To our knowledge this is the first study to show that schizophrenia is
associated with an overall impairment in habitual prospective memory
performance "........
original article link
The authors hypothesized that patients with schizophrenia would have problems
with tasks requiring prospective memory.
By the time he got to the bottom of the page, he could not connect there with
what had been happening at the top of the page. He told me that he had
great difficulty in connecting the characters with the descriptions
intervening.
He had found the same with other books he had tried to read.
He also
finds that any disturbance affects his ability to retain anything he has
read.
e.g. someone talking to him.Someone putting the T.V. or radio on. Someone
calling him away to undertake another task.
He then finds it difficult to
"pick up the string" and has to return to a previous area of the reading.
He
is able to write; uses the computer for this, but again does not like
disturbance.
A short ability to
continue a project, though he does ususally return to complete it. The discs
also showed how he made a record of what he had done, in order that he could
return and pick up the 'train' at a later date".
Six months later.
" He keeps to his medication and is pursuing his reading which I think is
improving.
He is concentrating mainly on short stories at present. .
They don't hold together the background information that is necessary to
continue without mistakes. In tasks, jobs, and in living.
Patients with schizophrenia must take medication regularly to reduce their risk
of relapse.
But the condition impairs working memory -
meaning these patients may have difficulty in remembering to take their
tablets.
Habitual tasks, like taking medicine every few hours, rely on
"'prospective' memory". that is, a scheduled signal laid down and
stored away in advance brings about the appropriate action at some time in the
future
This preamble suggest that schizophrenia does not allow for such a schedule,
confidently to be held in mind,
This type of memory, which appears to be impaired by schizophrenia, enables you
to remember that you have
to do something in the future
, without being prompted by something else or somebody else
Ordinarily there is a schedule framework 'inside' which 'reminds' , holds in
mind the thing that has to be done at a certain time, does the prompting -
time of day - relationship to something else [ a built in prompt - revives what
is necessary for the act to be done, soon, tomorrow, next week, whatever ] so
as to keeping holding on that topic and keeping to the point or getting back
to it ]
***
To test their hypothesis the researchers, based at NIMH and at the University
of Warwick, compared the
prospective
memory of people with and without the disease.
In each test participants manoeuvred a ball around an obstacle course for 90
seconds.
They were asked [
the holding injunction
] to turn over a counter when they were
at least 25 seconds into the test
.
The time delay ensured that
prospective
[ i.e. recall for a future event ] memory had to be used.
Participants with schizophrenia were more likely to forget to turn over the
counter.
The 'lie'
At the end of the test the participants were asked if they had remembered to
turn over the counter.
Approximately a third of the time participants with schizophrenia reported
they had done so
when they had not
.
[ doing this kind of thing in other situations - say at professional
interview responding to questions about something either done or not done - the
answers can be unreliable { which is why getting the views of an ' in between
' observer is vital ] ... see, for a striking example of a patient
forgetting amd therefore denying extreme illness, which the family carers but
not the professional staff have observed but are not able to report
page 143
Blom Cooper; Robinson Inquiry
Elvevåg and colleagues wrote: "
" This would seem a worryingly high probability for such an apparently
simple task
that posed few problems for control participants.
...
Our result suggests that patients' self-reports of having completed
a habitual prospective memory tas
k, for example taking medication, are likely to be
particularly unreliable
"
[ Ed. ....
This is an experimental situation and thus not an essential to the subject of
the experiment.
But translate this difficulty into real life events and happenings for the
patient.
Everything we do relies on holding some situations in mind whilst going ahead
with others.
People with schizophrenia have unreliable recall - cannot find and retrieve
the appropriate memories
If you fail to remember something that should be borne in mind - and you
cannot remember what that was - and when you may conclude that you did, or just
do not recall it at all, and cannot bring yourself back to what was a necessary
starting and holding context - then life becomes random, adrift without a
direction, and what guides, is what happens to be chanced upon: or, what
thread can be picked up on, from an internal connection, whose relevance and
conviction of assuredness, is not always relevant to what is going on around .
It describes and explains the faultline in schizophrenia ....explains why it
seems so difficult conversing with someone with schizophrenia - the original
point and direction of the talk loses the starting point, doesn't recall it '
... doesn't carry it in mind, doesn't monitor the conversation as ordinarily
happens.
Somewhere along the line people with schizophrenia become uncertain about what
is being talked about, about what they have read at the top of the page, about
what the TV programme that they started and stopped watching, was about;
especially fiction.
They may from this disability, come up with an idiosyncratic reason based upon
just selected fragments of reference , maybe just something in the last
exchange Or, some internal asssociation too idiosyncratic and personal to the
internal thinking store, to continue a conversational exchange.
......a carer ....
provided S. with a dosette box years ago, and it has been extremely helpful.
He fills it himself each week. fortunately he now remembers. he must live with
a streak of fear running through life as he remarks about patients with
schizophrenia who are sent to prison, It is very sad.
With regard to communication.
If we are having a conversation he sometimes stops speaking, or stops me
speaking, points his finger and says "listen - listen". am still unsure if
this is because he hears voices, or if he cannot keep up with the conversation.
Many people do seem to speak very quickly these days.
X. does not like to remain in a group situation for a long period of time, but
is very happy doing things with someone near to whom he can speak as and when
and if !
I'm afraid that for carers it is always a great concern, having seen their
patient through the acute stages of illness, and realising their continuing
vulnerability.
X. was always the out-going type before his schizophrenia. Full of fun and
harmless mischief. Very popular with his peers. but of course they move on, and
for someone with schizophrenia, it is difficult to make new friends.
Schizophrenia affects one in every hundred people at some point during their
lives. While there is no cure, it is ameliorated by medication, About 80
percent of those patients who stop taking their medications after an acute
episode relapse within a year.
Source:
BioMed Central Psychiatry
A help ?
There is a simple solution to this, used by St George's Hospital, Morpeth, U.K.
They have these little packs called "dosettes" which contain enough
medication for a week. Each dosette has 7 little daily "fingers"
which can easily be slipped into a pocket. The finger has compartments for meds
at breakfast, lunch, dinner and bedtime. If the patient wants to check if
they've taken their medication then all they have to do is look at their
dosette finger. To reduce the risk of confusion, each dosette finger is
labelled with a day name. The system works and is simple.
The original paper describing the experimental procedure does not describe the
way the subjects were introduced into the experimental situation. Were they
given trials to get used to what was required . How many ?
Establishing a memory for what is going to come up is a vital part of getting
people suffering with schizophrenia to leave their internal pre-occupation -
autism - and apply themselves i.e wake up the connections for an exterrnal
requirement.
Presumably the study organisers were carrying and conveying an authority to get
them to commit to the project.
Already that might be a stronger prompt than in a normal situation; a stronger
resonance for the expected behaviour.
Then presumably observers were standing by - again a prompting reminder to what
the subjects had to do - apply yourself to this task before you.
A 'guiding memory' to a future is not just about doing something, about
completing, a task that was set on earlier, that is going on now - there also
has to be a place where what is being learnt on the way - learnt in going
forward, is stored in a relevant place so that the experience can be called
upon again, or referred to for comparison and usefulness somewhere else.
The place where that goes - hippocampus and onward - and the route in to that
store, is not always woken up - called in for recollection, in active
schizophrenia.
Prompting, especially built in to the task -' jigging' - which is what a
dosette system is and does - is is helpful again - if done without criticism
or patronage but just built in to the task, or the help is given by someone
with whom 'face' will not be lost.
Often this means someone other than the family giving the lead - schizophrenia
usually presents during adolescence with 'emancipation' problems from family
standards, and incompletely matured expectations.
Posting lists of reminders - as people do when 'shopping; is another 'prompt'
system.
And providing a programme of sessional activities during the week, is an
underlying anchor, a pointing to something definite, which re-orientate the
internal confusion of the illness, onto an external structure of expectation,
confirmed by the sequence of reminders that lead into engagement.
Repetition in settings brings back into mind relevant associations; hopefully,
in doing that - drawing together connections inside the brain with what is
going on outside - calls back into play old habits and skills. re-establishing
their connection with outside expectation.
Ordinarily, work schedules and programmes have a repetitious quality which
holds people through their days - the various timetables become the framework
on which daily variations can be settled.
People with schizophrenia do not have these built in, built up programmes in
their days and weeks.
They cannot rebuild them because they lose their way forward - their
prospective memory habits are lost or uncertainly there, and they cannot be
recreated from within because of the illness. They drift along, diverted and
drawn on by happenings incompletely recognised, sometimes to random outside
lead events and lead figures. "passivity " responses can occur.
Studies at Netherne found that negative emotional expression by overseer
behaviour got worse work results.
Starting off, with impliedcriticism, means that
withdrawing into the negative direction is promoted.
The sensitivity is always there in schizophrenia.
A sensitivity [ "passivity " ] when exposed to unresolvable
anxiety and anger, which often arrive first then stops the flow of intention
at a point which cannot be remembered, and is not restarted.