Skip to main content Accessibility help
×
Home

Impaired verbal self-monitoring in individuals at high risk of psychosis

  • L. C. Johns (a1), P. Allen (a1), I. Valli (a1), T. Winton-Brown (a1), M. Broome (a1), J. Woolley (a1), P. Tabraham (a1), F. Day (a1), O. Howes (a1), T. Wykes (a1) and P. McGuire (a1)...

Abstract

Background

Cognitive models suggest that auditory verbal hallucinations arise through defective self-monitoring and the external attribution of inner speech. We used a paradigm that engages verbal self-monitoring (VSM) to examine whether this process is impaired in people experiencing prodromal symptoms, who have a very high risk of developing psychosis.

Method

We tested 31 individuals with an At-Risk Mental State (ARMS) and 31 healthy volunteers. Participants read single adjectives aloud while the source and pitch of the online auditory verbal feedback was manipulated, then immediately identified the source of the speech they heard (Self/Other/Unsure). Response choice and reaction time were recorded.

Results

When reading aloud with distorted feedback of their own voice, ARMS participants made more errors than controls (misidentifications and unsure responses). ARMS participants misidentified the source of their speech as ‘Other’ when the level of acoustic distortion was severe, and misidentification errors were inversely related to reaction times.

Conclusions

Impaired VSM is evident in people with an ARMS, although the deficit seems to be less marked than in patients with schizophrenia. Follow-up of these participants may clarify the extent to which the severity of this impairment predicts the subsequent onset of psychosis and development of positive symptoms.

Copyright

Corresponding author

*Address for correspondence: Dr L. C. Johns, Department of Psychology, PO77, Institute of Psychiatry, De Crespigny Park, LondonSE5 8AF, UK. (Email: louise.johns@kcl.ac.uk)

References

Hide All
Allen, P, Freeman, D, Johns, L, McGuire, P (2006). Misattribution of self-generated speech in relation to hallucinatory proneness and delusional ideation in healthy volunteers. Schizophrenia Research 84, 281288.
Allen, P, Freeman, D, McGuire, P, Garety, P, Kuipers, E, Fowler, D, Bebbington, P, Green, C, Dunn, G, Ray, K (2005). The prediction of hallucinatory predisposition in non-clinical individuals: examining the contribution of emotion and reasoning. British Journal of Clinical Psychology 44, 127132.
Allen, P, Johns, LC, Fu, CHY, Broome, MR, McGuire, PK, Vythelingum, GN (2004). Misattribution of external speech in patients with delusions and hallucinations. Schizophrenia Research 69, 277287.
Bentall, RP (1990). The illusion of reality: a review and integration of psychological research on hallucinations. Psychological Bulletin 107, 8285.
Broome, MR, Johns, LC, Valli, I, Woolley, JB, Tabraham, P, Brett, C, Valmaggia, L, Peters, E, Garety, PA, McGuire, PK (2007). Delusion formation and reasoning biases in those at clinical high risk for psychosis. British Journal of Psychiatry 191, s38s42.
Broome, MR, Woolley, JB, Johns, LC, Valmaggia, LR, Tabraham, P, Gafoor, R, Bramon, E, McGuire, PK (2005). Outreach and Support in South London (OASIS): clinical audit of a service for people at high risk of psychosis. European Psychiatry 20, 372378.
Cahill, C, Silbersweig, D, Frith, C (1996). Psychotic experiences induced in deluded patients using distorted auditory feedback. Cognitive Neuropsychiatry 1, 201211.
Ellett, L, Freeman, D, Garety, PA (2008). The psychological effect of an urban environment on individuals with persecutory delusions: the Camberwell walk study. Schizophrenia Research 99, 7784.
Farrer, C, Franck, N (2007). Self-monitoring in schizophrenia. Current Psychiatry Reviews 3, 19.
Faul, F, Erdfelder, E, Lang, A-G, Buchner, A (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behaviour Research Methods 39, 175191.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). American Psychiatric Press: Washington, DC.
Freeman, D (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychology Review 27, 425457.
Freeman, D, Garety, PA (2003). Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy 41, 923947.
Frith, CD (1987). The positive and negative symptoms of schizophrenia reflect impairments in the perception and initiation of action. Psychological Medicine 17, 631648.
Frith, CD (1996). The role of the prefrontal cortex in self-consciousness: the case of auditory hallucinations. Philosophical Transactions of the Royal Society of London B 351, 15051512.
Garety, PA, Bebbington, P, Fowler, D, Freeman, D, Kuipers, E (2007). Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychological Medicine 37, 13771391.
Garety, PA, Freeman, D, Jolley, S, Dunn, G, Bebbington, PE, Fowler, DG, Kuipers, E, Dudley, R (2005). Reasoning, emotions, and delusional conviction in psychosis. Journal of Abnormal Psychology 114, 373384.
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.
Howell, DC (1992). Statistical Methods for Psychology, 3rd edn. Duxbury Press: Belmont, CA.
Johns, LC, Allen, P, Broome, M, Woolley, J, Vythelingum, N, Wykes, T, McGuire, PK (2005). Verbal self-monitoring in people at high risk of psychosis. Schizophrenia Bulletin 31, 360361.
Johns, LC, Gregg, L, Allen, P, McGuire, PK (2006). Impaired verbal self-monitoring in psychosis: effects of state, trait and diagnosis. Psychological Medicine 36, 465474.
Johns, LC, Rossell, S, Frith, C, Ahmad, F, Hemsley, D, Kuipers, E, McGuire, PK (2001). Verbal self-monitoring and auditory verbal hallucinations in schizophrenia. Psychological Medicine 31, 705715.
Johns, LC, van Os, J (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review 21, 11251141.
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Keefe, RSE, Arnold, MC, Bayen, UJ, Harvey, PD (1999). Source monitoring deficits in patients with schizophrenia; a multinomial modelling analysis. Psychological Medicine 29, 903914.
Krabbendam, L, Myin-Germeys, I, Hanssen, M, de Graaf, R, Vollebergh, W, Bak, M, van Os, J (2005). Development of depressed mood predicts onset of psychotic disorder in individuals who report hallucinatory experiences. British Journal of Clinical Psychology 44, 113125.
Lappin, JM, Morgan, KD, Valmaggia, LR, Broome, MR, Woolley, JB, Johns, LC, Tabraham, P, Bramon, E, McGuire, PK (2007). Insight in individuals with an At Risk Mental State. Schizophrenia Research 90, 238244.
Linney, YM, Peters, ER, Ayton, P (1998). Reasoning biases in delusion-prone individuals. British Journal of Clinical Psychology 37, 285302.
McGorry, PD, Yung, AR, Phillips, LJ, Yuen, HP, Francey, S, Cosgrave, E, Germano, D, Bravin, J, McDonald, T, Blair, A, Adlard, S, Jackson, H (2002). Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Archives of General Psychiatry 59, 921928.
Morrison, AP, French, P, Walford, L, Lewis, SW, Kilcommons, A, Green, J, Parker, S, Bentall, RP (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. British Journal of Psychiatry 185, 291297.
Nelson, HE, Willison, J (1991). National Adult Reading Test (NART), Manual, 2nd edn. NFER-Nelson: Windsor, UK.
Phillips, LJ, Yung, AR, McGorry, PD (2000). Identification of young people at risk of psychosis: validation of Personal Assessment and Crisis Evaluation Clinic intake criteria. Australian and New Zealand Journal of Psychiatry 34, s164s169.
Pukrop, R, Ruhrmann, S, Schultze-Lutter, F, Bechdolf, A, Brockhaus-Dumke, A, Klosterkotter, J (2007). Neurocognitive indicators for a conversion to psychosis: comparison of patients in a potentially initial prodromal state who did or did not convert to a psychosis. Schizophrenia Research 92, 116125.
Schultze-Lutter, F, Ruhrmann, S, Picker, H, Graf Von Reventlow, H, Daumann, B, Brockhaus-Dumke, A, Klosterkötter, J, Pukrop, R (2007). Relationship between subjective and objective cognitive function in the early and late prodrome. British Journal of Psychiatry 191, s43s51.
Schutte, NS, Malouff, JM (1995). Sourcebook of Adult Assessment Strategies. Plenum Press: New York.
Slade, PD, Bentall, RP (1988). Sensory Deception: Towards a Scientific Analysis of Hallucinations. Croom Helm: London.
Van Dael, F, Versmissen, D, Janssen, I, Myin-Germeys, I, van Os, J, Krabbendam, L (2006). Data gathering: biased in psychosis? Schizophrenia Bulletin 32, 341351.
van Os, J, Hanssen, M, Bijl, RV, Ravelli, A (2000). Strauss (1969) revisited: a psychosis continuum in the general population? Schizophrenia Research 45, 1120.
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39, 179195.
Versmissen, D, Janssen, I, Johns, L, McGuire, P, Drukker, M, a Campo, J, Myin-Germeys, I, van Os, J, Krabbendam, L (2007 a). Verbal self-monitoring in psychosis: a non-replication. Psychological Medicine 37, 569576.
Versmissen, D, Myin-Germeys, I, Janssen, I, Franck, N, Georgieff, N, a Campo, J, Mengelers, R, van Os, J, Krabbendam, L (2007 b). Impairment of self-monitoring: part of the endophenotypic risk for psychosis. British Journal of Psychiatry 191, s58s62.
Wiles, NJ, Zammit, S, Bebbington, P, Singleton, N, Meltzer, H, Lewis, G (2006). Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey. British Journal of Psychiatry 188, 519526.
Yung, AR, Phillips, LJ, McGorry, PD, McFarlane, CA, Francey, S, Harrigan, S, Patton, GC, Jackson, HJ (1998). Prediction of psychosis: a step towards indicated prevention of schizophrenia. British Journal of Psychiatry (Suppl.) 172, 1420.
Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M, McGorry, PD (2003). Psychosis prediction: 12-month follow up of a high risk (‘prodromal’) group. Schizophrenia Research 60, 2132.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed