Knowledge corruption for visual perception in individuals high on paranoia

Confident memory errors and disrupted reality testing in early psychosis

Schizophrenia is a psychiatric disorder characterized by a disruption in reality testing most often manifest in the form of delusions and hallucinations. Because determining the reality-basis of prior experiences is dependent on episodic and associative memory, deficits in mnemonic processes could be involved in the genesis of impaired reality testing. In the present study, we used an associative memory paradigm incorporating confidence ratings to examine whether patients with a recent onset of schizophrenia (n = 48) show a greater propensity for confident, yet incorrect responses during retrieval testing than healthy controls (n = 26) and whether such confident incorrect responses, specifically, are more strongly associated with positive symptoms than with negative symptoms. Using an analysis of variance design, we found that first-episode schizophrenia patients made a significantly greater number of confident errors than controls (i.e. they expressed high confidence in having seen pairs of items that were not paired at encoding and high confidence in having not seen pairs of items that were paired at encoding). We also found that the number of confident errors was specifically and differentially associated with positive symptom severity, to a significantly greater degree than with negative symptom severity and psychosocial functioning, and this association was not found between positive symptoms and uncertain responses, nor positive symptoms and overall task performance. These findings suggest that the propensity for incorrect memory judgements with high confidence, specifically, may be uniquely associated with disrupted reality testing and that this type of cognitive impairment is distinct from general deficits in memory and cognition in this respect.

Are the symptoms really remitting? How the subjective interpretation of outcomes can produce an illusion of causality

Judgments of a treatment’s effectiveness are usually biased by the probability with which the outcome (e.g., symptom relief) appears: even when the treatment is completely ineffective (i.e., there is a null contingency between cause and outcome), judgments tend to be higher when outcomes appear with high probability. In this research, we present ambiguous stimuli, expecting to find individual differences in the tendency to interpret them as outcomes. In Experiment 1, judgments of effectiveness of a completely ineffective treatment increased with the spontaneous tendency of participants to interpret ambiguous stimuli as outcome occurrences (i.e., healings). In Experiment 2, this interpretation bias was affected by the overall treatment-outcome contingency, suggesting that the tendency to interpret ambiguous stimuli as outcomes is learned and context-dependent. In conclusion, we show that, to understand how judgments of effectiveness are affected by outcome probability, we need to also take into account the variable tendency of people to interpret ambiguous information as outcome occurrences.

No Correlation Between Perception of Meaning and Positive Schizotypy in a Female College Sample

We visually perceive meaning from stimuli in the external world. There are inter-individual variations in the perception of meaning. A candidate factor to explain this variation is positive schizotypy, which is a personality analogous to positive symptoms of schizophrenia (e.g., visual hallucination). The present study investigated the relationship between positive schizotypy, and the perception of meaning derived from meaningful and meaningless visual stimuli. Positive schizotypy in Japanese female undergraduates (n = 35) was assessed by the Cognitive-Perceptual dimension of the Schizotypal Personality Questionnaire. The participants were asked to report what they saw in noise-degraded images of meaningful objects (Experiment 1) and to respond whether the objects were meaningful (Experiment 2A) and which paired objects were meaningful (Experiment 2B). Positive schizotypy (i.e., Cognitive-Perceptual score) did not correlate with time to detect meaningful objects, and with false-alarm rates, sensitivity, and response criterion in the perception of meaning from meaningful and meaningless stimuli. These results were against our hypothesis and contradicted previous findings. The inconsistencies are discussed in terms of different methods (e.g., stimulus category) and conditions (e.g., paranormal beliefs).

Introspective accuracy for social competence in psychometric schizotypy

Introduction: Deficits in social competence have been identified in schizotypy; however, most studies rely on self-reports of these skills. Deficits in introspective accuracy (IA) have been identified within schizophrenia, and recent work suggests IA is impaired in schizotypy as well. Thus, the perception of poorer social competence among individuals high in schizotypy may be due to inaccurate self-assessments rather than actual skill deficits.Method: This study examined the relationship between schizotypy, perceived social competence, and observed social competence in 137 undergraduate students.Results: Differences in self-reported social competence were found such that individuals high in schizotypy reported greater deficits than individuals low in schizotypy. However, the groups performed comparably on an objective assessment of social competence. Within groups, individuals high in schizotypy underestimated their social competence, whereas controls overestimated their social competence. Thus, both groups demonstrated impairments in IA.Conclusions: These findings demonstrate that individuals high in schizotypal traits perceive that they have poor social competence despite displaying skills that are on par with their peers. Such perceptions may lead to avoidance of social interactions or employment opportunities and could contribute to deficits in social functioning.

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.

Emotion perception and overconfidence in errors under stress in psychosis

Vulnerability stress models are well-accepted in psychosis research, but the mechanisms that link stress to psychotic symptoms remain vague. Little is known about how social cognition and overconfidence in errors, two putative mechanisms for the pathogenesis of delusions, relate to stress. Using a repeated measures design, we tested four groups (N=120) with different liability to psychosis (schizophrenia patients [n=35], first-degree relatives [n=24], participants with attenuated positive symptoms [n=19] and healthy controls [n=28]) and depression patients (n=14) as a clinical control group under three randomized experimental conditions (no stress, noise and social stress). Parallel versions of the Emotion Perception and Confidence Task, which taps both emotion perception and confidence, were used in each condition. We recorded subjective stress, heart rate, skin conductance level and salivary cortisol to assess the stress response across different dimensions. Independent of the stress condition, patients with schizophrenia showed poorer emotion perception performance and higher confidence in emotion perception errors than participants with attenuated positive symptoms and healthy controls. However, they did not differ from patients with depression or first-degree relatives. Stress did not influence emotion perception or the extent of high-confident errors, but patients with schizophrenia showed an increase in high-confident emotion perception errors conditional on higher arousal. A possible clinical implication of our findings is the necessity to provide stress management programs that aim to reduce arousal. Moreover, patients with schizophrenia might benefit from interventions that help them to reduce overconfidence in their social cognition judgements in times in which they feel being under pressure.

The Importance of Metamemory Functioning to the Pathogenesis of Psychosis

Many studies up to date have implied that biases in the metacognition of memory, so called metamemory, contribute to the development and maintenance of positive symptoms in schizophrenia. However, no study exists which has longitudinally followed patients experiencing positive symptoms. The present article therefore reviews cross-sectional studies on retrospective metamemory abilities in participants within different stages of a schizophrenia spectrum disorder, with heterogeneous symptom severities, creating a pseudo-longitudinal overview. Summarized, a deterioration of these abilities correlating with psychosis development can be inferred. The reviewed publications indicate that metamemory biases can already be found in patients with an at-risk mental state for psychosis (ARMS). Patients in their first episode of psychosis (FEP) seem to be more severely impaired than ARMS-patients but similarly affected compared to chronic patients. The contribution of these biases to the pathogenesis of psychosis is discussed, giving consideration to relations with other cognitive- and metacognitive functions, neurochemical processes and neural correlates. It is hypothesized that the biases represent early cognitive markers of the beginning and persisting psychotic state. An early treatment program could help patients to ameliorate the general course of illness or even to prevent the risk of a transition to psychosis.

Overconfidence across the psychosis continuum: a calibration approach

INTRODUCTION

An 'overconfidence in errors' bias has been consistently observed in people with schizophrenia relative to healthy controls, however, the bias is seldom found to be associated with delusional ideation. Using a more precise confidence-accuracy calibration measure of overconfidence, the present study aimed to explore whether the overconfidence bias is greater in people with higher delusional ideation.

METHODS

A sample of 25 participants with schizophrenia and 50 non-clinical controls (25 high- and 25 low-delusion-prone) completed 30 difficult trivia questions (accuracy <75%); 15 'half-scale' items required participants to indicate their level of confidence for accuracy, and the remaining 'confidence-range' items asked participants to provide lower/upper bounds in which they were 80% confident the true answer lay within.

RESULTS

There was a trend towards higher overconfidence for half-scale items in the schizophrenia and high-delusion-prone groups, which reached statistical significance for confidence-range items. However, accuracy was particularly low in the two delusional groups and a significant negative correlation between clinical delusional scores and overconfidence was observed for half-scale items within the schizophrenia group. Evidence in support of an association between overconfidence and delusional ideation was therefore mixed.

CONCLUSIONS

Inflated confidence-accuracy miscalibration for the two delusional groups may be better explained by their greater unawareness of their underperformance, rather than representing genuinely inflated overconfidence in errors.

Measuring fluctuations in paranoia: Validity and psychometric properties of brief state versions of the Paranoia Checklist

Research increasingly assesses momentary changes in paranoia in order to elucidate causal mechanisms. Observed or manipulated changes in postulated causal factors should result in fluctuations in state paranoid ideation. Previous studies often employed a state-adapted Paranoia Checklist (Freeman et al., 2005) to measure state paranoia. This study examined whether the Paranoia Checklist or subsets of its items are appropriate for this purpose. Thirteen studies (N=860) were subjected to meta-analyses of each Paranoia Checklist item. We selected items based on (1) whether they showed pre-to-post change in the expected direction and (2) whether this effect was larger in experimental vs. control conditions. All resulting item selections were cross-validated on a hold-out sample (n=1893). Finally, we explored how much variation in paranoia was captured by the state-adapted version in a brief ambulatory assessment study (N=32). A thirteen item State Paranoia Checklist as well as a five item and a three item Brief State Paranoia Checklist were extracted. Cross validation revealed better model fit and increased sensitivity to change. Multilevel analysis indicated 25-30% of the variance in the Brief State Paranoia Checklists to be due to intra-individual daily fluctuations in paranoia. Our analyses produced reliable and valid revised scales. Increases in change sensitivity indicate that future assessment of state paranoia in experimental and ambulatory assessment studies can be optimized by using the revised scales.

More adaptive versus less maladaptive coping: What is more predictive of symptom severity? Development of a new scale to investigate coping profiles across different psychopathological syndromes

BACKGROUND

Lack of adaptive and enhanced maladaptive coping with stress and negative emotions are implicated in many psychopathological disorders. We describe the development of a new scale to investigate the relative contribution of different coping styles to psychopathology in a large population sample. We hypothesized that the magnitude of the supposed positive correlation between maladaptive coping and psychopathology would be stronger than the supposed negative correlation between adaptive coping and psychopathology. We also examined whether distinct coping style patterns emerge for different psychopathological syndromes.

METHODS

A total of 2200 individuals from the general population participated in an online survey. The Patient Health Questionnaire-9 (PHQ-9), the Obsessive-Compulsive Inventory revised (OCI-R) and the Paranoia Checklist were administered along with a novel instrument called Maladaptive and Adaptive Coping Styles (MAX) questionnaire. Participants were reassessed six months later.

RESULTS

MAX consists of three dimensions representing adaptive coping, maladaptive coping and avoidance. Across all psychopathological syndromes, similar response patterns emerged. Maladaptive coping was more strongly related to psychopathology than adaptive coping both cross-sectionally and longitudinally. The overall number of coping styles adopted by an individual predicted greater psychopathology. Mediation analysis suggests that a mild positive relationship between adaptive and certain maladaptive styles (emotional suppression) partially accounts for the attenuated relationship between adaptive coping and depressive symptoms.

LIMITATIONS

Results should be replicated in a clinical population.

CONCLUSIONS

Results suggest that maladaptive and adaptive coping styles are not reciprocal. Reducing maladaptive coping seems to be more important for outcome than enhancing adaptive coping. The study supports transdiagnostic approaches advocating that maladaptive coping is a common factor across different psychopathologies.

Investigation of metamemory functioning in the at-risk mental state for psychosis

BACKGROUND

Metamemory describes the monitoring and knowledge about one's memory capabilities. Patients with schizophrenia have been found to be less able in differentiating between correct and false answers (smaller confidence gap) when asked to provide retrospective confidence ratings in previous studies. Furthermore, higher proportions of very-high-confident but false responses have been found in this patient group (high knowledge corruption). Whether and how these biases contribute to the early pathogenesis of psychosis is yet unclear. This study thus aimed at investigating metamemory function in the early course of psychosis.

METHOD

Patients in an at-risk mental state for psychosis (ARMS, n = 34), patients with a first episode of psychosis (FEP, n = 21) and healthy controls (HCs, n = 38) were compared on a verbal recognition task combined with retrospective confidence-level ratings.

RESULTS

FEP patients showed the smallest confidence gap, followed by ARMS patients, followed by HCs. All groups differed significantly from each other. Regarding knowledge corruption, FEP patients differed significantly from HCs, whereas a statistical trend was revealed in comparison of ARMS and FEP groups. Correlations were revealed between metamemory, measures of positive symptoms and working memory performance.

CONCLUSIONS

These data underline the presence of a metamemory bias in ARMS patients which is even more pronounced in FEP patients. The bias might represent an early cognitive marker of the beginning psychotic state. Longitudinal studies are needed to unravel whether metacognitive deficits predict the transition to psychosis and to evaluate therapeutic interventions.

Subjective competence breeds overconfidence in errors in psychosis. A hubris account of paranoia

BACKGROUND AND OBJECTIVES

Overconfidence in errors is a well-replicated cognitive bias in psychosis. However, prior studies have sometimes failed to find differences between patients and controls for more difficult tasks. We pursued the hypothesis that overconfidence in errors is exaggerated in participants with a liability to psychosis relative to controls only when they feel competent in the respective topic and/or deem the question easy. Whereas subjective competence likely enhances confidence in those with low psychosis liability as well, we still expected to find more 'residual' caution in the latter group.

METHODS

We adopted a psychometric high-risk approach to circumvent the confounding influence of treatment. A total of 2321 individuals from the general population were administered a task modeled after the "Who wants to be a millionaire" quiz. Participants were requested to endorse one out of four response options, graded for confidence, and were asked to provide ratings regarding subjective competence for the knowledge domain as well as the subjective difficulty of each item.

RESULTS

In line with our assumption, overconfidence in errors was increased overall in participants scoring high on the Paranoia Checklist core paranoia subscale (2 SD above the mean). This pattern of results was particularly prominent for items for which participants considered themselves competent and which they rated as easy.

LIMITATIONS

Results need to be replicated in a clinical sample.

DISCUSSION

In support of our hypothesis, subjective competence and task difficulty moderate overconfidence in errors in psychosis. Trainings that teach patients the fallibility of human cognition may help reduce delusional ideation.

Associations between visual perception accuracy and confidence in a dopaminergic manipulation study

Delusions are defined as fixed erroneous beliefs that are based on misinterpretation of events or perception, and cannot be corrected by argumentation to the opposite. Cognitive theories of delusions regard this symptom as resulting from specific distorted thinking styles that lead to biased integration and interpretation of perceived stimuli (i.e., reasoning biases). In previous studies, we were able to show that one of these reasoning biases, overconfidence in errors, can be modulated by drugs that act on the dopamine system, a major neurotransmitter system implicated in the pathogenesis of delusions and other psychotic symptoms. Another processing domain suggested to involve the dopamine system and to be abnormal in psychotic disorders is sensory perception. The present study aimed to investigate whether (lower-order) sensory perception and (higher-order) overconfidence in errors are similarly affected by dopaminergic modulation in healthy subjects. Thirty-four healthy individuals were assessed upon administration of l-dopa, placebo, or haloperidol within a randomized, double-blind, cross-over design. Variables of interest were hits and false alarms in an illusory perception paradigm requiring speeded detection of pictures over a noisy background, and subjective confidence ratings for correct and incorrect responses. There was a significant linear increase of false alarm rates from haloperidol to placebo to l-dopa, whereas hit rates were not affected by dopaminergic manipulation. As hypothesized, confidence in error responses was significantly higher with l-dopa compared to placebo. Moreover, confidence in erroneous responses significantly correlated with false alarm rates. These findings suggest that overconfidence in errors and aberrant sensory processing might be both interdependent and related to dopaminergic transmission abnormalities in patients with psychosis.

Overconfidence in incorrect perceptual judgments in patients with schizophrenia

Background

Patients with schizophrenia show overconfidence in memory and social cognition errors. The present investigation examined whether this cognitive distortion also manifests in perceptual tasks.

Methods

A total of 55 individuals with schizophrenia, 58 with obsessive–compulsive disorder (OCD) as well as 45 non-clinical controls were presented 24 blurry black and white pictures, half of which contained a hidden object; the other half contained (“snowy”) visual noise. Participants had to judge whether the pictures depicted an object or not and how confident they were in this judgment.

Results

Participants with schizophrenia showed overconfidence in errors and an enhanced knowledge corruption index (i.e. rate of high-confident errors on all high-confident responses) relative to both control groups. In contrast, accuracy scores did not differ between clinical groups. Metacognitive parameters were correlated with self-rated levels of current paranoia.

Discussion

To the best of our knowledge, this is the first study to demonstrate overconfidence in errors among individuals with psychosis using a visual perception task. Speaking to the specificity of this abnormality for schizophrenia and its pathogenetic relevance, overconfidence in errors and knowledge corruption were elevated in patients with schizophrenia relative to both control groups and were correlated with paranoia.