Metacognitive control over false memories: A key determinant of delusional thinking

Springer Science and Business Media LLC - Tập 8 - Trang 184-190 - 2006
Steffen Moritz1, Todd S. Woodward
1Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

Tóm tắt

This article reviews the current literature on false memories in schizophrenia. Increasing evidence suggests that neither memory impairment in general nor false memories in particular can reliably differentiate patients with schizophrenia or delusions from psychiatric controls. In contrast, it is proposed that a reduced metacognitive awareness of one’s own fallibility, and overconfidence in errors, may predispose a person to fixed, false beliefs (ie, delusions). Congruent with this position, a number of recent investigations suggest that the memory of patients with schizophrenia, as well as healthy subjects scoring high on delusional ideation, is corrupted by an increased number of incorrect memories held with high confidence, possibly relating to a jumping-to-conclusions or liberal acceptance bias in schizophrenia spectrum disorders. A new training approach is described that is intended to sharpen patients’ awareness of such errors and reduce confidence in fallible memories. Some empirical gaps and directions for further research are outlined. Delusional Thinking

Tài liệu tham khảo

Lamb W: I Know This Much Is True. London: HarperCollins; 1998. Aleman A, Hijman R, de Haan EH, Kahn RS: Memory impairment in schizophrenia: a meta-analysis. Am J Psychiatry 1999, 156:1358–1366. Pelletier M, Achim AM, Montoya A, et al.: Cognitive and clinical moderators of recognition memory in schizophrenia: a meta-analysis. Schizophr Res 2005, 74:233–252. Heinrichs RW, Zakzanis KK: Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 1998, 12:426–445. Bleuler E: Dementia praecox oder Gruppe der Schizophrenien. In Handbuch der Psychiatrie. Edited by Aschaffenburg G. Leipzig: Franz Deuticke; 1911. Moritz S, Heeren D, Andresen B, Krausz M: An analysis of the specificity and the syndromal correlates of verbal memory impairments in schizophrenia. Psychiatry Res 2001, 101:23–31. Nelson MD, Saykin AJ, Flashman LA, Riordan HJ: Hippocampal volume reduction in schizophrenia as assessed by magnetic resonance imaging: a meta-analytic study. Arch Gen Psychiatry 1998, 55:433–440. Heckers S: Neuroimaging studies of the hippocampus in schizophrenia. Hippocampus 2001, 11:520–528. Squire LR: Memory and the hippocampus: a synthesis from findings with rats, monkeys, and humans [review]. Psychol Rev 1992, 99:195–231. Egeland J, Sundet K, Rund BR, et al.: Sensitivity and specificity of memory dysfunction in schizophrenia: a comparison with major depression. J Clin Exp Neuropsychol 2003, 25:79–93. Duffy L, O’Carroll R: Memory impairment in schizophrenia —a comparison with that observed in the alcoholic Korsakoff syndrome. Psychol Med 1994, 24:155–165. Zakzanis KK, Andrikopoulos J, Young DA, et al.: Neuropsychological differentiation of late-onset schizophrenia and dementia of the Alzheimer’s type. Appl Neuropsychol 2003, 10:105–114. Heaton R, Paulsen JS, McAdams LA, et al.: Neuropsychological deficits in schizophrenics. Relationship to age, chronicity, and dementia. Arch Gen Psychiatry 1994, 51:469–476. Brébion G, Amador X, Smith MJ, et al.: Opposite links of positive and negative symptomatology with memory errors in schizophrenia. Psychiatry Res 1999, 88:15–24. Brébion G, David AS, Jones H, Pilowsky LS: Hallucinations, negative symptoms, and response bias in a verbal recognition task in schizophrenia. Neuropsychology 2005, 19:612–617. Brébion G, Smith MJ, Gorman JM, Amador X: Discrimination accuracy and decision biases in different types of reality monitoring in schizophrenia. J Nerv Ment Dis 1997, 185:247–253. Brébion G, Amador X, David A, et al.: Positive symptomatology and source-monitoring failure in schizophrenia—an analysis of symptom-specific effects. Psychiatry Res 2000, 95:119–131. Moritz S, Woodward TS, Cuttler C, et al.: False memories in schizophrenia. Neuropsychology 2004, 18:276–283. Elvevåg B, Fisher JE, Weickert TW, et al.: Lack of false recognition in schizophrenia: a consequence of poor memory? Neuropsychologia 2004, 42:546–554. Huron C, Danion J-M: Impairment of constructive memory in schizophrenia. Int Clin Psychopharmacol 2002, 17:127–133. Koren D, Seidman LJ, Poyurovsky M, et al.: Metacognition: a potential bridge between basic neurocognition and real-life performance in schizophrenia. Schizophr Res 2004, 67(Suppl):263–264. In this and subsequent papers, the authors conclude that the prediction accuracy of functional outcome variables in schizophrenia could be enhanced when research into cognition is complemented by metacognitive variables. Moritz S, Woodward TS, Whitman JC, Cuttler C: Con-fidence in errors as a possible basis for delusions in schizophrenia. J Nerv Ment Dis 2005, 193:9–16. Moritz S, Woodward TS, Ruff C: Source monitoring and memory confidence in schizophrenia. Psychol Med 2003, 33:131–139. Moritz S, Woodward TS: Memory confidence and false memories in schizophrenia. J Nerv Ment Dis 2002, 190:641–643. Huron C, Danion J-M, Giacomoni F, et al.: Impairment of recognition memory with, but not without, conscious recollection in schizophrenia. Am J Psychiatry 1995, 152:1737–1742. Moritz S, Ferahli S, Naber D: Memory and attention performance in psychiatric patients: lack of correspondence between clinician-rated and patient-rated functioning with neuropsychological test results. J Int Neuropsychol Soc 2004, 10:623–633. Danion JM, Gokalsing E, Robert P, et al.: Defective relationship between subjective experience and behavior in schizophrenia. Am J Psychiatry 2001, 158:2064–2066. Danion JM, Rizzo L, Bruant A: Functional mechanisms underlying impaired recognition memory and conscious awareness in patients with schizophrenia. Arch Gen Psychiatry 1999, 56:639–644. Applying a "remember-know" recognition procedure, these authors were the first to show that patients with schizophrenia memorize items less vividly (lack of "autonoetic" awareness) than controls, as evidenced by an enhanced number of "know" responses. Danion JM, Kazes M, Huron C, Karchouni N: Do patients with schizophrenia consciously recollect emotional events better than neutral events? Am J Psychiatry 2003, 160:1879–1881. Huron C, Danion JM, Rizzo L, et al.: Subjective qualities of memories associated with the picture superiority effect in schizophrenia. J Abnorm Psychol 2003, 112:152–158. Bacon E, Danion JM, Kauffmann-Muller F, Bruant A: Consciousness in schizophrenia: a metacognitive approach to semantic memory. Conscious Cogn 2001, 10:473–484. Koren D, Seidman LJ, Poyurovsky M, et al.: The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study. Schizophrenia Research 2004, 70:195–202. Koriat A, Goldsmith M: Monitoring and control processes in the strategic regulation of memory accuracy. Psychol Rev 1996, 103:490–517. Gonzalez R, Nelson TO: Measuring ordinal association in situations that contain tied scores. Psychol Bull 1996, 119:159–165. Moritz S, Woodward TS, Chen E: Investigation of metamemory dysfunctions in first-episode schizophrenia. Schizophr Res 2006, 81:247–252. Moritz S, Woodward TS: The contribution of metamemory deficits to schizophrenia. J Abnorm Psychol 2006, In press. In this study, patients with schizophrenia displayed greater knowledge corruption (percentage of high-confident responses that are errors) and a higher confidence gap than both healthy and psychiatric controls, whereas the psychiatric samples were indistinguishable with respect to accuracy (eg, source memory errors) alone. The investigation of metacognitive variables may help to identify a performance profile unique to schizophrenia. Moritz S, Woodward TS, Rodriguez-Raecke R: Patients with schizophrenia do not commit more false memories than controls but are more confident in them. Psychol Med 2006, In press. Laws KR, Bhatt R: False memories and delusional ideation in normal healthy subjects. Pers Individ Dif 2005, 39:775–781. This study was the first to show that increased knowledge corruption may also occur in healthy subjects scoring high on a measure of delusional ideation. The authors found that high scorers not only committed more false memories but also expressed greater confidence in them than low-scoring subjects. Peters ER, Joseph SA, Garety PA: Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophr Bull 1999, 25:553–576. Roediger HL III, McDermott KB: Creating false memories: remembering words not presented in lists. J Exp Psychol Learn Mem Cogn 1995, 21:803–814. Moritz S, Woodward TS, Hausmann D: Incautious reasoning as a pathogenetic factor for the development of psychotic symptoms in schizophrenia. Schizophr Bull 2005 [Epub ahead of print]. Moritz S, Woodward TS: Plausibility judgment in schizophrenic patients: evidence for a liberal acceptance bias. German J Psychiatry 2004, 7:66–74. Garety PA, Hemsley DR, Wessely S: Reasoning in deluded schizophrenic and paranoid patients. Biases in performance on a probabilistic inference task. J Nerv Ment Dis 1991, 179:194–201. Menon M, Pomarol-Clotet E, McKenna PJ, McCarthy RA: Probabilistic reasoning in schizophrenia: a comparison of deluded and non-deluded schizophrenics and an exploration of possible cognitive underpinnings. Cognitive Neuropsychiatry 2006, In press. Dudley REJ, Over DE: People with delusions jump to conclusions: a theoretical account of research findings on the reasoning of people with delusions. Clin Psychol Psychother 2003, 263–274. Moritz S, Woodward TS: Jumping to conclusions in delusional and non-delusional schizophrenic patients. Br J Clin Psychol 2005, 44:193–207. Huq SF, Garety PA, Hemsley DR: Probabilistic judgements in deluded and non-deluded subjects. Q J Exp Psychol A 1988, 40:801–812. Van Dael F, Versmissen D, Janssen I, et al.: Data gathering: biased in psychosis? Schizophr Bull 2005 [Epub ahead of print]. This study of four groups differing in their liability to schizophrenia showed that the higher the estimated liability to psychosis, the stronger the so-called jumping-to-conclusions bias, particularly with increasing level of delusional ideation, lending further support to the claim that hasty decision-making is a core determinant of psychosis formation. Weiss AP, Dodson CS, Goff DC, et al.: Intact suppression of increased false recognition in schizophrenia. Am J Psychiatry 2002, 159:1506–1513. Using a novel memory task with words and pictures, the results suggest that patients with schizophrenia commit overall more false recognition than healthy participants and rely more on familiarity than recollection when making memory decisions for words. Heilbrun AB, Jr, Blum NA: Cognitive vulnerability to auditory hallucination. Impaired perception of meaning. Br J Psychiatry 1984, 144:508–512. Gibbs AA, David AS: Delusion formation and insight in the context of affective disturbance [review]. Epidemiol Psichiatr Soc 2003, 12:167–174. Gunduz-Bruce H, McMeniman M, Robinson DG, et al.: Duration of untreated psychosis and time to treatment response for delusions and hallucinations. Am J Psychiatry 2005, 162:1966–1969. Hemsley DR: The schizophrenic experience: taken out of context? Schizophr Bull 2005, 31:43–53. Salzinger K, Serper M: The immediacy mechanism. Int J Psychol Psycholog Ther 2004, 4:1–13. Chua EF, Schacter DL, Rand-Giovannetti E, Sperling RA: Understanding metamemory: neural correlates of the cognitive process and subjective level of confidence in recognition memory. Neuroimage 2006, 29:1150–1160. Slotnick SD, Schacter DL: A sensory signature that distinguishes true from false memories. Nat Neurosci 2004, 7:664–672. Schacter DL, Slotnick SD: The cognitive neuroscience of memory distortion. Neuron 2004, 44:149–160. Loftus EF: Planting misinformation in the human mind: a 30-year investigation of the malleability of memory. Learn Mem 2005, 12:361–366. Glahn DC, Ragland JD, Abramoff A, et al.: Beyond hypofrontality: a quantitative meta-analysis of functional neuroimaging studies of working memory in schizophrenia. Hum Brain Mapping 2005, 25:60–69. Blackwood N, Ffytche D, Simmons A, et al.: The cerebellum and decision making under uncertainty. Brain Res Cogn Brain Res 2004, 20:46–53. Moritz S, Burlon M, Woodward TS: Metacognitive Skill Training for Patients with Schizophrenia. Hamburg: VanHam Campus Verlag; 2005. Garety PA, Freeman D, Jolley S, et al.: Reasoning, emotions, and delusional conviction in psychosis. J Abnorm Psychol 2005, 114:373–384. Betsch T, Brinkmann BJ, Fiedler K, Breining K: When prior knowledge overrules new evidence: adaptive use of decision strategies and the role of behavioral routines. Swiss J Psychol 1999, 58:151–160. Woodward TS, Moritz S, Cuttler C, Whitman JC: A generalized cognitive bias against disconfirmatory evidence (BADE) contributes to delusions in schizophrenia. J Clin Exp Neuropsychol 2006, In press. Jaspers K: Allgemeine Psychopathologie [General Psychopathology]. Berlin: Springer; 1973. Garety PA: Making sense of delusions. Psychiatry 1992, 55:282–291. Spanos NP, Burgess CA, Burgess MF: Past-life identities, UFO abductions, and satanic ritual abuse: the social construction of memories. Int J Clin Exp Hypn 1994, 42:433–446.