Delusions and metacognition in patients with schizophrenia.
BACKGROUND
The aim of the present study was to explore the basis of the strong feeling of conviction and the high resistance to change characteristic of delusions and to test whether patients with schizophrenia suffering from delusions have specific metacognitive impairments when compared to both patients without delusions and healthy controls.


METHODS
14 actively delusional patients with schizophrenia, 14 nondelusional patients, and 14 healthy subjects were administered two measures assessing different aspects of metacognition: an emotional metacognitive version of the WCST adapted from Koren et al. (2004) and the Beck Cognitive Insight Scale.


RESULTS
Relative to both healthy controls and nondelusional patients, delusional participants were specifically impaired on metacognitive measures of free choice improvement and global monitoring. This was correlated with high self-certainty on the BCIS relative to nondelusional patients.


CONCLUSIONS
Our results suggest that metacognitive impairments play an important role in the maintenance of delusional beliefs. It may therefore be important to adapt remediation strategies to the metacognitive profiles of patients.
Institut Jean-Nicod (CNRS and Ecole Normale Supérieure), Paris, France. nicolas.bruno@sat
Nicolas
N
Bruno
Nadia
N
Sachs
Caroline
C
Demily
Nicolas
N
Franck
Elisabeth
E
Pacherie
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002755:Choice Behavior; D003071:Cognition / Q000502:physiology*; D003702:Delusions / Q000209:etiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004522:Educational Status; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000502:physiology; D012565:Schizophrenic Psychology
D014150:Antipsychotic Agents