Abigail Wright1, Geoff Davies3, David Fowler1, Kathryn Greenwood1,2; 1University of Sussex, 2Sussex Partnership NHS Foundation Trust, 3University of Surrey
Background: Functional outcome in psychosis may be predicted by many factors including cognition, functional capacity, symptoms and, importantly, metacognition. Metacognition was recently demonstrated to mediate between cognition and functional outcome in First Episode Psychosis. Given previous research, metacognition may predict long-term functioning after first-episode. This study aimed to assess whether cognition, functional capacity, and metacognition in the early stages of psychosis may predict functional outcome later on. Methods: 80 individuals with First Episode Psychosis were re-contacted after average of 36-months later (range: 26-45 month follow-up). 26 participants completed measures for neurocognition, metacognition (Metacognitive Assessment Interview), functional capacity, functional outcome (hours spent in structured activity per week), and psychotic symptoms at baseline and follow-up. Results: Firstly, regression analyses demonstrated neurocognition, functional capacity and metacognition at baseline significantly predicted functional outcome at follow-up (p<.011, .001, .005). Next, regression analyses, with baseline functional outcome as a covariate, demonstrated metacognitive ability was a significant predictor of change in functional outcome from baseline to 36-month follow-up, F(3, 25) 19.22, p<.001. This model explained 72% (adjusted r² = .69) of the variance in change functional outcome between baseline and follow-up. Therefore, good metacognitive ability at baseline predicted improvement in engagement of structured activity at 36-months. Including negative symptoms did not change the model. Discussion: This highlights the importance of intervening to enhance metacognitive ability, over neurocognition or functional capacity, in order to improve functioning later on, and to target interventions to improve functioning in those with the poor metacognition in the early stages of psychosis.
