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Jean-Marie Danion, MD; Lydia Rizzo, PhD; Agnès Bruant, MSc

Arch Gen Psychiatry. 1999;56:639-644.

Background  Schizophrenia impairs episodic memory in its critical feature, autonoetic awareness, ie, the type of awareness that is characterized by mentally reliving events from one's personal past. It spares noetic awareness, another form of awareness based on feelings of familiarity. We investigated the hypothesis that the impairment of autonoetic awareness is related to defective information that binds together separate aspects of events.

Methods  An experiential approach to recognition memory was used. Twenty-five patients with schizophrenia and 25 normal subjects performed or watched actions consisting of pairing objects. Then, they had to recognize pairs of objects and who paired them (source recognition). Subjects were also asked to provide a "remember" (autonoetic awareness) or a "know" (noetic awareness) response according to their subjective state at the time they recognized each pair of objects and each source.

Results  Patients exhibited an impaired recognition memory. When actions were observed, recognition of pairs of objects, but not of source, was no better than chance. There was a reduction in frequency of autonoetic awareness, its consistency throughout recognition of objects and source, and its relationship to source discrimination accuracy. Recognition was based largely on noetic awareness.

Conclusions  Patients with schizophrenia are unable to link the separate aspects of events into a cohesive, memorable, and distinctive whole. The corollary of this defective relational binding is a quantitative and qualitative impairment of autonoetic awareness.

From the Institut National de la Santé et de la Recherche Médicale Unit 405 Psychopathology and Pharmacology of Cognition, Psychiatry Department, University Hospitals of Strasbourg, Strasbourg, France.

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