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

Highlights

• Poor recall of episodic details from negative events predicted impaired insight.

• Recall of semantic details from negative events did not predict illness awareness.

• Autobiographical memory of positive or neutral events was not predictive of insight.

Abstract

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.

Introduction

People with schizophrenia often have impaired insight into their disorder (Amador and Gorman, 1998). Lack of insight predicts poorer treatment adherence (Beck et al., 2011) and worse outcomes (Drake et al., 2007, Lincoln et al., 2007). Insight has been conceptualized as a storied account or narrative of different aspects of illness and their consequences that requires different forms of awareness and the recognition of pertinent historical details such as a hospitalization (Lysaker et al., 2009, Lysaker et al., 2013). Patients with schizophrenia produce less coherent personal narratives (Raffard et al., 2010, Lysaker et al., 2005); and deficits in narrative identity are associated with aspects of poor insight (Lysaker et al., 2002, Lysaker et al., 2008). Construction of a coherent identity across time relies on autobiographical memory (Conway, 2005, Tulving, 2002) and the ability to synthesize these personal memories with future goals (McAdams and McLean, 2013). Autobiographical memory recall is compromised in schizophrenia (e.g., Elvevåg et al., 2003, Riutort et al., 2003, Danion et al., 2005, McLeod et al., 2006, Cuervo-Lombard et al., 2007, D’Argembeau et al., 2008) with recent findings suggesting that recollection of negative autobiographical events is particularly affected (Neumann et al., 2007; MacDougall et al., unpublished results). It has been suggested that an impoverished autobiographical memory may hinder the ability to think in more complex ways about oneself or others (Dimaggio et al., 2012). This notion has led to the development of promising therapeutic approaches that consider the complex interplay of autobiographical memory and metacognitive impairments (Lysaker et al., 2011, Bargenquast and Schweitzer, 2013).

Despite conceptualization of insight as an autobiographical narrative, there is little research on the relationship between insight and autobiographical memory performance in schizophrenia. Lalova et al. (2013) recently demonstrated that poor insight was more strongly related to inability to recall specific autobiographical memories than to other basic cognitive measures including general episodic memory. However, to date, no studies have explored the relation between insight in individuals with schizophrenia and the specific components of autobiographical memory recollection—episodic and semantic (Tulving, 1972, Tulving, 1985). Episodic memory involves the conscious recollection of temporally and spatially specific events that occurred in one׳s past and is associated with subjective sense of personal continuity across time (‘autonoetic consciousness’) (Tulving, 2002). By contrast, semantic memory consists of facts that are time- and context-independent, and either personal or general in nature. Behavioral, neuropsychological, and neuroimaging techniques confirm that these two forms of memory are dissociable (e.g., Eslinger, 1998, Gardiner and Java, 1991, Levine et al., 2004, Mäntylä, 1993, McKinnon et al., 2006, Parkin and Walter, 1992, Svoboda et al., 2006).

Accordingly, in the present study of persons with schizophrenia, we employed the Autobiographical Interview (AI; Levine et al., 2002), a measure that separates episodic and semantic components of autobiographical memory thus minimizing the potential for episodic recollection to be subject to contamination by semantic processing (McKinnon et al., 2008). It also utilizes cueing methods associated with improved recall in schizophrenia (Potheegadoo et al., 2014; MacDougall et al., unpublished results). Finally, given that emotional valence of recalled events (Dieleman and Röder, 2013, Holland and Kensinger, 2010) may be an important moderator in the relation between autobiographical memory and insight, we surveyed recollection of positive, negative and neutral events.

We hypothesized that insight relies particularly on episodic autobiographical memory as opposed to semantic information that bears less relation to personal identity over time (Conway, 2005, Tulving, 2002). Given that illness-related events are typically negative in nature, we further hypothesized that poor insight into having a mental disorder and its symptoms and social consequences would be specifically associated with impaired recall of negative personal events.