No deficits in nonverbal memory, metamemory and internal as well as external source memory in obsessive-compulsive disorder (OCD). Behav Res Ther. 2009;47:308-315. [PMID: 19208441 DOI: 10.1016/j.brat.2009.01.004]

Opening new vistas on obsessive-compulsive disorder with the observing response task

Obsessive-compulsive disorder (OCD), a highly prevalent and debilitating disorder, is incompletely understood in terms of underpinning behavioural, psychological, and neural mechanisms. This is attributable to high symptomatic heterogeneity; cardinal features comprise obsessions and compulsions, including clinical subcategories. While obsessive and intrusive thoughts are arguably unique to humans, dysfunctional behaviours analogous to those seen in clinical OCD have been examined in nonhuman animals. Genetic, ethological, pharmacological, and neurobehavioural approaches all contribute to understanding the emergence and persistence of compulsive behaviour. One behaviour of particular interest is maladaptive checking, whereby human patients excessively perform checking rituals despite these serving no purpose. Dysfunctional and excessive checking is the most common symptom associated with OCD and can be readily operationalised in rodents. This review considers animal models of OCD, the neural circuitries associated with impairments in habit-based and goal-directed behaviour, and how these may link to the compulsions observed in OCD. We further review the Observing Response Task (ORT), an appetitive instrumental learning procedure that distinguishes between functional and dysfunctional checking, with translational application in humans and rodents. By shedding light on the psychological and neural bases of compulsive-like checking, the ORT has potential to offer translational insights into the underlying mechanisms of OCD, in addition to being a platform for testing psychological and neurochemical treatment approaches.

Investigating Retrospective and Prospective Metamemory Judgments During Episodic Memory in Patients With Obsessive-Compulsive Disorders

It is clear evidence that individuals diagnosed with obsessive-compulsive disorder (OCD) lack confidence in their memory and have low metamemory performance (judgment and accuracy). However, it is still unclear whether low metamemory performance is specific to first, domain general or domain specific, and second, to stimulus domain. To address these issues, we compared individuals diagnosed with OCD and healthy controls (HCs) on recognition, retrospective (judgments of learning [JOL]) and prospective (feeling of knowing [FOK]) metamemory judgments and under three different episodic memory tasks, which consisted of symptom-free, familiar and unfamiliar stimuli (word, scene, and face photo). OCD patients showed lower recognition performance, JOL and FOK judgments, and accuracy in all tasks than HCs. Also, OCD patients were slower than HCs during all cognitive performances. In both groups, metamemory performances were lower in familiar items than unfamiliar items. However, recognition performances were not affected by stimulus type. Our results support the idea of general episodic memory and a metamemory deficit in OCD. Moreover, metamemory deficits in OCD are domain general.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

The self, neuroscience and psychosis study: Testing a neurophenomenological model of the onset of psychosis

AIM

Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self-disturbance model of psychosis by examining the relationship between specific clinical, neurocognitive, and neurophysiological variables in UHR patients, and (2) develop a prediction model using these neurophenomenological disturbances for persistence or deterioration of UHR symptoms at 12-month follow-up.

METHODS

SNAP is a longitudinal observational study. Participants include 400 UHR individuals, 100 clinical controls with no attenuated psychotic symptoms, and 50 healthy controls. All participants complete baseline clinical and neurocognitive assessments and electroencephalography. The UHR sample are followed up for a total of 24 months, with clinical assessment completed every 6 months.

RESULTS

This paper presents the protocol of the SNAP study, including background rationale, aims and hypotheses, design, and assessment procedures.

CONCLUSIONS

The SNAP study will test whether neurophenomenological disturbances associated with basic self-disturbance predict persistence or intensification of UHR symptomatology over a 2-year follow up period, and how specific these disturbances are to a clinical population with attenuated psychotic symptoms. This may ultimately inform clinical care and pathoaetiological models of psychosis.

Are people with obsessive-compulsive disorder under-confident in their memory and perception? A review and meta-analysis

People with obsessive-compulsive disorder (OCD) tend to distrust their memory, perception, and other cognitive functions, and many OCD symptoms can be traced to diminished confidence in one's cognitive processes. For example, poor confidence in recall accuracy can cause doubt about one's memory and motivate repeated checking. At the same time, people with OCD also display performance deficits in a variety of cognitive tasks, so their reduced confidence must be evaluated in relation to their actual performance. To that end, we conducted an exhaustive review and meta-analysis of studies in which OCD participants and non-clinical control participants performed cognitive tasks and reported their confidence in their performance. Our search resulted in 19 studies that met criteria for inclusion in the quantitative analysis, with all studies addressing either memory or perception. We found that both performance and reported confidence were lower in OCD than in control participants. Importantly, however, confidence was more impaired than performance in participants with OCD. These findings suggest that people with OCD are less confident in their memory and perception than they should be, indicating a genuine under-confidence in this population. We discuss potential mechanisms that might account for this finding and suggest avenues for further research into under-confidence and related meta-cognitive characteristics of OCD.

How Local and Global Metacognition Shape Mental Health

Metacognition is the ability to reflect on our own cognition and mental states. It is a critical aspect of human subjective experience and operates across many hierarchical levels of abstraction-encompassing local confidence in isolated decisions and global self-beliefs about our abilities and skills. Alterations in metacognition are considered foundational to neurologic and psychiatric disorders, but research has mostly focused on local metacognitive computations, missing out on the role of global aspects of metacognition. Here, we first review current behavioral and neural metrics of local metacognition that lay the foundation for this research. We then address the neurocognitive underpinnings of global metacognition uncovered by recent studies. Finally, we outline a theoretical framework in which higher hierarchical levels of metacognition may help identify the role of maladaptive metacognitive evaluation in mental health conditions, particularly when combined with transdiagnostic methods.

Experience-based knowledge increases confidence in discriminating our memories

The present study investigated the accuracy of metacognitive judgments in source monitoring with self-report scales engaging either information- or experienced-based knowledge. We expected that the source monitoring abilities may be affected by the origins of meta-knowledge that underlie post-decision wagering (PDW) based on economic categorizations (experience-based scale) and confidence ratings (CR) using a conventional taxonomy of confidence (information-based scale). To examine this hypothesis, healthy participants (N = 50) performed an action memory task, in which simple actions were presented in order to be performed or imagined. In the second phase of the task, participants were required to assess source monitoring by distinguishing whether the presented action was performed or imagined. Then, the participants randomly assigned into the PDW or CR group rated their confidence in responses related to source monitoring performance. It was found that source monitoring ability is resistant to manipulation of the type of knowledge used in the scales. However, measures of metacognition indicated that accuracy of the experienced-based judgments of PDW was higher as compared to the CR scale while source monitoring. These findings suggest the origin of knowledge whose justification rests more on empirical observations generates more accurate knowledge than self-evident direct intuition with respect to discriminations of one’s own memories.

Distinguishing schizophrenia spectrum from non-spectrum disorders among young patients with first episode psychosis and at high clinical risk: The role of basic self-disturbance and neurocognition

INTRODUCTION

The distinction between the schizophrenia spectrum and other types of disorders may be clinically relevant in terms of its predictive validity as suggested by studies showing schizophrenia spectrum patients have more unfavourable outcomes compared to other psychotic disorders. The present study aimed to investigate whether basic self-disturbances and neurocognitive processes that have been linked to psychosis risk have discriminative power for schizophrenia spectrum disorders in patients presenting with first episode psychosis (FEP) and at ultra-high risk for psychosis (UHR).

METHODS

38 FEP patients, 48 UHR patients, and 33 healthy controls were assessed for basic self-disturbances (using the Examination of Anomalous Self-Experience, EASE, interview), source monitoring and aberrant salience (behavioural tasks to measure neurocognitive constructs). Clinical groups were divided into patients with schizophrenia spectrum disorders and those with other non-spectrum disorders and were further compared on measures controlling for symptom severity and age.

RESULTS

Basic self-disturbances distinguished schizophrenia spectrum from non-spectrum disorders in the 'FEP only' sample, F = 19.76, p < 0.001, η²_partial = 0.37, and also in the combined UHR/FEP sample, F = 23.56, p < 0.001, η²_partial = 0.22. Additionally, some processes related to source monitoring deficits were elevated in schizophrenia spectrum disorders. In contrast, the two groups (schizophrenia spectrum vs other diagnoses) performed similarly in aberrant salience tasks. Comparable results were obtained for analyses performed with an FEP/UHR combined sample and the 'FEP only' sample.

DISCUSSION

Basic self-disturbances at the phenomenological level and source monitoring deficits on the neurocognitive level may be useful in identifying risk of schizophrenia spectrum disorders at the earliest clinical presentation.

The Indirect Effect of Trauma via Cognitive Biases and Self-Disturbances on Psychotic-Like Experiences

Although self-disturbances (SD) are considered to be a core psychopathological feature of schizophrenia spectrum disorders, there is still insufficient empirical data on the mechanisms underlying these anomalous self-experiences. The aim of the present study was to test a hypothesized model in which cognitive biases and exposure to traumatic life events are related to the frequency of SD which, in turn, contribute to the frequency of psychotic-like experiences (PLEs). Our sample consisted of 193 Polish young adults from the general population (111 females; 18-35 years of age, M = 25.36, SD = 4.69) who experience frequent PLEs. Participants were interviewed for PLEs, SD and social functioning as well as completed self-reported questionnaires and behavioral tasks that measure cognitive biases (e.g., safety behaviors, attention to threat, external attribution, jumping to conclusion, source monitoring, overperceptualization). The model was tested using path analysis with structural equation modeling. All of the hypothesized relationships were statistically significant and our model fit the data well [χ²(23) = 31.201; p = 0.118; RMSEA = 0.043 (90% CI = 0.00-0.078), CFI = 0.985, SRMR = 0.041, TLI = 0.976]. The results revealed a significant indirect effect of traumatic life events on PLEs through SD and self-reported cognitive biases. However, performance-based cognitive biases measured with three behavioral tasks were unrelated to SD and PLEs. The frequency of SD explained a substantial part (43.1%) of the variance in PLEs. Further studies with longitudinal designs and clinical samples are required to verify the predictive value of the model.

The memory deficit hypothesis of compulsive checking in OCD: what are we really talking about? A narrative review

We reviewed studies that have specifically explored the memory deficit hypothesis of Obsessive Compulsive Disorder (OCD) checking, highlighting the methodological differences between these studies that may explain inconsistencies regarding memory deficits in OCD checkers. Based on Conway's proposition that one function of episodic memories is to keep an adaptive record of recent goal processing in order to check that actions have actually been accomplished, we suggest that impaired autonoetic consciousness -one of the main features of episodic memory- may be at the heart of the issue of checking compulsion. Autonoetic consciousness, that can be experimentally assessed by the Remember/Know/Guess paradigm,could be impaired in OCD checkers leading them to be unable to mentally relive their actions in order to be assured that they have been accomplished (e.g., having locked the door). We make methodological suggestions to improve the assessment of autonoetic consciousness deficit in OCD checkers and understand its role in the etiology and maintenance of compulsive checking.

Dissociable source-monitoring impairments in obsessive-compulsive disorder and schizophrenia

BACKGROUND

Based on the observed clinical overlap between obsessive-compulsive disorder (OCD) and schizophrenia (SCZ), both conditions may share, at least in part, common cognitive underpinnings. Among the cognitive deficits that could be involved, it has been hypothesized that patients share a failure in their abilities to monitor their own thoughts (source monitoring), leading to confusion between what they actually did or perceived and what they imagined. Although little is known regarding source-monitoring performances in patients with OCD, numerous studies in patients with SCZ have observed a relationship between delusions and/or hallucinations and deficits in both internal source- and reality-monitoring abilities.

METHODS

The present work compared source-monitoring performances (internal source and reality monitoring) between patients with OCD (n = 32), patients with SCZ (n = 38), and healthy controls (HC; n = 29).

RESULTS

We observed that patients with OCD and patients with SCZ displayed abnormal internal source-monitoring abilities compared to HC. Only patients with SCZ displayed abnormalities in reality monitoring compared to both patients with OCD and HC.

CONCLUSIONS

Internal source-monitoring deficits are shared by patients with OCD and SCZ and may contribute to the shared cognitive deficits that lead to obsessions and delusions. In contrast, reality-monitoring performance seems to differentiate patients with OCD from patients with SCZ.

Bradykinesia In Patients With Obsessive-Compulsive Disorder

Objective

To investigate the frequency of bradykinesia in patients with obsessive-compulsive disorder (OCD) and to see whether patients with OCD who also have bradykinesia display distinctive neuropsychological and neuropsychiatric features.

Methods

We studied 23 antipsychotic-free patients with OCD and 13 healthy controls. Bradykinesia was assessed with section III of the Unified Parkinson Disease Rating Scale. The Wechsler Adult Intelligent Scales-Revised (WAIS-R) was used to assess the Full Scale IQ and to measure visuospatial, visuoconstructional ability and psychomotor speed/mental slowness.

Results

Of the 23 patients with OCD studied, 8 (34%) had mild symptoms of bradykinesia. No relationship was found between bradykinesia and the sociodemographic variables assessed but this motor symptom was significantly associated with the severity of compulsions. Patients with bradykinesia differed from those without: they had a higher frequency of repeating compulsions, and lower IQ scores, performance scores, and WAIS-R subtest scores for similarities and picture completion. No significant differences were found between patients without bradykinesia and healthy controls in any test.

Conclusions

Clinical assessment of motor symptoms in adult patients with OCD often discloses mild bradykinesia sometimes associated with repeating compulsions and poor WAIS-R performance scores.

Review of source-monitoring processes in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a severe mental illness characterized by persistent, intrusive and distressing obsessions and/or compulsions. Such symptoms have been conceptualized as resulting from a failure in source-monitoring processes, suggesting that patients with OCD fail to distinguish actions they perform from those they just imagine doing. In this study, we aimed to provide an updated and exhaustive review of the literature examining the relationship between source-monitoring and OCD. A systematic search in the literature through January 2019 allowed us to identify 13 relevant publications investigating source-monitoring abilities in patients with OCD or participants with subclinical compulsive symptoms. Most of the retrieved studies did not report any source-monitoring deficits in clinical and subclinical subjects compared with healthy volunteers. However, most of the studies reported that patients with OCD and subclinical subjects displayed reduced confidence in source-monitoring judgments or global cognitive confidence compared to controls. The present review highlighted some methodological and statistical limitations. Consequently, further studies are needed to explore source monitoring with regard to the subcategories of OCD symptoms (i.e., symmetry-ordering, contamination-washing, hoarding, aggressive obsession-checking, sexual-religious thoughts) and to clarify the relationship between source-monitoring subtypes (i.e., reality or internal source-monitoring) and confidence in these populations.

Impaired action self-monitoring and cognitive confidence among ultra-high risk for psychosis and first-episode psychosis patients

Background

Self-monitoring biases and overconfidence in incorrect judgments have been suggested as playing a role in schizophrenia spectrum disorders. Little is known about whether self-monitoring biases may contribute to early risk factors for psychosis. In this study, action self-monitoring (i.e., discrimination between imagined and performed actions) was investigated, along with confidence in judgments among ultra-high risk (UHR) for psychosis individuals and first-episode psychosis (FEP) patients.

Methods

Thirty-six UHR for psychosis individuals, 25 FEP patients and 33 healthy controls (CON) participated in the study. Participants were assessed with the Action memory task. Simple actions were presented to participants verbally or non-verbally. Some actions were required to be physically performed and others were imagined. Participants were asked whether the action was presented verbally or non-verbally (action presentation type discrimination), and whether the action was performed or imagined (self-monitoring). Confidence self-ratings related to self-monitoring responses were obtained.

Results

The analysis of self-monitoring revealed that both UHR and FEP groups misattributed imagined actions as being performed (i.e., self-monitoring errors) significantly more often than the CON group. There were no differences regarding performed actions as being imagined. UHR and FEP groups made their false responses with higher confidence in their judgments than the CON group. There were no group differences regarding discrimination between the types of actions presented (verbal vs non-verbal).

Conclusions

A specific type of self-monitoring bias (i.e., misattributing imagined actions with performed actions), accompanied by high confidence in this judgment, may be a risk factor for the subsequent development of a psychotic disorder.

Monetary Incentives Increase Metacognitive Confidence in Source Memory Performance in Patients With Schizophrenia

BACKGROUND

Contemporary psychiatric research focuses its attention on the patient's dysfunction of metacognition in relation to the basic cognitive processes of mental activity. The current study investigated dysfunctional metacognition in relation to self-monitoring of memory in patients diagnosed with schizophrenia. Dysfunctions in metacognition were examined by focusing on two types of metacognitive measures: post-decision wagering (PDW) scale and confidence ratings (CR) scale (CR).

OBJECTIVES

The research employed an action-memory task that required patients with schizophrenia (N = 39) and healthy controls (N = 50) to evaluate their metacognition by categorizing self-monitoring actions (imagined vs. performed actions) either with PDW or CR. It was hypothesized that metacognition in self-monitoring activity in patients diagnosed with schizophrenia is improved by imaginary monetary incentives.

MATERIAL AND METHODS

To test this hypothesis, participants were asked to memorize actions either performed or imagined during the first phase of the experiment. The second phase was to identify previous actions as performed, imagined or new, and then to express confidence using two measures of metacognition (CR or PDW scales) that were randomly allocated to participants.

RESULTS

Our study showed reduced performance in the action memory task for patients with schizophrenia, although there were no group differences in confidence measures when assessing self-monitoring actions. In particular, irrespective of the diagnosis, no differences in confidence measures for correct responses were found in the case of the PDW and CR scales. We also observed that metacognitive judgements were more accurate for incorrect responses when both groups used monetary incentives to reveal their metacognition.

CONCLUSIONS

Our findings suggest that monetary incentives improve accuracy of metacognition among both patients and healthy controls. This accuracy-enhancing effect of monetary incentives on metacognition was possibly a result of motivational processes, including aversion to loss. The paper discusses the potential application of PDW in therapeutic metacognitive training for patients with schizophrenia.

Abnormalities of confidence in psychiatry: an overview and future perspectives

Our behavior is constantly accompanied by a sense of confidence and its' precision is critical for adequate adaptation and survival. Importantly, abnormal confidence judgments that do not reflect reality may play a crucial role in pathological decision-making typically seen in psychiatric disorders. In this review, we propose abnormalities of confidence as a new model of interpreting psychiatric symptoms. We hypothesize a dysfunction of confidence at the root of psychiatric symptoms either expressed subclinically in the general population or clinically in the patient population. Our review reveals a robust association between confidence abnormalities and psychiatric symptomatology. Confidence abnormalities are present in subclinical/prodromal phases of psychiatric disorders, show a positive relationship with symptom severity, and appear to normalize after recovery. In the reviewed literature, the strongest evidence was found for a decline in confidence in (sub)clinical OCD, and for a decrease in confidence discrimination in (sub)clinical schizophrenia. We found suggestive evidence for increased/decreased confidence in addiction and depression/anxiety, respectively. Confidence abnormalities may help to understand underlying psychopathological substrates across disorders, and should thus be considered transdiagnostically. This review provides clear evidence for confidence abnormalities in different psychiatric disorders, identifies current knowledge gaps and supplies suggestions for future avenues. As such, it may guide future translational research into the underlying processes governing these abnormalities, as well as future interventions to restore them.

Neurocognitive deficits in obsessive-compulsive disorder: A selective review

Obsessive-compulsive disorder (OCD) is a debilitating mental illness characterized by an early onset and chronic course. Evidence from several lines of research suggests significant neuropsychological deficits in patients with OCD; executive dysfunction and nonverbal memory deficits have been reported consistently in OCD. These deficits persist despite controlling potential confounders such as comorbidity, severity of illness, and medications. Neuropsychological impairments are independent of illness severity, thus suggesting that the neuropsychological deficits are trait markers of the disease. In addition, these deficits are seen in first-degree relatives of individuals with OCD. These reports suggest that neuropsychological deficits are potential endophenotype markers in OCD. Neuropsychological studies in pediatric OCD are limited; they show impairments of small effect size across multiple domains but with doubtful clinical significance. Preliminary evidence shows that different symptom dimensions of OCD may have unique neuropsychological deficits suggestive of discrete but overlapping neuroanatomical regions for individual symptom dimensions. Overall, neuropsychological deficits further support the role of frontostriatal circuits in the neurobiology of OCD. In addition, emerging literature also suggests the important role of other areas, in particular parietal cortex. Preliminary evidence suggests the possible role of neuropsychological deficits to be markers of treatment response but needs to be examined in future. Longitudinal studies with examination of patients at different time points and examination of their potential utility as predictors of treatment response are needed in future.

Decreased memory confidence in obsessive-compulsive disorder for scenarios high and low on responsibility: is low still too high?

Previous research suggests that patients with obsessive-compulsive disorder (OCD), particularly checkers, display an inflated sense of responsibility. For the present study, we tested whether memory confidence in OCD is reduced under conditions of heightened responsibility and/or reflects poor memory vividness. A computerized task designed to modulate perceived responsibility was administered to 26 OCD patients (12 checkers) and 21 healthy controls. In the experimental condition (high responsibility), participants had to allocate daily medications to ten fictive patients in a hospital emergency ward, whereas in the control condition (low responsibility) participants had to allocate bath essences for ten hotel guests. Participants' response time and accuracy were recorded as well as their memory confidence, memory vividness, and subjective success. Irrespective of the condition, OCD patients performed as accurately as healthy controls, but appraised their performance as worse than that of controls. Memory confidence was decreased in patients, particularly checkers. No group differences emerged on vividness, and none of the effects were moderated by the condition (high versus low responsibility). The relationship between responsibility and OCD behavior is complex. Results suggest metamemory problems in OCD checkers, even when induced responsibility is low. The findings speak against "cold" memory deficits in OCD, as patients did not differ from controls on accuracy, reaction time, or vividness. Future research should focus on idiosyncratic beliefs and scenarios that inflate responsibility and elicit cognitive biases.

Self-reported cognitive distortions in the psychosis continuum: A Polish 18-item version of the Davos Assessment of Cognitive Biases Scale (DACOBS-18)

AIM

The aim of this study was to provide a short version of the Davos Assessment of Cognitive Biases Scale (DACOBS), which is a self-report tool to assess cognitive distortions related to psychosis.

METHODS

A principal component analysis (PCA) was conducted on a large non-clinical sample (n=1207) and cross-validated with a confirmatory factor analysis on an independent non-clinical sample (n=653). Discriminative validity was performed by contrasting the high risk for psychosis non-clinical sample (n=63), low risk for psychosis non-clinical sample (n=152), patients with schizophrenia (n=105), and patients with depression (n=56). Correlations between symptoms, cognitive functions, source monitoring deficits, and jumping to conclusions were performed among a subgroup of patients with schizophrenia.

RESULTS

An 18-item scale (DACOBS-18) with a four-factor solution was established. Internal consistency (α=0.84) and test-retest reliability (r=0.84, p<0.001) were good. The DACOBS-18 has satisfactory discriminative power, with 99.1% sensitivity and 74.3% specificity in discriminating low risk for psychosis from schizophrenia patients. The DACOBS-18 subscales correlate significantly with psychotic symptoms and psychotic-like experiences. After Bonferroni correction, significant correlations between Safety Behaviors and neuropsychological functioning were found.

CONCLUSIONS

The DACOBS-18 is a reliable scale with satisfactory discriminative power and thus may be a valuable self-report screening tool for use in everyday clinical practice with psychotic patients and with people at risk for psychosis. Further research on its relationship to objective cognitive measures is needed.

The Cognitive Heterogeneity of Obsessive-Compulsive Checking

The present article reviews the phenomenology of obsessive-compulsive checking, examining how action processing can be differentially affected across distinct checking subtypes. Checking is a normal phenomenon which ensures that an intended goal has been actually completed. Checking symptoms have consistently been connected to impairments in processing information related to self-performances. Theoretical and empirical work has explained compulsive checking as a result of various cognitive deficits related to action processing (e.g., low confidence in cognitive abilities, impaired memory for actions, abnormal reality monitoring, overactive action monitoring, defective goal processing). Such apparent inconsistencies are, however, in agreement with clinical and empirical observations highlighting substantial variability in the subjective experience preceding/accompanying checking. Many factors can in fact prevent the cognitive system from determining whether or not an intended goal has actually been achieved. We argue that several action processing mechanisms are likely affected in checking; the related subjective experience may vary accordingly.

NEUROPSYCHOLOGICAL PREDICTORS OF TREATMENT RESPONSE TO COGNITIVE BEHAVIORAL GROUP THERAPY IN OBSESSIVE-COMPULSIVE DISORDER

BACKGROUND

The available research on the relationship between neuropsychological functioning and the therapeutic outcome of obsessive-compulsive disorder (OCD) has yielded inconsistent results. In this study, our aim was twofold. First, we sought to evaluate the effects of cognitive behavioral group therapy (CBGT) on neurocognitive functions in OCD patients. Second, we assessed the viability of neuropsychological test performance as a predictor of treatment response to CBGT.

METHODS

One hundred fifty carefully screened OCD patients were randomized to receive either 12-week CBGT (n = 75) or to remain on a waiting list (WL; n = 75) for the corresponding time. Forty-seven participants dropped out of the study, leaving 103 participants that were included in the analysis (CBGT, n = 61; WL, n = 42). Participants had several neuropsychological domains evaluated both at baseline and at end-point.

RESULTS

A significant difference in obsessive-compulsive, anxiety, and depression symptoms was observed between treated patients and controls favoring the CBGT group, but no significant differences were found on neuropsychological measures after 3 months of CBGT. In addition, there were no differences between treatment responders and nonresponders on all neuropsychological outcome measures. Employing a conservative alpha, neuropsychological test performance did not predict CBGT treatment response.

CONCLUSIONS

Although the CBGT group demonstrated significant improvement in OCD symptoms, no significant difference was found on all neuropsychological domains, and test performance did not predict treatment response.

Towards a cognitive model of hallucinations in the course of alcohol dependence? A source monitoring-based pilot study

BACKGROUND

We investigated whether source-monitoring deficits (here a discrimination between imagined and performed actions) underlie hallucinations among patients with a history of hallucinations in the course of their alcohol dependence.

METHOD

We assessed 29 patients with alcohol dependence who had no history of hallucinations during their course of alcoholism and 29 patients with a history of at least one episode of hallucinations of any modality during their course of alcohol dependency. The control group consisted of 24 healthy participants. Participants were assessed with an action memory task. Simple actions were presented to the participants verbally or non-verbally. Some actions were performed physically and others were imagined. In the recognition phase, participants were asked whether the action was presented verbally or non-verbally (action presentation type discrimination) and whether the action was performed or imagined (self-monitoring). A confidence score related to self-monitoring responses was also obtained.

RESULTS

Alcoholics with a history of hallucinations misremembered imagined actions as perceived ones more frequently than patients without hallucinations, but not the reverse. Only patients with a history of hallucinations committed more errors of this type than healthy subjects. There were no group differences regarding discrimination between an action presentation type. Both clinical groups committed errors with a higher degree of confidence than healthy subjects.

CONCLUSIONS

Our results tentatively suggest that a specific type of source-monitoring deficit (i.e., confusing imagery with reality) may be involved in the hallucinations in patients with alcohol dependence. The findings are discussed in the light of a transdiagnostic approach to hallucinations.

Exploring metacognitive components of confidence and control in individuals with obsessive-compulsive tendencies

BACKGROUND AND OBJECTIVES

Obsessive-compulsive (OC) patients typically display reduced metacognitive confidence, but findings regarding the scope of this phenomenon and factors that mediate it have been inconsistent. This study aimed to further the understanding of reduced metacognitive confidence in obsessive-compulsive disorder (OCD) by exploring the relationship between metacognitive processes and OC tendencies.

METHODS

High and low OC participants answered a general-knowledge questionnaire, rated their confidence in each answer, and decided whether or not to report each answer.

RESULTS

High and low OC participants did not differ either in their performance (general knowledge) or in their subjective estimations or confidence regarding their performance. The two groups also did not differ in the effectiveness of their metacognitive monitoring or in the relationship between monitoring and report-control decisions (control sensitivity). However, the two groups did differ in response criterion, with high OC participants less willing to report answers held with low-to-medium levels of subjective confidence.

LIMITATIONS

The study was conducted with non-clinical participants, which limits generalization to OCD.

CONCLUSIONS

These results suggest that conservative response criterion among OC individuals might be the critical factor underlying feelings of doubt and uncertainty endemic in OCD.

Impaired action self-monitoring in schizophrenia patients with auditory hallucinations

BACKGROUND

It has been suggested that the process of discriminating between inner and outer experiences underlies auditory hallucinations (AHs). The aim of the present study was to investigate whether discrimination between imagined and performed action (i.e., action self monitoring) differed between schizophrenia patients with auditory hallucinations (AHs) and those without.

METHOD

Twenty-eight schizophrenia patients with AHs, twenty-six patients without AHs, and thirty-four healthy subjects were assessed with an action memory task. Simple actions were presented to the participant verbally (text) or non-verbally (icons). Some actions were physically performed and others were imagined. Following the learning phase, participants were presented with each action as well as new ones, were asked whether the action was presented verbally or non-verbally (action's presentation type discrimination), and whether the action was performed or imagined (self-monitoring). A confidence score related to self-monitoring responses was also obtained.

RESULTS

Patients with AHs more often remembered imagined actions as performed than patients without AHs and healthy controls. Schizophrenia patients made significantly more incorrect responses in action presentation type discrimination than healthy controls. Self-monitoring errors were followed by high confidence ratings in the schizophrenia group. No differences between patients with and without AH in old/new recognition emerged.

CONCLUSIONS

Our study suggests that action self-monitoring deficits but not impairments in discriminating presentation type are related to AHs. In the schizophrenia group, action-self monitoring errors were associated with overconfidence.

The effect of practice on the recall of salient information in obsessive-compulsive disorder

Deficits in memory and cognitive inhibition have been proposed as underlying mechanisms of obsessive-compulsive disorder (OCD). To test this hypothesis, an emotional variant of the retrieval-induced forgetting (RIF) paradigm was constructed which investigates whether repeated retrieval of previously learned material (Rp+) leads to enhanced forgetting of related but nonretrieved material (Rp-) in comparison to unrelated material (NRp). Paradigm (involving OCD-relevant, neutral and negative material) was presented to 21 participants with OCD and 22 healthy controls. To compare personally relevant stimuli across groups, salience ratings of the material were included. RIF was not reduced in OCD per se. Tentative evidence was found for a weakened RIF effect for personally salient OCD-relevant material in OCD patients in comparison to healthy controls.

Impaired discrimination between imagined and performed actions in schizophrenia

The main aim of the present study was to investigate whether a specific type of source monitoring, namely self-monitoring for actions (differentiation between imagined and performed actions), is disrupted in schizophrenia. Persons diagnosed with schizophrenia (n=32) and healthy participants (n=32) were assessed with an action memory task. Simple actions were presented to the participants either verbally (short instructions) or nonverbally (icons). Some of the items required participants to physically perform the action whereas other actions had to be imagined. In the recognition phase of the study, participants were asked whether an action was previously displayed (verbally or nonverbally), whether it was a new action (not presented before), and if they had performed or imagined the action. In addition, participants were asked how confident they were in their decision. Participants in the group with schizophrenia significantly more often misattributed imagined actions as performed and vice versa and were more convinced about their wrong decision than participants in the control group. Patients revealed worse recognition for both verbal and nonverbal actions. In accordance with prior studies, we found that patients were less confident in their correct answers than healthy subjects. However, no enhanced confidence in incorrect answers was found. There was no observed significant relationship between source misattributions and the severity of psychopathological symptoms. Our findings suggest tentatively general source monitoring deficits in schizophrenia.

Study of neurocognitive endophenotypes in drug-naïve obsessive-compulsive disorder patients, their first-degree relatives and healthy controls

OBJECTIVE

Obsessive-compulsive disorder (OCD) is a debilitating heritable neuropsychiatric condition. Attempts to delineate genetic contributions in OCD have met with limited success, with an ongoing search for neurocognitive endophenotypes. In this study, an attempt has been made to study and compare the neurocognitive functioning of patients with OCD, their first-degree relatives (FDRs) and healthy controls.

METHOD

A cross-sectional design study was carried out with thirty dyads of patients with OCD, their FDRs and thirty matched healthy controls and screened using Mini International Neuropsychiatric Interview, Verbal Adult Intelligence Scale, Yale Brown Obsessive-Compulsive Scale, Montgomery Åsberg Depression Rating Scale, International Personality Disorder Examination (Anankastic personality scale).Tests of National Institute of Mental Health and Neurosciences Neuropsychological Battery were used to assess domains of attention, verbal memory, visual memory, set-shifting, response inhibition, planning and visuoconstructive abilities. spss version 14.0 was used for descriptive and analytical data analysis.

RESULTS

There were no statistically significant differences between patients with OCD and their FDRs on neurocognitive domains of delayed verbal recall, set-shifting, response inhibition and visuoconstructive abilities (P > 0.05) which were impaired compared with healthy controls. Significant differences (P < 0.05) on domains of attention, planning time and visual memory were noted between FDRs and patients.

CONCLUSION

The present study supports set-shifting and inhibitory control and proposes visuoconstructive abilities and delayed verbal recall as potential endophenotypes for OCD.

Incorrigibility, jumping to conclusions, and decision threshold in schizophrenia

INTRODUCTION

Previous studies confirmed a bias against disconfirmatory evidence (BADE) for both delusional and delusion-neutral events in paranoid schizophrenia. In the present study, we examined a potential relationship between the BADE and delusional ideation.

METHODS

Fifty-five patients with schizophrenia (32 with current delusions), 20 patients with obsessive-compulsive disorder and 30 healthy participants were presented written scenarios composed of three successive sentences which increasingly disambiguated the situation. Participants were asked to rate interpretations presented along with the sentences. After each new sentence, participants could adjust their judgements in view of the new information. One interpretation ("true") did not seem to fit the first statement but became increasingly plausible, whereas "lure" interpretations appeared very likely initially but were eventually incorrect. Patients were given the option to decide for one of the statements.

RESULTS

Patients with schizophrenia, irrespective of delusion severity, attenuated their ratings significantly less for lure interpretations in face of disconfirmatory evidence (BADE) compared to both control groups. We found no impairment regarding the integration of confirmatory evidence. Patients with schizophrenia made more incorrect decisions after the first sentence indicating jumping to conclusions relative to healthy controls. Participants with schizophrenia showed a lowered decision threshold compared to the controls.

CONCLUSIONS

The findings lend further evidence to the claim that patients with schizophrenia are hastier and rather inflexible in their decision making. This response pattern may represent a trait-like vulnerability factor for the emergence of delusional incorrigibility, a hallmark symptom of schizophrenia.