Bias against disconfirmatory evidence in the ‘at-risk mental state’ and during psychosis

Abstract

Prior studies have confirmed a bias against disconfirmatory evidence (BADE) in schizophrenia which has been associated with delusions. However, its role in the pathogenesis of psychosis is yet unclear. The objective was to investigate BADE for the first time in subjects with an at-risk-mental-state for psychosis (ARMS), patients with a first episode of psychosis without antipsychotic treatment (FEP) and healthy controls (HC). A standard BADE test presenting written scenarios was employed. In addition, psychometric rating scales and a neuropsychological test battery were applied. A three-staged image was revealed. FEP-patients showed a significant BADE compared to the other groups. The performance of ARMS-patients lay in between HC and FEP-patients. A trend towards significance became evident for a bias against confirmatory evidence (BACE) in FEP-patients. Results were not attributable to antipsychotic or other medication or depressive symptoms. Correlations with delusions reached medium effect sizes but failed significance after Bonferroni-corrections. These results provide evidence for aberrations in evidence integration in the pathogenesis of psychosis and contribute to our knowledge of metacognitive functioning which can be used for (meta-)cognitive intervention in psychosis.

The Importance of Metamemory Functioning to the Pathogenesis of Psychosis

“…Some diagnostic interviews require a generally low or decreasing global functioning, such as the Comprehensive Assessment of At Risk Mental States (CAARMS; Yung et al, 2005). Another comprehensive instrument, the ERIraos (Early Recognition Inventory; Rausch et al, 2013; Maurer et al, 2016), has been used to identify ARMS-samples in studies investigating metacognitive deficits, such as the bias against disconfirmatory evidence (BADE Eisenacher et al, 2016a), the jumping to conclusion bias (JTC; Rausch et al, 2015) and metamemory biases (Eisenacher et al, 2015). …”

“…Metacognitive deficits in ARMS have been examined rather rarely up to date. Experimental evidence exists for a JTC bias (Rausch et al, 2015, 2016) and some support for a an increasing BADE along the illness process, starting from the ARMS (Eisenacher et al, 2016a), both in comparison to healthy controls. One study exists which examined metamemory functioning in ARMS-patients using the above introduced false memory DRM-paradigm (Eisenacher et al, 2015).…”

Data gathering ability contributes to visual organization and probabilistic reasoning

“…In our view, people who would be slow to update hypotheses would be less likely to have their opinions changed about bizarre and strange thoughts to which they subscribe, even when exposed to new evidence. This bias against discomfirmatory evidence has been found in schizophrenia ( Woodward et al., 2006 ), at-risk ( Eisenacher et al., 2016 ), and delusion prone, non-clinical populations ( Woodward et al., 2007 ), and correlates with delusional ideation in the general population ( Orenes et al., 2012 ; Zawadzki et al., 2012 ). Our study adds support to this idea.…”

Liberale Akzeptanz als kognitiver Mechanismus bei Psychose: Eine 2-Stufen-Theorie der Pathogenese schizophrener Positivsymptome

“…Nach einer aktuellen Meta-Analyse ist diese besondere Form der Unkorrigierbarkeit (BADE) bei Patienten mit Psychose stärker ausgeprägt als bei gesunden Kontrollprobanden oder Menschen mit anderen psychiatrischen Störungen [McLean et al, 2016]. Wie auch bei der Überkonfi-denz in Fehlurteile findet sich ein erhörter BADE nicht nur bei akut erkrankten Patienten, sondern ebenfalls bei Hochrisiko-Personen Woodward et al, 2008;Eisenacher et al, 2016].…”