Self-monitoring deficits in schizophrenia: A cross-sectional study of the underlying cognitive mechanisms

• Published in: Schizophrenia research 2024-02, Vol.264, p.378-385
• Main Authors: Ghieh, Rachid, Krężołek, Martyna, Gawęda, Łukasz
• Format: Article
• Language: English
• Subjects: Cognition; Cognition Disorders; Cross-Sectional Studies; Humans; Imagination - physiology; Perception; Psychosis; Recognition, Psychology; Schizophrenia; Schizophrenia - complications; Schizophrenia - diagnosis; Signal detection theory; Source monitoring
• ISSN: 0920-9964; 1573-2509; 1573-2509
• DOI: 10.1016/j.schres.2024.01.015

People diagnosed with schizophrenia share underlying cognitive deficits in self-monitoring (i.e., identifying the source of self-generated behaviours). This study aimed to investigate whether self-monitoring deficits in schizophrenia are due to a cognitive response bias towards external perceptions or a reduced discriminability of imagined and performed actions. We hypothesised that self-monitoring deficits in individuals with schizophrenia are primarily driven by bottom-up processes, leading to a compromised ability to discriminate between internally generated behaviours as opposed to a cognitive response bias towards performed actions. We recruited 333 participants, including 192 with schizophrenia and 141 healthy controls. As part of the Action-Memory Task, participants were instructed to either imagine or physically perform 36 different actions, half of which were presented as pictograms and half as text. In the test phase, participants indicated whether they had performed or imagined each action, whether it appeared in text or pictogram, or whether it was a new action. Using Signal Detection Theory, the study primarily analysed group differences in discriminability and response-bias. Participants with schizophrenia made significantly more self-monitoring errors than healthy controls. This was primarily due to significantly lower sensitivity, but not a response bias. Whereas recognition memory errors were driven by both lower sensitivity and a response bias. The findings suggest that self-monitoring in schizophrenia was specifically impaired by a compromised discriminability of imagined and performed events and an inability to appropriately compensate by adjusting decision-thresholds. Implications on the role of bottom-up and top-down cognitive mechanisms are discussed.