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Smith AJ, Bisby JA, Dercon Q, Bevan A, Kigar SL, Lynall ME, Dalgleish T, Hitchcock C, Nord CL. Hot metacognition: poorer metacognitive efficiency following acute but not traumatic stress. Transl Psychiatry 2024; 14:133. [PMID: 38438352 PMCID: PMC10912213 DOI: 10.1038/s41398-024-02840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
Aberrations to metacognition-the ability to reflect on and evaluate self-performance-are a feature of poor mental health. Theoretical models of post-traumatic stress disorder propose that following severe stress or trauma, maladaptive metacognitive evaluations and appraisals of the event drive the development of symptoms. Empirical research is required in order to reveal whether disruptions to metacognition cause or contribute to symptom development in line with theoretical accounts, or are simply a consequence of ongoing psychopathology. In two experiments, using hierarchical Bayesian modelling of metacognition measured in a memory recognition task, we assessed whether distortions to metacognition occur at a state-level after an acute stress induction, and/or at a trait-level in a sample of individuals experiencing intrusive memories following traumatic stress. Results from experiment 1, an in-person laboratory-based experiment, demonstrated that heightened psychological responses to the stress induction were associated with poorer metacognitive efficiency, despite there being no overall change in metacognitive efficiency from pre- to post-stress (N = 27). Conversely, in experiment 2, an online experiment using the same metamemory task, we did not find evidence of metacognitive alterations in a transdiagnostic sample of patients with intrusive memory symptomatology following traumatic stress (N = 36, compared to 44 matched controls). Our results indicate a relationship between state-level psychological responses to stress and metacognitive alterations. The lack of evidence for pre- to post-stress differences in metamemory illustrates the importance for future studies to reveal the direction of this relationship, and consequently the duration of stress-associated metacognitive impairments and their impact on mental health.
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Affiliation(s)
- Alicia J Smith
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - James A Bisby
- Division of Psychiatry, University College London, London, UK
| | - Quentin Dercon
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Division of Psychiatry, University College London, London, UK
| | - Anna Bevan
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Stacey L Kigar
- Department of Psychiatry, Herchel Smith Building of Brain & Mind Sciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
- Department of Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Mary-Ellen Lynall
- Department of Psychiatry, Herchel Smith Building of Brain & Mind Sciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Caitlin Hitchcock
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Camilla L Nord
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Psychiatry, Herchel Smith Building of Brain & Mind Sciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
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Fox CA, Lee CT, Hanlon AK, Seow TXF, Lynch K, Harty S, Richards D, Palacios J, O'Keane V, Stephan KE, Gillan CM. An observational treatment study of metacognition in anxious-depression. eLife 2023; 12:RP87193. [PMID: 37818942 PMCID: PMC10567110 DOI: 10.7554/elife.87193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Prior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulnerability, or if it resolves when anxious-depression improves. Data were collected as part of a large-scale transdiagnostic, four-week observational study of individuals initiating internet-based cognitive behavioural therapy (iCBT) or antidepressant medication. Self-reported clinical questionnaires and perceptual task performance were gathered to assess anxious-depression and metacognitive bias at baseline and 4-week follow-up. Primary analyses were conducted for individuals who received iCBT (n=649), with comparisons between smaller samples that received antidepressant medication (n=82) and a control group receiving no intervention (n=88). Prior to receiving treatment, anxious-depression severity was associated with under-confidence in performance in the iCBT arm, replicating previous work. From baseline to follow-up, levels of anxious-depression were significantly reduced, and this was accompanied by a significant increase in metacognitive confidence in the iCBT arm (β=0.17, SE=0.02, p<0.001). These changes were correlated (r(647)=-0.12, p=0.002); those with the greatest reductions in anxious-depression levels had the largest increase in confidence. While the three-way interaction effect of group and time on confidence was not significant (F(2, 1632)=0.60, p=0.550), confidence increased in the antidepressant group (β=0.31, SE = 0.08, p<0.001), but not among controls (β=0.11, SE = 0.07, p=0.103). Metacognitive biases in anxious-depression are state-dependent; when symptoms improve with treatment, so does confidence in performance. Our results suggest this is not specific to the type of intervention.
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Affiliation(s)
- Celine Ann Fox
- School of Psychology, Trinity College DublinDublinIreland
- Trinity College Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Chi Tak Lee
- School of Psychology, Trinity College DublinDublinIreland
- Trinity College Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Anna Kathleen Hanlon
- School of Psychology, Trinity College DublinDublinIreland
- Trinity College Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Tricia XF Seow
- Wellcome Centre for Human Neuroimaging, University College LondonLondonUnited Kingdom
| | - Kevin Lynch
- School of Psychology, Trinity College DublinDublinIreland
| | - Siobhán Harty
- SilverCloud Science, SilverCloud Health LtdDublinIreland
| | - Derek Richards
- School of Psychology, Trinity College DublinDublinIreland
- SilverCloud Science, SilverCloud Health LtdDublinIreland
| | - Jorge Palacios
- School of Psychology, Trinity College DublinDublinIreland
- SilverCloud Science, SilverCloud Health LtdDublinIreland
| | - Veronica O'Keane
- Department of Psychiatry, Trinity College DublinDublinIreland
- Tallaght Hospital, Trinity Centre for Health Sciences, Tallaght University HospitalDublinIreland
| | - Klaas Enno Stephan
- Translational Neuroimaging Unit (TNU), Institute for Biomedical Engineering, University of ZurichZurichSwitzerland
- Max Planck Institute for Metabolism ResearchCologneGermany
| | - Claire M Gillan
- School of Psychology, Trinity College DublinDublinIreland
- Trinity College Institute of Neuroscience, Trinity College DublinDublinIreland
- Global Brain Health Institute, Trinity College DublinDublinIreland
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Associations between acceptance of the implausible bias, theory of mind and delusions in first-episode psychosis patients; A longitudinal study. Schizophr Res 2023; 254:27-34. [PMID: 36774695 DOI: 10.1016/j.schres.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 10/14/2022] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
Multiple different cognitive biases, among them the liberal acceptance (LA) bias, have been suggested to contribute to reality distortion in psychotic disorders. Earlier studies have been cross-sectional and considered a limited set of cognitive correlates of psychosis, thus the relationship between LA bias and psychosis remains poorly known. We studied a similar bias (acceptance of the implausible (AOI)) in 62 first-episode psychosis (FEP) patients and 62 control subjects, who watched movie scenes with varying degrees of realism and were asked to evaluate the probability of these events occurring in real life. We assessed theory of mind (ToM) performance using the Hinting task and delusion severity using Brief Psychiatric Rating Scale item 11. We correlated the magnitude of AOI with the severity of delusions and performance in the ToM task. Furthermore, we used 1-year follow-up data from 40 FEP patients and 40 control subjects to disentangle state vs trait-like characteristics of AOI. At baseline FEP patients expressed more AOI than control subjects, and the magnitude of AOI correlated positively with the severity of delusions and negatively with ToM performance. At the one-year follow-up, when most patients were in remission, patients still displayed increased AOI, which no longer correlated with delusions. These findings support the notion that the AOI bias could represent a trait rather than a state feature and support further studies to test the hypothesis that it could be one of the causal factors of psychotic disorders, possibly associated with ToM.
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Hohendorf M, Bauer M. Metacognitive sensitivity and symptoms of mental disorder: A systematic review and meta-analysis. Front Psychol 2023; 14:991339. [PMID: 36818089 PMCID: PMC9932734 DOI: 10.3389/fpsyg.2023.991339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Metacognition is a term used to refer to cognition about cognitive processes. In this systematic review and meta-analysis, we reviewed studies that investigated the relationship between experimentally measured objective metacognitive sensitivity and diverse symptoms of mental disorder. In these studies, metacognitive sensitivity is operationalized as the correspondence between the accuracy of task performance and reported confidence therein. Methods A literature search was conducted across four databases and studies were selected for review based on predefined eligibility criteria. Twenty studies were included in the review and separate meta-analyses were conducted for psychotic and non-psychotic categories of psychiatric symptoms. Results A significant reduction (medium effect size) in metacognitive sensitivity was found in individuals with psychosis-related symptoms of mental disorder compared to healthy control groups, but no significant difference was found for individuals with non-psychotic symptoms. It should be noted though, that fewer studies were available for the latter group. Sub-group analysis found no evidence that the effect of metacognitive impairment depended on whether perceptual or non-perceptual experimental tasks were employed. Discussion These findings are discussed in relation to other conceptualizations of metacognition and the role reduced metacognitive sensitivity may play in forms of mental disorder.
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Affiliation(s)
- Marianne Hohendorf
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Markus Bauer
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
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Koller WN, Cannon TD. Aberrant memory and delusional ideation: A pernicious partnership? Clin Psychol Rev 2023; 99:102231. [PMID: 36469975 DOI: 10.1016/j.cpr.2022.102231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/02/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Delusions can be conceptualized as beliefs that are both at odds with consensus reality and espoused with high conviction. While delusions represent a cardinal symptom of schizophrenia, delusion-like beliefs can be found in the general population. Do similar cognitive mechanisms support delusionality across this spectrum? If so, what are they? Here, we examine evidence for a mechanistic role of the (associative) memory system in the formation and maintenance of delusions and delusion-like beliefs. While general neurocognitive metrics do not tend to associate with delusionality, our scoping review of the clinical and subclinical literature reveals several subdomains of memory function that do. These include a propensity to commit errors of commission (i.e., false alarms and intrusions), source memory biases, and metamemory impairment. We discuss how several of these effects may stem from aberrant associative memory function and offer recommendations for future research. Further, we propose a state/trait interaction model in which underlying traits (i.e., impaired associative and metamemory function) may become coupled with delusionality during states of acute psychosis, when memory function is particularly challenged by aberrant salience attribution and noisy perceptual input. According to this model, delusions may arise as explanations to high-salience (but low-source) mnemonic content that is endorsed with high confidence.
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Affiliation(s)
- William N Koller
- Department of Psychology, Yale University, Hillhouse Avenue, New Haven, CT 06520-8205, United States of America.
| | - Tyrone D Cannon
- Department of Psychology, Yale University, Hillhouse Avenue, New Haven, CT 06520-8205, United States of America
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Georgiou N, Delfabbro P, Balzan R. Autistic traits as a potential confounding factor in the relationship between schizotypy and conspiracy beliefs. Cogn Neuropsychiatry 2021; 26:273-292. [PMID: 33970807 DOI: 10.1080/13546805.2021.1924650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Conspiracy Theories (CT) are complex belief systems that view the world as being manipulated by multiple actors collaborating in the pursuit of malevolent goals. Although culture, education and sociological factors have been implicated in their development, psychological factors are recognized as important. Certain individual differences, including schizotypy and cognitive processing style, have been shown to make some individuals susceptible to CTs. However, the finding that schizotypy often co-occurs with autism spectrum disorder raises a question as to the relative and potentially confounding role of autistic traits in increasing vulnerability to CT beliefs. METHOD A total of 508 adults were recruited from an international online panel. The study included measures of conspiracy beliefs, schizotypy and autistic traits as well as measures of information searching and cognitive style. RESULTS The results confirmed that both autistic and schizotypy traits were positively associated with CT beliefs, but that schizotypy traits were the strongest predictor. Exploratory analyses of cognitive style measures indicated potential avenues for further investigation in relation in differences in cognitive processes that might underlie the development of CTs for in people with autistic traits as opposed to schizotypal traits. LIMITATIONS The study was based on a self-report methodology and did not utilise a clinical sample. CONCLUSION Both schizotypal and autistic traits are reliable predictors of conspiracy beliefs, but schizotypy appears to be the stronger predictor and that autistic traits are not a strong confounding factor in this relationship. However, autistic traits may pose an additional risk factor for CT beliefs.
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Affiliation(s)
- Neophytos Georgiou
- Faculty of Health and Medical Science, School of Psychology, University of Adelaide
| | - Paul Delfabbro
- Faculty of Health and Medical Science, School of Psychology, University of Adelaide
| | - Ryan Balzan
- College of Education, Psychology and Social Work, Flinders University
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Lajoie MP, Gilbert E, Rouleau N. Effect of non-pharmacological interventions on source memory processes in the early course of psychosis: A systematic review. Early Interv Psychiatry 2021; 15:219-233. [PMID: 32141226 DOI: 10.1111/eip.12951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/20/2019] [Accepted: 01/27/2020] [Indexed: 12/29/2022]
Abstract
UNLABELLED People with a psychotic disorder suffer from major cognitive impairments which prevent their functional recovery. Source memory impairments have been shown to be associated with psychotic symptoms and even to precede their onset. Source memory has thus been hypothesized as a cognitive precursor of psychosis. However, few interventions targeting source memory are included in current therapeutic approaches for early psychosis. AIM This systematic review aimed to identify non-pharmacological interventions for early psychosis which have impacted source memory processes. METHODS Studies were selected from nine databases when they included: (a) a non-pharmacological intervention involving a sample of patients with early-onset psychotic disorder or subclinical psychotic symptoms; and (b) effects on source memory processes, measured directly or inferred through an episodic memory task. RESULTS Thirteen studies were identified, including two cognitive remediation programs and one repetitive transcranial magnetic stimulation treatment that reported beneficial effects on source memory. CONCLUSIONS Relevant intervention strategies for source memory impairments were identified. This review points up a need to further develop interventions targeting theoretically defined source memory concepts and assess their effects with specific and valid tasks. Recommendations regarding underlying mechanisms which could have a beneficial impact on source memory may provide guidance for the future development of early psychosis interventions.
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Affiliation(s)
- Marie-Pier Lajoie
- MANDALAB (Mindfulness AND Attention LAB), CERVO Brain Research Center, Quebec, Canada.,School of Psychology, Laval University, Quebec, Canada
| | - Elsa Gilbert
- Health Sciences Department, University of Quebec in Rimouski, Quebec, Canada
| | - Nancie Rouleau
- MANDALAB (Mindfulness AND Attention LAB), CERVO Brain Research Center, Quebec, Canada.,School of Psychology, Laval University, Quebec, Canada
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Rouy M, Saliou P, Nalborczyk L, Pereira M, Roux P, Faivre N. Systematic review and meta-analysis of metacognitive abilities in individuals with schizophrenia spectrum disorders. Neurosci Biobehav Rev 2021; 126:329-337. [PMID: 33757817 DOI: 10.1016/j.neubiorev.2021.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
Metacognitive deficits are well documented in schizophrenia spectrum disorders as a decreased capacity to adjust confidence to performance in a cognitive task. Because metacognitive ability directly depends on task performance, metacognitive deficits might be driven by lower task performance among patients. To test this hypothesis, we conducted a Bayesian meta-analysis of 42 studies comparing metacognitive abilities in 1425 individuals with schizophrenia compared to 1256 matched controls. We found a global metacognitive deficit in schizophrenia (g = -0.57, 95 % CrI [-0.72, -0.43]), which was driven by studies which did not control task performance (g = -0.63, 95 % CrI [-0.78, -0.49]), and inconclusive among controlled-studies (g = -0.23, 95 % CrI [-0.60, 0.16], BF01 = 2.2). No correlation was found between metacognitive deficit and clinical features. We provide evidence that the metacognitive deficit in schizophrenia is inflated due to non-equated task performance. Thus, efforts should be made to develop experimental protocols accounting for lower task performance in schizophrenia.
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Affiliation(s)
- Martin Rouy
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France.
| | - Pauline Saliou
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France
| | - Ladislas Nalborczyk
- Univ. Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, 38000, Grenoble, France
| | - Michael Pereira
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France
| | - Paul Roux
- Service universitaire de psychiatrie d'adulte et d'addictologie du Centre Hospitalier de Versailles, CESP, Equipe DisAP-DevPsy, INSERM, Université Paris-Saclay et Université de Versailles Saint-Quentin-En-Yvelines, France
| | - Nathan Faivre
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France
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Baumgartner J, Litvan Z, Koch M, Hinterbuchinger B, Friedrich F, Baumann L, Mossaheb N. Metacognitive beliefs in individuals at risk for psychosis: a systematic review and meta-analysis of sex differences. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2020; 34:108-115. [PMID: 32338344 PMCID: PMC7467958 DOI: 10.1007/s40211-020-00348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/30/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sex differences were found in several domains in individuals at ultra-high risk for psychosis, but no previous work has systematically reviewed and analysed possible sex differences in metacognition in this population. However, alterations in metacognitive beliefs have been shown in the at-risk mental state for psychosis population. Our aim was to qualitatively review and quantitatively analyse the existing literature for data on sex differences in metacognitive beliefs-mainly depicted by the Metacognitions Questionnaire (MCQ) and its short form (MCQ-30)-in individuals with at-risk mental states. METHODS We performed a systematic review of the literature on metacognition in help-seeking adolescents and young adults at ultra-high risk for psychosis. We included peer-reviewed articles that included a high-risk for psychosis group assessed with operationalised criteria and instruments. For the quantitative meta-analysis, only studies comparing MCQ data in high-risk individuals were included. A fixed-effect meta-model was used and forest plots drawn for each subscale and overall score. The studies were weighted according to the inverse variance method in order to calculate pooled confidence intervals and p values. RESULTS No article on metacognitive beliefs in individuals at increased risk for psychosis explicitly reported possible sex differences. Our meta-analysis of 234 (57% male) individuals' scores in the MCQ yielded no significant sex difference. CONCLUSIONS Currently, no sex differences in metacognition can be described in the at-risk population; however, data are insufficient and heterogeneous with regard to thoroughly answering the question whether sex differences in clinical high-risk populations are mirrored in the metacognitive domain.
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Affiliation(s)
- Josef Baumgartner
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Zsuzsa Litvan
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marlene Koch
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Barbara Hinterbuchinger
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Fabian Friedrich
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lukas Baumann
- Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Institute for Medical Statistics, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Dietrichkeit M, Grzella K, Nagel M, Moritz S. Using virtual reality to explore differences in memory biases and cognitive insight in people with psychosis and healthy controls. Psychiatry Res 2020; 285:112787. [PMID: 32058878 DOI: 10.1016/j.psychres.2020.112787] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/11/2020] [Accepted: 01/12/2020] [Indexed: 01/31/2023]
Abstract
Memory biases (e.g. overconfidence in false memories) are implicated in the pathogenesis of delusions. Virtual reality (VR) may provide an opportunity to observe such biases and improve cognitive insight in patients with psychosis via corrective feedback. Thirty-nine patients with psychosis and 20 healthy controls explored VR environments designed to elicit false memories and subsequently had to recollect items and faces. We used a randomised-controlled design where half of the sample received performance feedback on the recollection task in order to correct overconfidence. Changes in cognitive insight were measured using the Beck Cognitive Insight Scale. Regarding accuracy, patients performed worse on the social task (recollection of faces) only. Patients displayed overconfidence in false memories for emotions and gave more high-confident responses compared to healthy controls on the social task. Feedback did not improve cognitive insight. Patients rated their cognitive insight higher than healthy controls. Future research should address problems with subjective measurements for cognitive insight. To conclude, patients with psychosis showed impaired social cognition and there was evidence for impaired metacognition, as patients reported higher cognitive insight despite comparable or worse performance as well as overconfidence relative to controls.
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Affiliation(s)
- Mona Dietrichkeit
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany
| | - Karsten Grzella
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany; Clinic of Psychiatry and Psychotherapy, University Luebeck, Luebeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Impaired action self-monitoring and cognitive confidence among ultra-high risk for psychosis and first-episode psychosis patients. Eur Psychiatry 2020; 47:67-75. [DOI: 10.1016/j.eurpsy.2017.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/29/2017] [Accepted: 09/07/2017] [Indexed: 01/06/2023] Open
Abstract
AbstractBackgroundSelf-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.MethodsThirty-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.ResultsThe 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).ConclusionsA 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.
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Hoven M, Lebreton M, Engelmann JB, Denys D, Luigjes J, van Holst RJ. Abnormalities of confidence in psychiatry: an overview and future perspectives. Transl Psychiatry 2019; 9:268. [PMID: 31636252 PMCID: PMC6803712 DOI: 10.1038/s41398-019-0602-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/03/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Monja Hoven
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Maël Lebreton
- 0000 0001 2322 4988grid.8591.5Swiss Center for Affective Science (CISA), University of Geneva (UNIGE), Geneva, Switzerland ,0000 0001 2322 4988grid.8591.5Neurology and Imaging of Cognition (LabNIC), Department of Basic Neurosciences, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jan B. Engelmann
- 0000000084992262grid.7177.6CREED, Amsterdam School of Economics (ASE), University of Amsterdam, Amsterdam, The Netherlands ,0000000084992262grid.7177.6Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, The Netherlands ,0000 0001 2353 4804grid.438706.eThe Tinbergen Institute, Amsterdam, The Netherlands
| | - Damiaan Denys
- 0000000084992262grid.7177.6Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands ,0000 0001 2171 8263grid.419918.cNeuromodulation & Behavior, Netherlands Institute for Neuroscience, KNAW, Amsterdam, The Netherlands
| | - Judy Luigjes
- 0000000084992262grid.7177.6Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruth J. van Holst
- 0000000084992262grid.7177.6Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Koren D, Scheyer R, Stern Y, Adres M, Reznik N, Apter A, Seidman LJ. Metacognition strengthens the association between neurocognition and attenuated psychosis syndrome: Preliminary evidence from a pilot study among treatment-seeking versus healthy adolescents. Schizophr Res 2019; 210:207-214. [PMID: 30630704 DOI: 10.1016/j.schres.2018.12.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In a pilot study, we assessed the potential value of deficits at the metacognitive versus the neurocognitive level of functioning for identifying adolescents with attenuated psychotic syndrome (APS). METHOD Twenty-two treatment-seeking adolescents with APS, 42 treatment-seeking comparisons, and 34 age-matched healthy comparisons were evaluated using the Prodromal Questionnaire, the Structured Interview for Prodromal Syndromes, and the Mood and Anxiety Symptom Questionnaire. Neurocognitive and metacognitive functioning were assessed in two non-social (verbal memory and executive functioning) and two social (facial emotion perception and theory of mind) cognitive domains. In addition to the standard neurocognitive administration of the tasks, subjects were asked to rate their confidence level on each answer and to choose whether they wanted it "counted" toward their overall task performance score on the task. Choices were rewarded. RESULTS As hypothesized, APS among treatment-seeking adolescents was more strongly associated with impaired neurocognition than with impaired metacognition. Likewise, as hypothesized, impaired metacognition was shown to significantly improve the APS prediction beyond the contribution of impaired neurocognition alone, even after controlling for general intellectual ability, negative symptoms, social functioning, and depression. CONCLUSIONS These results suggest that metacognitive monitoring and control play a strengthening role in the association between neurocognition and APS. One possible explanation is that metacognition serves as an indicator of insight into the condition, accounting for differences in insight not explained by neurocognition alone. However, further research with larger samples that include non-treatment seeking individuals, established measures of insight, and follow-up data is required to assess this possibility.
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Affiliation(s)
- Danny Koren
- Psychology Department, University of Haifa, Haifa, Israel; Psychiatry Division, Rambam Medical Center, Haifa, Israel.
| | - Ravit Scheyer
- Psychology Department, University of Haifa, Haifa, Israel
| | - Yonatan Stern
- Psychology Department, University of Haifa, Haifa, Israel
| | - Merav Adres
- Psychology Department, University of Haifa, Haifa, Israel
| | - Noa Reznik
- Psychology Department, University of Haifa, Haifa, Israel
| | - Alan Apter
- Psychological Medicine Clinic, Schneider Children's Medical Center, Petach Tiqva, Israel
| | - Larry J Seidman
- The Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, United States of America
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Urbańska D, Moritz S, Gawęda Ł. The impact of social and sensory stress on cognitive biases and delusions in schizophrenia. Cogn Neuropsychiatry 2019; 24:217-232. [PMID: 31043127 DOI: 10.1080/13546805.2019.1611551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Stress aggravates delusional symptoms, but the exact underlying mechanisms are still not fully understood. One of the routes may be via exacerbation of information processing distortions frequently observed in psychosis. The aim of the present study was thus to investigate the impact of social and sensory stress on specific cognitive processes along with different dimensions of delusional thinking. METHODS Nineteen individuals affected by schizophrenia and 15 healthy controls were assessed under 3 experimental conditions (social stress, neutral, noise stress), with counter-balanced presentation of stress conditions across participants of both groups. Under each condition participants performed parallel versions of experimental tasks and had to report their level of paranoid thinking and subjective distress. RESULTS Irrespective of condition, patients showed significant impairments in metacognitive accuracy compared with controls. When social stress was applied first, mentalising accuracy decreased significantly in the subsequent condition among patients only. Following exposure to either social or sensory stress, patients reported significantly higher conviction in their paranoid ideas in the subsequent condition. CONCLUSIONS Only limited evidence was found for the negative impact of stress on cognitive processes in schizophrenia patients. However, this may not be true for those with more severe information processing abnormalities and/or delusions.
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Affiliation(s)
- Dorota Urbańska
- a Faculty of Psychology , University of Warsaw , Warsaw , Poland
| | - Steffen Moritz
- b Department of Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Łukasz Gawęda
- c Psychopathology and Early Interventions Lab, II Department of Psychiatry , The Medical University of Warsaw , Warsaw , Poland
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Wright AC, Fowler D, Greenwood KE. Developing a dynamic model of anomalous experiences and function in young people with or without psychosis: a cross-sectional and longitudinal study protocol. BMJ Open 2018; 8:e022546. [PMID: 30391913 PMCID: PMC6231554 DOI: 10.1136/bmjopen-2018-022546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/06/2018] [Accepted: 09/21/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Anomalous experiences are common within the general population, but the frequency and intensity is increased in young people with psychosis. Studies have demonstrated that perceptual biases towards noticing these phenomena plays a role, but the way one thinks about one's experience (metacognition) may also be relevant. While poor metacognitive function has been theoretically associated with anomalous experiences, this relationship is currently unclear. However, metacognition may work along a continuum with various metacognitive levels, many of which have been demonstrated as impaired in psychosis. These metacognitive components may interact via processes that maintain poor metacognition across levels, and that potentially impact both what people do in their everyday lives (functional outcome) and how people feel about their everyday lives (subjective recovery outcome) in young people with psychosis compared with healthy control participants. METHODS AND ANALYSIS This study will investigate the association and contribution of metacognition to anomalous experiences and outcome measures cross-sectionally and longitudinally in a 36-month follow-up. First, young people with psychosis will be compared with healthy control participants on selected measures of anomalous experience, metacognition, and function, using analysis of covariance to identify group differences. Next, the relationship between metacognitive components and processes will be explored, including processes connecting the different components, using regression analyses. Finally, mediation analyses will be used to assess the predictive value of metacognitive measures on outcome measures, both cross-sectionally and longitudinally at 36 months, while controlling for symptoms and cognition. ETHICS AND DISSEMINATION Ethical and Health Research Authority approval has been obtained through Camberwell St. Giles Research Ethics Committee (reference number: 17/LO/0055). This research project will be reported within a PhD thesis and submitted for journal publication. Once key predictive components of poor outcome in psychosis are identified, this study will develop a series of dynamic models to understand influences on outcome for young people with psychosis.
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Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
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Monocausal Attributions Along Cross-Sections of Psychosis Development and Links with Psychopathology and Data Gathering Style. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9907-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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17
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Two case studies from a virtual reality intervention for delusions: feasibility and preliminary evidence. COGNITIVE BEHAVIOUR THERAPIST 2018. [DOI: 10.1017/s1754470x18000090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe use of virtual reality (VR) interventions for psychosis is on the rise. As information-processing biases such as overconfidence in memory are likely to be involved in the formation and maintenance of delusions, VR could also be used to correct cognitive distortions and in turn ameliorate delusions. The present study illustrates two case studies in which a VR intervention was employed to reduce delusions by means of correcting experiences. Participants navigated four virtual environments via a head-mounted display (HMD) and computer and were asked to recollect previously seen faces and objects and to rate their response confidence. The scenarios were created to elicit false memories. Immediately after each response, they received feedback to correct possible overconfidence in false memories. We present two case studies to illustrate individual differences. Both participants benefited from the intervention: delusions were reduced from pre- to post-assessment (after 3 weeks) as measured with the Positive and Negative Syndrome Scale and Psychotic Symptom Scale. This was corroborated by results on the Paranoia Checklist and the Community Assessment of Psychic Experiences collected immediately after the session. Immediate effects also showed a reduction in delusion conviction rate. The present study provides preliminary evidence that delusions may be ameliorated by a VR paradigm designed to correct memory overconfidence. Cybersickness emerged as a problem in one of the patients.
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Greenland-White SE, Ragland JD, Niendam TA, Ferrer E, Carter CS. Episodic memory functions in first episode psychosis and clinical high risk individuals. Schizophr Res 2017; 188:151-157. [PMID: 28143678 PMCID: PMC5533652 DOI: 10.1016/j.schres.2017.01.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Individuals with schizophrenia have disproportionate memory impairments when encoding relational versus item-specific information, and when using recollection versus familiarity during retrieval. It is unclear whether this pattern is unique to people with chronic schizophrenia, or if it occurs in individuals after a first episode of psychosis (FE), or when at clinical high-risk for psychosis (CHR). METHODS We administered the Relational and Item-Specific Memory task (RiSE) to 22 CHR, 101 FE, and 58 typically developing (TD) participants. We examined group differences in item and relational encoding, and familiarity-based and recollection-based retrieval using parametric analysis and structural equation modeling (SEM). Longitudinal data allowed us to examine relations between baseline RiSE performance and change in clinical symptoms at 1-year follow-up in the FE group. RESULTS Groups did not differ on familiarity. FE and CHR groups were equally impaired on overall recognition accuracy. Although recollection was impaired in both FE and CHR groups following relational encoding, only the FE group had impaired recollection following item encoding. SEM showed atypical relationships between familiarity and recollection, as well as familiarity and item recognition for both the FE and CHR groups. For FE individuals, better baseline recognition accuracy predicted less severe negative symptoms at 1-year follow-up. CONCLUSIONS Impaired relational and recollective memory may reflect neurodevelopmental abnormalities predating conversion to psychosis. These memory deficits appear related to negative symptom changes. In contrast, item specific recollection deficits appear to occur after the development of full psychosis. Familiarity appears to be a relatively preserved memory function across the psychosis spectrum.
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Affiliation(s)
| | - J. Daniel Ragland
- Corresponding Author. Center for Neuroscience, UC Davis Imaging Research Center, 4701 X Street Sacramento CA, 95817. Tel +1 916 734 5802; fax +1 916 734 8750.
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Eisenacher S, Zink M. Holding on to false beliefs: The bias against disconfirmatory evidence over the course of psychosis. J Behav Ther Exp Psychiatry 2017; 56:79-89. [PMID: 27608522 DOI: 10.1016/j.jbtep.2016.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The ability to integrate evidence into a reasoning process is crucial in order to react to changing information, e.g. to adapt one's beliefs according to new evidence or to generate new beliefs when facing better alternatives. Evidence integration ability is thus associated with belief flexibility. A specific bias of evidence integration, a bias against disconfirmatory evidence (BADE), can be found in patients with schizophrenia and has been linked to delusion development and maintenance. Knowledge about whether the BADE occurs already in risk constellations of psychosis can clarify its role in the pathogenesis of psychosis. METHODS This article reviews the current literature on BADE. Many studies demonstrate BADE over the course of illness, ranging from healthy controls with subclinical properties of schizotypy, over patients with at-risk mental states (ARMS) and patients with a first episode of psychosis to patients with chronic schizophrenia. These data allow a comparison of competences and deficits over the course of illness. Underlying mechanisms of BADE are discussed, including interrelations with neurocognitive performance and dopaminergic processes. RESULTS The BADE could be found in different phases of psychosis development and can be regarded as a cognitive marker of the beginning psychotic state. LIMITATIONS The presented findings are derived from independent cross-sectional studies. So far, no comprehensive longitudinal assessment has been published. CONCLUSIONS Treatments of metacognitive deficits in general and as early as in the ARMS might interfere with the cognitive pathogenesis of psychosis, and thereby ameliorate, postpone or even prevent the transition to psychosis.
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Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany.
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
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Eisenacher S, Zink M. The Importance of Metamemory Functioning to the Pathogenesis of Psychosis. Front Psychol 2017; 8:304. [PMID: 28321200 PMCID: PMC5337512 DOI: 10.3389/fpsyg.2017.00304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 02/17/2017] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim Mannheim, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty MannheimMannheim, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital AnsbachAnsbach, Germany
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Balzan RP, Woodward TS, Delfabbro P, Moritz S. Overconfidence across the psychosis continuum: a calibration approach. Cogn Neuropsychiatry 2016; 21:510-524. [PMID: 27710199 DOI: 10.1080/13546805.2016.1240072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Ryan P Balzan
- a School of Psychology , Flinders University , Adelaide , Australia
| | - Todd S Woodward
- b Department of Psychiatry , University of British Columbia , Vancouver , Canada
| | - Paul Delfabbro
- c School of Psychology , University of Adelaide , Adelaide , Australia
| | - Steffen Moritz
- d Department of Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Eisenacher S, Rausch F, Mier D, Fenske S, Veckenstedt R, Englisch S, Becker A, Andreou C, Moritz S, Meyer-Lindenberg A, Kirsch P, Zink M. Bias against disconfirmatory evidence in the 'at-risk mental state' and during psychosis. Psychiatry Res 2016; 238:242-250. [PMID: 27086240 DOI: 10.1016/j.psychres.2016.02.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/27/2022]
Abstract
Prior studies have confirmed a bias against disconfirmatory evidence (BADE) in schizophrenia which has been associated with delusions. However, its role in the pathogenesis of psychosis is yet unclear. The objective was to investigate BADE for the first time in subjects with an at-risk-mental-state for psychosis (ARMS), patients with a first episode of psychosis without antipsychotic treatment (FEP) and healthy controls (HC). A standard BADE test presenting written scenarios was employed. In addition, psychometric rating scales and a neuropsychological test battery were applied. A three-staged image was revealed. FEP-patients showed a significant BADE compared to the other groups. The performance of ARMS-patients lay in between HC and FEP-patients. A trend towards significance became evident for a bias against confirmatory evidence (BACE) in FEP-patients. Results were not attributable to antipsychotic or other medication or depressive symptoms. Correlations with delusions reached medium effect sizes but failed significance after Bonferroni-corrections. These results provide evidence for aberrations in evidence integration in the pathogenesis of psychosis and contribute to our knowledge of metacognitive functioning which can be used for (meta-)cognitive intervention in psychosis.
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Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany.
| | - Franziska Rausch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Sabrina Fenske
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Anna Becker
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
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Schneider BC, Brüne M, Bohn F, Veckenstedt R, Kolbeck K, Krieger E, Becker A, Drommelschmidt KA, Englisch S, Eisenacher S, Lee-Grimm SI, Nagel M, Zink M, Moritz S. Investigating the efficacy of an individualized metacognitive therapy program (MCT+) for psychosis: study protocol of a multi-center randomized controlled trial. BMC Psychiatry 2016; 16:51. [PMID: 26921116 PMCID: PMC4769526 DOI: 10.1186/s12888-016-0756-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/18/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Psychological interventions are increasingly recommended as adjunctive treatments for psychosis, but their implementation in clinical practice is still insufficient. The individualized metacognitive therapy program (MCT+; www.uke.de/mct_plus ) represents a low-threshold psychotherapeutic approach that synthesizes group metacognitive training (MCT) and cognitive behavioral therapy for psychosis, and addresses specific cognitive biases that are involved in the onset and maintenance of psychosis. It aims to "plant the seed of doubt" regarding rigid delusional convictions and to encourage patients to critically reflect, extend and change their approach to problem solving. Its second edition also puts more emphasis on affective symptoms. A recent meta-analysis of metacognitive interventions (MCT, MCT+) indicate small to moderate effects on positive symptoms and delusions, as well as high rates of acceptance. Nonetheless, no long-term studies of MCT+ involving large samples have been conducted. METHODS The goal of the present multi-center, observer-blind, parallel-group, randomized controlled trial is to compare the efficacy of MCT+ against an active control (cognitive remediation; MyBrainTraining(©)) in 328 patients with psychosis at three time points (baseline, immediately after intervention [6 weeks] and 6 months later). The primary outcome is change in psychosis symptoms over the 6-month follow-up period as assessed by the delusion subscale of the Psychotic Symptom Rating Scale. Secondary outcomes include jumping to conclusions, other positive symptoms of schizophrenia, depressive symptoms, self-esteem, quality of life, and cognitive insight. The study also seeks to elucidate mediating factors that promote versus impede symptom improvement across time. DISCUSSION This is the first multi-center randomized controlled trial to test the efficacy of individualized MCT+ in a large sample of patients with psychosis. The rationale for the trial, the design, and the strengths and limitations of the study are discussed. TRIAL REGISTRATION The trial is registered through the German Clinical Trials Register ( www.drks.de ) as DRKS00008001 . Registered 6 May 2015.
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Affiliation(s)
- Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Francesca Bohn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Katharina Kolbeck
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
| | - Eva Krieger
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
| | - Anna Becker
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Kim Alisha Drommelschmidt
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sie-In Lee-Grimm
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Berger GE, Smesny S, Schäfer MR, Milleit B, Langbein K, Hipler UC, Milleit C, Klier CM, Schlögelhofer M, Holub M, Holzer I, Berk M, McGorry PD, Sauer H, Amminger GP. Niacin Skin Sensitivity Is Increased in Adolescents at Ultra-High Risk for Psychosis. PLoS One 2016; 11:e0148429. [PMID: 26894921 PMCID: PMC4764507 DOI: 10.1371/journal.pone.0148429] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/18/2016] [Indexed: 12/14/2022] Open
Abstract
Background Most studies provide evidence that the skin flush response to nicotinic acid (niacin) stimulation is impaired in schizophrenia. However, only little is known about niacin sensitivity in the ultra-high risk (UHR) phase of psychotic disorders. Methods We compared visual ratings of niacin sensitivity between adolescents at UHR for psychosis according to the one year transition outcome (UHR-T n = 11; UHR-NT n = 55) with healthy controls (HC n = 25) and first episode schizophrenia patients (FEP n = 25) treated with atypical antipsychotics. Results Contrary to our hypothesis niacin sensitivity of the entire UHR group was not attenuated, but significantly increased compared to the HC group, whereas no difference could be found between the UHR-T and UHR-NT groups. As expected, niacin sensitivity of FEP was attenuated compared to HC group. In UHR individuals niacin sensitivity was inversely correlated with omega-6 and -9 fatty acids (FA), but positively correlated with phospholipase A2 (inPLA2) activity, a marker of membrane lipid repair/remodelling. Conclusions Increased niacin sensitivity in UHR states likely indicates an impaired balance of eicosanoids and omega-6/-9 FA at a membrane level. Our findings suggest that the emergence of psychosis is associated with an increased mobilisation of eicosanoids prior to the transition to psychosis possibly reflecting a “pro-inflammatory state”, whereas thereafter eicosanoid mobilisation seems to be attenuated. Potential treatment implications for the UHR state should be further investigated.
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Affiliation(s)
- Gregor E. Berger
- University Hospital of Child and Adolescent Psychiatry, University of Zurich, Neumünsterallee 9, 8032 Zurich, Switzerland
- Orygen Youth Health Research Centre, The University of Melbourne, Locked Bag 10, 35 Poplar Road Parkville, Victoria 3052, Melbourne, Australia
| | - Stefan Smesny
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
- * E-mail:
| | - Miriam R. Schäfer
- Orygen Youth Health Research Centre, The University of Melbourne, Locked Bag 10, 35 Poplar Road Parkville, Victoria 3052, Melbourne, Australia
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18–20, A–1090 Vienna, Austria
| | - Berko Milleit
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Kerstin Langbein
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Uta-Christina Hipler
- Department of Dermatology, University Hospital Jena, Erfurter Straße 35, D-07743 Jena, Germany
| | - Christine Milleit
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Claudia M. Klier
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18–20, A–1090 Vienna, Austria
| | - Monika Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18–20, A–1090 Vienna, Austria
| | - Magdalena Holub
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austria
| | - Ingrid Holzer
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austria
| | - Michael Berk
- Deakin University of Melbourne, School of Medicine, Barwon Health, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - Patrick D. McGorry
- Orygen Youth Health Research Centre, The University of Melbourne, Locked Bag 10, 35 Poplar Road Parkville, Victoria 3052, Melbourne, Australia
| | - Heinrich Sauer
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - G. Paul Amminger
- Orygen Youth Health Research Centre, The University of Melbourne, Locked Bag 10, 35 Poplar Road Parkville, Victoria 3052, Melbourne, Australia
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18–20, A–1090 Vienna, Austria
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Affiliation(s)
- Ryan P. Balzan
- School of Psychology, Flinders University, GPO Box 2100 Adelaide, SA 5001, Australia
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