study provides preliminary evidence that aMCI patients may benefit from a cognitive intervention program based on re-experiencing recent autobiographical events. However, future studies incorporating a control group will be needed to confirm these preliminary findings.

Seeing or hearing one's memories: Manipulating autobiographical memory imagery in schizophrenia

The prevalence of auditory hallucinations in schizophrenia, and theories suggesting a link between autobiographical memory and hallucination, raise the possibility of a dominant role of auditory imagery in autobiographical remembering in patients with schizophrenia, whereas visual imagery is dominant in autobiographical memory of healthy adults. The present study explored this possibility by comparing autobiographical memory characteristics, according to sensory modality, in patients with schizophrenia versus healthy controls. Twenty-eight patients and 28 matched controls were asked to retrieve autobiographical memories that were dominated by auditory, visual, gustatory-olfactory, or tactile imagery. ANOVA analysis showed that patients rated their memories lower on specificity, contextual information, feeling of reliving, overall vividness, coherence and autobiographical me-ness (i.e. whether an autobiographical memory is experienced as belonging to the self), ps < 0.03, compared with control participants. The effects of sensory modality imagery were largely similar for patients and controls, as no interaction effects were observed. The findings did not support a dominance of auditory imagery in patients' autobiographical memory. In the patient group, reduced autobiographical me-ness was predicted by lower ratings of contextual information related to the setting of the event. Future research should examine whether these effects extend to involuntary autobiographical memory in schizophrenia.

Episodic Autobiographical Memory in Adults With Autism Spectrum Disorder: An Exploration With the Autobiographical Interview

Introduction: The literature has provided contradictory results regarding the status of episodic memory in autism spectrum disorder (ASD). This might be explained by methodological differences across studies. In the present one, the well-recommended Autobiographical Interview was used in which important aspects of episodic memory were assessed, namely, the number and richness of phenomenological memory details, before and after a retrieval support. Method: Twenty-five well-documented adults with ASD without Intellectual Disability (nine women) and 25 control participants were included and asked to recall six specific autobiographical events. The number and richness of details were assessed globally and for five categories of details (perceptual/sensory, temporal, contextual, emotional, and cognitive), firstly before and then after a specific cueing phase consisting in a series of specific questions to elicit more precise memory details. Results: Cumulatively, from the spontaneous recall to the cueing phase, the number of internal details was lower in ASD individuals compared to controls, but this difference was relevant only after the specific cueing procedure and observed only for contextual details. In contrast, no relevant group difference was observed during spontaneous recall. The detail richness was not impaired in ASD throughout the Autobiographical Interview procedure. Conclusion: Our results speak against a clear impairment of episodicity of autobiographical memory in ASD individuals. They thus challenge previous ones showing both a reduced specificity and episodicity of autobiographical memory in this population and call for further studies to get a better understanding on the status of episodic autobiographical memory in ASD.

A review of autobiographical memory studies on patients with schizophrenia spectrum disorders

BACKGROUND

Patients suffering from schizophrenia spectrum disorders demonstrate various cognitive deficiencies, the most pertinent one being impairment in autobiographical memory. This paper reviews quantitative research investigating deficits in the content, and characteristics, of autobiographical memories in individuals with schizophrenia. It also examines if the method used to activate autobiographical memories influenced the results and which theoretical accounts were proposed to explain the defective recall of autobiographical memories in patients with schizophrenia.

METHODS

PsycINFO, Web of Science, and PubMed databases were searched for articles published between January 1998 and December 2018. Fifty-seven studies met the inclusion criteria. All studies implemented the generative retrieval strategy by inducing memories through cue words or pictures, the life-stage method, or open-ended retrieval method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines were followed for this review.

RESULTS

Most studies reported that patients with schizophrenia retrieve less specific autobiographical memories when compared to a healthy control group, while only three studies indicated that both groups performed similarly on memory specificity. Patients with schizophrenia also exhibited earlier reminiscence bumps than those for healthy controls. The relationship between comorbid depression and autobiographical memory specificity appeared to be independent because patients' memory specificity improved through intervention, but their level of depression remained unchanged. The U-shaped retrieval pattern for memory specificity was not consistent. Both the connection between the history of attempted suicide and autobiographical memory specificity, and the relationship between psychotic symptoms and autobiographical memory specificity, remain inconclusive. Patients' memory specificity and coherence improved through cognitive training.

CONCLUSIONS

The overgeneral recall of autobiographical memory by patients with schizophrenia could be attributed to working memory, the disturbing concept of self, and the cuing method implemented. The earlier reminiscence bump for patients with schizophrenia may be explained by the premature closure of the identity formation process due to the emergence of psychotic symptoms during early adulthood. Protocol developed for this review was registered in PROSPERO (registration no: CRD42017062643).

Retrieval practice improves memory in patients with schizophrenia: new perspectives for cognitive remediation

BACKGROUND

Schizophrenia is associated with severe cognitive deficits, particularly episodic memory deficits, that interfere with patients' socio-professional functioning. Retrieval practice (also known as testing effect) is a well-established episodic memory strategy that involves taking an initial memory test on a previously learned material. Testing later produces robust long-term memory improvements in comparison to the restudy of the same material both in healthy subjects and in some clinical populations with memory deficits. While retrieval practice might represent a relevant cognitive remediation strategy in patients with schizophrenia, studies using optimal procedures to explore the benefits of retrieval practice in this population are still lacking. Therefore, the purpose of our study was to investigate the benefits of retrieval practice in patients with schizophrenia.

METHODS

Nineteen stabilised outpatients with schizophrenia (DSM-5 criteria) and 20 healthy controls first studied a list of 60 word-pairs (30 pairs with weak semantic association and 30 non associated pairs). Half the pairs were studied again (restudy condition), while only the first word of the pair was presented and the subject had to recall the second word for the other half (retrieval practice condition). The final memory test consisted in a cued-recall which took place 2 days later. Statistical analyses were performed using Bayesian methods.

RESULTS

Cognitive performances were globally altered in patients. However, in both groups, memory performances for word-pairs were significantly better after retrieval practice than after restudy (56.1% vs 35.7%, respectively, Pr(RP > RS) > 0.999), and when a weak semantic association was present (64.7% vs 27.1%, respectively; Pr(weak > no) > 0.999). Moreover, the positive effect of RP was observed in all patients but one.

CONCLUSIONS

Our study is the first to demonstrate that retrieval practice efficiently improves episodic memory in comparison to restudy in patients with schizophrenia. This learning strategy should therefore be considered as a useful tool for cognitive remediation programs. In this perspective, future studies might explore retrieval practice using more ecological material.

Autobiographical memory deficits in remitted patients with bipolar disorder I: The effect of impaired memory retrieval

Autobiographical memory (AM) has been studied extensively in different psychiatric disorders. However, less is known about AM in bipolar disorder (BD). Aim of the present study was to investigate BD patients' ability to recall episodic and semantic autobiographical memories after controlling for the effect of other possible neurocognitive deficits. Participants included 30 clinically remitted outpatients with BD type I and 30 healthy controls, matched for age, gender and educational level. Autobiographical memory was examined by the Questionnaire of Autobiographical Memory. Premorbid intellectual functioning, verbal memory, verbal fluency, attention and working memory were also assessed. Bipolar patients were impaired in both episodic and semantic AM, compared with healthy individuals. Deficits involved recall of memories from childhood-adolescence, early adulthood and recent life. Additionally, patients were impaired in verbal memory compared with controls. Differences between study groups in both episodic and semantic AM remained significant even after controlling for the effect of verbal memory deficits. Remitted BD-I patients showed deficits in recalling personal episodic memories and facts dating to three different life periods. These deficits were independent of patients' lower verbal memory performance. Additional research is required to gain a better understanding of the pattern and the mechanisms underlying AM impairment in BD.

From a Lived Event to Its Autobiographical Memory: An Ecological Study Using Wearable Camera in Schizophrenia

Cognitive disorders are considered as a core symptom of schizophrenia. Importantly, episodic autobiographical memory deficits are strongly related to patients' social dysfunction. Although the cognitive mechanisms underlying autobiographical memory deficit are highly important to open the door for specific cognitive remediation, they are yet to be understood. The present study focused on event segmentation to check to which extent possible impairments in temporal ordering and segmenting in patients hinder memories construction. Twenty-seven patients with schizophrenia and 27 matched controls took part in an outdoor circuit while wearing a wearable camera. A week later, their memory and the temporal organization of this event have been assessed. Results showed that patients, compared with control participants, reported a reduced amount of details, especially less actions with interaction related to the event. Contrary to our initial hypotheses, event segmentation abilities in patients were not affected. The relationship between event segmentation and memory is discussed.

The effect of impaired verbal memory retrieval on autobiographical memory across different life periods in schizophrenia

OBJECTIVES

Autobiographical memory (AM) involves recollection of personal events and facts about one's life. Αim of the present study was to investigate AM in schizophrenia patients, and, in particular, patients' ability to recall autobiographical memories after controlling for verbal memory and verbal fluency deficits.

METHOD

Participants included 40 schizophrenia patients (23 male) and 40 healthy controls (23 male), matched for age, gender, educational level, and premorbid intellectual functioning. Participants' verbal memory (list learning and story recall) and verbal fluency were assessed. AM was evaluated by the Questionnaire of Autobiographical Memory, consisting of the Personal Semantic Memory scale and the Autobiographical Incidents scale. Furthermore, personal incidents' specificity was examined.

RESULTS

Schizophrenia patients showed deficits in verbal memory and verbal fluency, as well as in both semantic and episodic AM compared with healthy controls. Deficits were shown in episodic and semantic memories of events and facts dating to three different life periods (childhood, early adulthood and recent life). Regarding specificity of recalled events, patients reported fewer specific autobiographical incidents than controls. After controlling AM deficits for patients' verbal memory and verbal fluency impairment, it was shown that schizophrenia patients recalled fewer memories of autobiographical incidents dating only to recent life, compared with healthy controls.

CONCLUSIONS

Schizophrenia patients showed impaired AM after controlling for verbal memory and verbal fluency impairment only in regard with personal episodic memories from recent life. Current findings raise the important issue of cognitive remediation therapy in schizophrenia.

Characteristics of memories of delusion-like experiences within the psychosis continuum: Pilot studies providing new insight on the relationship between self and delusions

BACKGROUND AND OBJECTIVES

Delusions are usually anchored in past events associated with abnormal experiences or delusional interpretations of personal events. The characteristics of the memory of these experiences may contribute to maintain delusional beliefs by providing confirmatory evidence for the delusions. However, these aspects have not been investigated properly.

METHOD

Seventeen patients with schizophrenia were examined in study 1 during a face-to-face interview. The second study used a web-based design and included 83 participants without a psychotic disorder. Participants were asked to rate the vividness, emotional intensity and valence, and the centrality to the self of memories of delusion-like experiences (that were cued by means of the Peters et al. Delusional Inventory, PDI; Peters, Joseph, Day, & Garety, 2004) and positive and negative memories used as comparators.

RESULTS

In both studies, the memories of delusion-like experiences were less vivid, less emotionally intense than positive (but not negative) memories and emotionally neutral. Their centrality to the self did not differ from that of positive and negative memories. Moreover, the severity of delusions in study 1 and delusion-proneness in study 2 were significantly correlated with vividness, emotional intensity, and centrality of memories of delusion-like experiences.

LIMITATIONS

The accuracy of memories of delusion-like experiences could not be checked making it difficult to distinguish them from delusional memories. The sample size was small in study 1.

CONCLUSIONS

Our results point to reciprocal relationships between delusions, self, and autobiographical memories of delusion-like experiences that are similar within the psychosis continuum and that may be involved in the maintenance of delusions.

Mapping autobiographical memory in schizophrenia: Clinical implications

Increasing evidence suggests that impaired autobiographical memory (AM) mechanisms may be associated with the onset and maintenance of psychopathology. However, there is not yet a comprehensive review of the components of autobiographical memory in schizophrenic patients. The first aim of this review is a synthesis of evidence about the functioning of AM in schizophrenic patients. The main autobiographical elements reviewed in schizophrenic patients include the study of overgeneral memory (form); self-defining memories (contents); consciousness during the process of retrieval (awareness), and the abnormal early reminiscence bump (distribution). AM impairments have been involved in the clinical diagnosis and prognosis of other psychopathologies, especially depression. The second aim is to examine potential parallels between the mechanisms responsible for the onset and maintenance of disturbed AM in other clinical diagnosis and the mechanisms of disturbed autobiographical memory functioning in schizophrenic patients. Cognitive therapies for schizophrenic patients are increasingly demanded. The third aim is the suggestion of key elements for the adaptation of components of autobiographical recall in cognitive therapies for the treatment of symptoms and consequences of schizophrenia.

Self-continuity across time in schizophrenia: An exploration of phenomenological and narrative continuity in the past and future

BACKGROUND

Disorders of the self, such as a reduced sense of personal continuity in time, are a core symptom of schizophrenia, but one that is still poorly understood. In the present study, we investigated two complementary aspects of self-continuity, namely phenomenological and narrative continuity, in 27 patients with schizophrenia, and compared them with 27 control participants.

METHODS

Participants were asked to identify important past events and to narrate a story from their life that included these events. They were also asked to imagine important events that might happen in their personal future and to build a narrative of their future life. The vividness of these important life events and the proportion of self-event connections in the narratives were used as a measure of phenomenological and narrative continuity, respectively.

RESULTS

Our study showed patients with schizophrenia experienced less vivid representations of personally significant events (p = .02) for both temporal directions (past and future) (p < .001). In addition, their ability to make explicit connections between personal events and self-attributes in life narratives was also impaired (p = .03), but only in the case of past narratives (p < .001).

CONCLUSIONS

These results shed new light on the cognitive mechanisms underlying self-disorders in schizophrenia. The clinical and therapeutic implications of these findings are discussed.

Cued fluency protocol reveals dynamic symptomatic-dependent processes of goal-directed behaviours in schizophrenia

INTRODUCTION

Differential impairments of willed actions and routine behaviours are the subject of many studies into schizophrenia. These impairments in generating and controlling goal-directed behaviours are reported in studies showing the effect of cueing in cognitive or motor tasks in people with schizophrenia. The aim of this study was to assess the performance of people with schizophrenia in a cued fluency protocol reworked to fit the concept of goal-directed behaviour. The extent to which results could be better explained by goal-directed generation issues, according to a symptomatic framework, than by semantic retrieval or semantic processing impairments, was also investigated.

METHODS

We compared the performance of 43 individuals with schizophrenia to a control group of 26 participants. Participants were assessed with neuropsychological tests. The dominance of positive and negative symptoms, and apathetic profile, were also evaluated. All participants completed a cued fluency protocol.

RESULTS

Despite a significant improvement, not all people with schizophrenia exhibited equal cueing benefits. The participants with negative symptom dominance appeared to benefit more from cueing, even though their baseline performance was lower.

CONCLUSIONS

These results suggest that, in addition to semantic memory impairments, some cognitive tasks may be more broadly influenced by difficulties in generating goal-directed behaviours.

Self-disorders in individuals with attenuated psychotic symptoms: Contribution of a dysfunction of autobiographical memory

Patients with schizophrenia and people with subclinical psychotic symptoms have difficulties getting a clear and stable representation of their self. The cognitive mechanisms involved in this reduced clarity of self-concept remain poorly understood. The present study examined whether an altered way of thinking or reasoning about one's past may account for the reduced clarity of self-concept in individuals with attenuated psychotic symptoms (APS). An online study comprising 667 participants examined the capacity to give a meaning to past events and to scrutinize autobiographical memory to better understand him/herself. Our results showed that in this sample, individuals with APS (n=49) have a lower clarity of self-concept and a higher tendency to scrutinize autobiographical memory than controls subjects (n=147). A mediation analysis performed on the full sample revealed that the relation between APS and clarity of self-concept was mediated by a tendency to scrutinize autobiographical memory. Our results suggest that the weakness of self-concept, which increases with the intensity of psychotic symptoms, may be related to an altered function of autobiographical memory, so that examining past events may fail to sustain a stable and clear representation of the self when psychotic symptoms increase.

Toward an understanding of anticipatory pleasure deficits in schizophrenia: Memory, prospection, and emotion experience

Anticipatory pleasure deficits have been observed in people with schizophrenia. Less is known about the extent to which interrelated processes that comprise anticipatory pleasure, including memory, prospection, and emotion experience are disrupted. We asked people with (n = 32) and without (n = 29) schizophrenia or schizoaffective disorder to provide memory and prospection narratives in response to specific cues. Half of the prospections followed a memory task, and half followed a control task. People with schizophrenia generated memories similar in content and experience as controls even as they described them less clearly. However, people with schizophrenia were less likely to explicitly reference the past in their prospections, and their prospections were less detailed and richly experienced than controls, regardless of the task completed before prospection. People with schizophrenia reported similar levels of positive emotion (current and predicted) in positive prospections that followed the memory task, but less positive emotion than controls in positive prospections that followed the control task. Taken together, these results suggest that people with schizophrenia experience difficulties drawing from past experiences and generating detailed prospections. However, asking people with schizophrenia to recall and describe memories prior to prospection may increase the likelihood of drawing from the past in prospections, and may help boost current and predicted pleasure.

A Meta-Analysis of Autobiographical Memory Studies in Schizophrenia Spectrum Disorder

Meta-analyses and reviews on cognitive disorders in schizophrenia have shown that the most robust and common cognitive deficits are found in episodic memory and executive functions. More complex memory domains, such as autobiographical memory (AM), are also impaired in schizophrenia, but such impairments are reported less often despite their negative impact on patients' outcome. In contrast to episodic memory, assessed in laboratory tasks, memories of past personal events are much more complex and directly relate to the self. The meta-analysis included 20 studies, 571 patients with schizophrenia spectrum disorder, and 503 comparison subjects. It found moderate-to-large effect sizes with regard to the 3 parameters commonly used to assess AM: memory specificity (g = -0.97), richness of detail (g = -1.40), and conscious recollection (g = -0.62). These effect sizes were in the same range as those found in other memory domains in schizophrenia; for this reason, we propose that defective memories of personal past events should be regarded as a major cognitive impairment in this illness.

Projecting the self into the future in individuals with schizophrenia: a preliminary cross-sectional study

The ability to project oneself into the future contributes to development and maintenance of a coherent sense of identity. If recent research has revealed that schizophrenia is associated with difficulties envisioning the future, little is known about patients' future self-representations. In this study, 27 participants with schizophrenia and 26 healthy controls were asked to simulate mental representations of plausible and highly significant future events (self-defining future projections, SDFPs) that they anticipate to happen in their personal future. Main results showed that schizophrenia patients had difficulties in reflecting on the broader meaning and implications of imagined future events. In addition, and contrary to our hypothesis, a large majority of SDFPs in schizophrenia patients were positive events, including achievements, relationship, and leisure contents. Interestingly, patients and controls did not differ on the perceived probability that these events will occur in the future. Our results suggest that schizophrenia patients have an exaggerated positive perception of their future selves. Together, these findings lend support to the idea that past and future self-defining representations have both similar and distinct characteristics in schizophrenia.

The relationship between insight and autobiographical memory for emotional events in schizophrenia

The relation of episodic and semantic memory for emotional- (positive, negative) and neutral-valenced autobiographical events to illness insight was examined in individuals with schizophrenia. Reduced recall of episodic details for negative events was significantly associated with impaired awareness of having a past mental disorder and its social consequences. Deficits in episodic memory for negative autobiographical events may underlie impaired insight in schizophrenia.

Rumination and autobiographical memory impairment in patients with schizophrenia

Although patients with schizophrenia exhibit autobiographical memory impairment, which is considered to be a limiting factor in their daily life, the mechanisms underlying such impairment have been rarely studied. In the current study, we investigate whether rumination and, in particular, brooding, which is a form of maladaptive repetitive thinking, may be linked to the difficulty that patients with schizophrenia experience when attempting to access specific autobiographical memories. Our results indicate that patients reported less specific autobiographical memories compared to control participants. Patients also displayed a higher level of brooding and had more depressive symptoms. According to the CaR-FA-X model (Williams et al., 2007), depression and brooding were associated with memory specificity in control participants. In contrast, neither depression nor brooding was correlated with memory specificity in patients. These results suggest that depression and rumination may not be directly related to patients' difficulty to recall specific memories and that other factors, such as metacognitive deficits, must first be considered when seeking interventions aimed to improve autobiographical memory in patients with schizophrenia.