Metamemory in schizophrenia: Retrospective confidence ratings interact with neurocognitive deficits

Abstract

Prior studies with schizophrenia patients described a reduced ability to discriminate between correct and false memories in terms of confidence compared to control groups. This metamemory bias has been associated with the emergence and maintenance of delusions. The relation to neuropsychological performance and other clinical dimensions is incompletely understood. In a cross-sectional study, metamemory functioning was explored in 32 schizophrenia patients and 25 healthy controls. Metamemory was assessed using a verbal recognition task combined with retrospective confidence level ratings. Associations of metamemory performance with six neuropsychological domains (executive functioning/problem solving, speed of processing, working memory, verbal and visual learning, and attention/vigilance) and psychopathological measures were analyzed. Results revealed a significantly smaller discrepancy between confidence ratings for correct and incorrect recognitions in the patient group. Furthermore, patients showed significantly lower recognition accuracy in the metamemory task and marked deficits in all neuropsychological domains. Across all participants, metamemory performance significantly correlated with executive functioning and working memory. No associations with delusions were found. This data confirms prior findings of metamemory biases in schizophrenia. Selective neuropsychological abilities seem to be modulating factors of metamemory functioning. Longitudinal studies in at risk mental state and first-episode patients are needed to reveal causal interrelations.

The Importance of Metamemory Functioning to the Pathogenesis of Psychosis

“…Information can either be verbal (word recognition) or visual (picture recognition) in nature. However, the verbal paradigm has been implemented more often (Laws and Bhatt, 2005; Bhatt et al, 2010; Moritz et al, 2014b; Eifler et al, 2015; Eisenacher et al, 2015; Hodgetts et al, 2015). In this version, participants are usually asked to encode lists of words which are strongly associated with a not presented lure or “theme” word.…”

“…Higher confidences in errors could be found persistently in patients with schizophrenia irrespective of the implemented task design. In contrast to healthy control groups these studies robustly suggested a biased metamemory performance (Moritz and Woodward, 2002; Moritz et al, 2003, 2004, 2005, 2006a; Kircher et al, 2007; Bhatt et al, 2010; Peters et al, 2012, 2013; Eifler et al, 2015), apart from one exception (Bacon et al, 2001). Moritz and Woodward (2002) were the first to compare the previously described source monitoring task between patients with schizophrenia and a healthy control group.…”

“…Furthermore, certain cognitive correlates were identified. Poorer delayed verbal recall was associated with an increased knowledge corruption in a source monitoring task (Garcia et al, 2012) and deficits in several neurocognitive measures, executive functioning and working memory in particular, were associated with a decreased confidence gap as well as with an increased knowledge corruption index in a false memory task (Eifler et al, 2015). Examining further influencing factors, it was hypothesized that the initial forewarning of the DRM-effect would decrease metamemory biases.…”

“…Therefore, this review focuses on CL ratings as a measure of metamemory ability. CL ratings have been assessed in a variety of tasks, for example verbal recognition tasks (Kircher et al, 2007), verbal (Moritz et al, 2004; Laws and Bhatt, 2005; Bhatt et al, 2010; Eifler et al, 2015; Eisenacher et al, 2015; Hodgetts et al, 2015) or visual (Moritz et al, 2008; Peters et al, 2012, 2013) false memory tasks, source monitoring tasks (Moritz and Woodward, 2002, 2006a,b; Moritz et al, 2003, 2005; Doré et al, 2007; Garcia et al, 2012) or general knowledge tasks (Bacon et al, 2001). …”

“…The importance of metamemory functioning to schizophrenia lies not only in its potential mode of action within the development and maintenance of positive symptoms (Eifler et al, 2015; Eisenacher et al, 2015) but also in its relevance to psychosocial functioning (Scheyer et al, 2014). It is assumed that biases in metamemory are associated with a stronger severity of positive symptoms, particularly with delusions (Moritz and Woodward, 2006a).…”