Metacognition
Does psychosis weaken memory, confidence judgments or effort?
Open access · cc by · source: Europe PMC
People with psychosis or more psychotic-like experiences remembered shapes less precisely, but they judged their own memory accurately and put as much effort into searching as everyone else.
Study at a glance
- Design
- Cross-sectional — Study 1 correlated questionnaire-measured psychotic-like symptoms with task performance in healthy adults; Study 2 compared first-episode psychosis patients with age- and gender-matched controls on the same visual memory-and-search task and neurocognitive tests.
- N
- Study 1: 52 healthy adults. Study 2: 46 participants (23 patients with psychosis, 23 matched healthy controls). No single pooled N is reported for the main analyses.
- Population
- Norwegian healthy adults (Study 1) and patients with a first episode of psychosis recruited from the TIPS early-intervention study plus matched controls (Study 2)
- Outcome
- Error in visual short-term memory, size of a self-drawn capture area relative to that error (metacognitive calibration), search perseverance on trials with no target, latency and vigor of searching, plus Trail Making and digit-symbol test scores
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Key findings
In healthy adults, more positive psychotic-like experiences went with larger memory errors and fewer digit-symbol pairings, and patients were slower on both Trail Making tests and had larger memory errors than controls. Confidence was well calibrated in everyone: the capture area matched actual memory error regardless of symptoms or diagnosis. Both patients and controls searched beyond their own capture area and searched less when success was less likely, with no group difference in perseverance, search cost, latency or vigor. In healthy adults only, people reporting more symptoms gave up search somewhat sooner.
Methodology
Participants played a computer game in which they memorised a shape, picked its location on a ring of 30 similar shapes, drew an area around their choice big enough to be sure it contained the target (an implicit confidence judgment), and then clicked to search for a nut that a squirrel sometimes secretly stole. In Study 1, 52 healthy adults also filled in a questionnaire on psychotic-like, negative and depressive experiences. In Study 2, 23 patients with psychosis and 23 matched controls did the same task, with patients' symptoms rated by interview. Everyone also completed Trail Making and digit-symbol tests of processing speed and flexibility.
Limitations
Both samples were small, and the authors say they lacked power to detect subtle motivational differences or subgroups of patients with low motivation. Symptoms were measured with a self-report questionnaire in Study 1 but a clinical interview in Study 2, so the two studies cannot be compared directly. Patients came from an early-intervention programme and may have had relatively mild negative symptoms, which could explain why effort looked normal. The available text omits the introduction and the first stage of the task and the Study 1 recruitment details, and the design is correlational, so it cannot show that symptoms cause the memory deficits.
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