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

  • S. Eisenacher (a1), F. Rausch (a1), F. Ainser (a1), D. Mier (a2), R. Veckenstedt (a3), F. Schirmbeck (a1) (a4), A. Lewien (a1), S. Englisch (a1), C. Andreou (a3), S. Moritz (a3), A. Meyer-Lindenberg (a1), P. Kirsch (a2) and M. Zink (a1)...



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.


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.


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.


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.


Corresponding author

* Address for correspondence: S. Eisenacher, M.Sc. (Psych.), Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim/Heidelberg University, Central Institute of Mental Health, PO Box 12 21 20, D-68072 Mannheim, Germany. (Email:


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Andreou, C, Moritz, S, Veith, K, Veckenstedt, R, Naber, D (2013). Dopaminergic modulation of probabilistic reasoning and overconfidence in errors:a double-blind study. Schizophrenia Bulletin 40, 558565.
Ashton, CH (2002). The Ashton Manual. ( Accesssed 10 February 2015.
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 (Suppl.) 51, s38s42.
Chua, EF, Schacter, DL, Sperling, RA (2009). Neural correlates of metamemory: a comparison of feeling-of-knowing and retrospective confidence judgments. Journal of Cognitive Neuroscience 21, 17511765.
Deese, J (1959). On the prediction of occurence of particular verbal intrusions in immediate recall. Journal of Experimental Psychology 58, 1722.
Eifler, S, Rausch, F, Schirmbeck, F, Veckenstedt, R, Englisch, S, Meyer-Lindenberg, A, Kirsch, P, Zink, M (2014 b). Neurocognitive capabilities modulate the integration of evidence in schizophrenia. Psychiatry Research 219, 7278.
Eifler, S, Rausch, F, Schirmbeck, F, Veckenstedt, R, Mier, D, Esslinger, C, Englisch, S, Meyer-Lindenberg, A, Kirsch, P, Zink, M (2014 a). Metamemory in schizophrenia: retrospective confidence ratings interact with neurocognitive deficits. Psychiatry Research 225, 596603.
Fine, C, Gardner, M, Craigie, J, Gold, I (2007). Hopping, skipping or jumping to conclusions? Clarifying the role of the JTC bias in delusions. Cognitive Neuropsychiatry 12, 4677.
Flavell, JH (1979). Metacognition and cognitive monitoring: a new area of cognitive developmental inquiry. American Psychologist 34, 906911.
Freeman, D (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychology Review 27, 425457.
Freeman, D, Garety, P (2014). Advances in understanding and treating persecutory delusions: a review. Social Psychiatry and Psychiatric Epidemiology 49, 11791189.
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E, McGuire, P (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220229.
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rossler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, de, HL, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkotter, J, McGuire, P, Yung, A (2013). The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107120.
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.
Gaweda, L, Moritz, S, Kokoszka, A (2012). Impaired discrimination between imagined and perfomed actions in schizophrenia. Psychiatry Research 195, 18.
Gaweda, L, Woodward, TS, Moritz, S, Kokoszka, A (2013). Impaired action self-monitoring in schizophrenia patients with auditory hallucinations. Schizophrenia Research 144, 7279.
Gilleen, J, Greenwood, K, David, AS (2014). The role of memory in awareness of memory deficits in Alzheimer's disease, schizophrenia, and brain injury. Journal of Clinical and Experimental Neuropsychology 36, 4357.
Goldstein, G, Beers, SR, Shemansky, WJ (1996). Neuropsychological differences between schizophrenic patients with heterogeneous Wisconsin Card Sorting Test performance. Schizophrenia Research 21, 1318.
Gusnard, DA, Raichle, ME, Raichle, ME (2001). Searching for a baseline: functional imaging and the resting human brain. Nature Reviews Neuroscience 2, 685694.
Häfner, H, Bechdolf, A, Klosterkoetter, J, Maurer, K (2012). Psychosen – Früherkennung und Frühintervention. Der Praxisleitfaden. Schattauer: Stuttgart, Germany.
Häfner, H, Maurer, K, Löffler, W, an der Heiden, W, Hambrecht, M, Schultze-Lutter, F (2003). Modeling the early course of schizophrenia. Schizophrenia Bulletin 29, 325340.
Heaton, R (1981). Wisconsin Card Sorting Test (WCST) . Professional Assessment Resources: Odessa, FL.
Juarez-Ramos, V, Rubio, JL, Delpero, C, Mioni, G, Stablum, F, Gomez-Milan, E (2014). Jumping to conclusions bias, BADE and feedback sensitivity in schizophrenia and schizotypy. Consciousness and Cognition 26, 133144.
Kahn, RS, Keefe, RS (2013). Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry 70, 11071112.
Kircher, TTJ., Koch, K, Stottmeister, F, Durst, V (2007). Metacognition and reflexivity in patients with schizophrenia. Psychopathology 40, 254260.
Laws, KR, Bhatt, R (2005). False memories and delusional ideation in normal healthy subjects. Personality and Individual Differences 39, 775781.
Lehrl, S (2005). Mehrfachwahl-Wortschatz-Intelligenztest MWT-B [Multiple Choice Vocabulary Test: MWT-B, 5th edn. SpittaVerlag: Balingen, Germany.
Levine, E, Jonas, H, Serper, MR (2004). Interpersonal attributional biases in hallucinatory-prone individuals. Schizophrenia Research 69, 2328.
Lou, HC, Skewes, JC, Thomsen, KRM, Overgaard, M, Lau, HC, Mouridsen, K, Roepstorff, A (2011). Dopaminergic stimulation enhances confidence and accuracy in seeing rapidly presented words. Journal of Vision 11, 16.
Mäntylä, T, Rönnlund, M, Kliegel, M (2010). Components of executive functioning in metamemory. Applied Neuropsychology 17, 289298.
McGorry, PD, Nelson, B, Amminger, GP, Bechdolf, A, Francey, SM, Berger, G, Riecher-Rossler, A, Klosterkotter, J, Ruhrmann, S, Schultze-Lutter, F, Nordentoft, M, Hickie, I, McGuire, P, Berk, M, Chen, EY, Keshavan, MS, Yung, AR (2009). Intervention in individuals at ultra-high risk for psychosis: a review and future directions. Journal of Clinical Psychiatry 70, 12061212.
Moritz, S, Gläscher, J, Sommer, T, Buechel, C, Braus, DF (2006 a). Neural correlates of memory confidence. Neuroimage 33, 11881193.
Moritz, S, Göritz, AS, Schafschetzy, M, Van Quaquebeke, N, Peters, MJ, Andreou, C (2015). Subjective competence breeds overconfidence in errors in psychosis. A hubris account of paranoia. Journal of Behavior Therapy and Experimental Psychiatry 48, 118124.
Moritz, S, Goritz, AS, Van, QN, Andreou, C, Jungclaussen, D, Peters, MJ (2014 a). Knowledge corruption for visual perception in individuals high on paranoia. Psychiatry Research 215, 700705.
Moritz, S, Kerstan, A, Veckenstedt, R, Randjbar, S, Vitzthum, F, Schmidt, C, Heise, M, Woodward, TS (2011). Further evidence for the efficacy of a metacognitive group training in schizophrenia. Behaviour Research and Therapy 49, 151157.
Moritz, S, Ramdani, N, Klass, H, Andreou, C, Jungclaussen, D, Eifler, S, Englisch, S, Schirmbeck, F, Zink, M (2014b). Overconfidence in incorrect perceptual judgments in patients with schizophrenia. Schizophrenia Research: Cognition 1, 165170.
Moritz, S, Vitzthum, F, Randjbar, S, Veckenstedt, R, Woodward, TS (2010). Detecting and defusing cognitive traps: metacognitive intervention in schizophrenia. Current Opinion in Psychiatry 23, 561569.
Moritz, S, Woodward, TS (2004). Plausibility judgement in schizophrenic patients: evidence for a liberal acceptance bias. German Journal of Psychiatry 7, 6674.
Moritz, S, Woodward, TS (2006 a). Metacognitive control over false memories: a key determinant of delusional thinking. Current Psychiatric Report 8, 184190.
Moritz, S, Woodward, TS (2006 b). The contribution of metamemory deficits to schizophrenia. Journal of Abnormal Psychology 115, 1525.
Moritz, S, Woodward, TS, Chen, E (2006 b). Investigation of metamemory dysfunctions in first-episode schizophrenia. Schizophrenia Research 81, 247252.
Moritz, S, Woodward, TS, Cuttler, C, Whitman, JC, Watson, JM (2004). False memories in schizophrenia. Neuropsychology 18, 276283.
Moritz, S, Woodward, TS, Jelinek, L, Klinge, R (2008). Memory and metamemory in schizophrenia: a liberal acceptance account of psychosis. Psychological Medicine 38, 825832.
Moritz, S, Woodward, TS, Rodriguez-Raecke, R (2006 c). Patients with schizophrenia do not produce more false memories than controls but are more confident in them. Psychological Medicine 36, 659667.
Moritz, S, Woodward, TS, Ruff, CC (2003). Source monitoring and memory confidence in schizophrenia. Psychological Medicine 33, 131139.
Moritz, S, Woodward, TS, Whitman, JC, Cuttler, C (2005). Confidence in errors as a possible basis for delusions in schizophrenia. Journal of Nervous and Mental Disease 193, 916.
Nuechterlein, KH, Green, MF, Kern, RS, Baade, LE, Barch, DM, Cohen, JD, Essock, S, Fenton, WS, Frese, FJ III, Gold, JM, Goldberg, T, Heaton, RK, Keefe, RS, Kraemer, H, Mesholam-Gately, R, Seidman, LJ, Stover, E, Weinberger, DR, Young, AS, Zalcman, S, Marder, SR (2008). The MATRICS consensus cognitive battery, part 1: test selection, reliability, and validity. American Journal of Psychiatry 165, 203213.
Orfei, MD, Spoletini, I, Banfi, G, Caltagirone, C, Spalletta, G (2010). Neuropsychological correlates of cognitive insight in schizophrenia. Psychiatry Research 178, 5156.
Peters, MJV., Hauschildt, M, Moritz, S, Jelinek, L (2013). Impact of emotionality on memory and meta-memory in schizophrenia using video sequences. Journal of Behavior Therapy and Experimental Psychiatry 44, 7783.
Rausch, F, Eifler, S, Esser, A, Esslinger, C, Schirmbeck, F, Meyer-Lindenberg, A, Zink, M (2013). The early recognition inventory ERIraos detects at risk mental states of psychosis with high sensitivity. Comprehensive Psychiatry 54, 10681076.
Rausch, F, Mier, D, Eifler, S, Esslinger, C, Schilling, C, Schirmbeck, F, Englisch, S, Meyer-Lindenberg, A, Kirsch, P, Zink, M (2014). Reduced activation in ventral striatum and ventral tegmental area during probabilistic decision-making in schizophrenia. Schizophrenia Research 156, 143149.
Rausch, F, Mier, D, Eifler, S, Fenske, S, Schilling, C, Schirmbeck, F, Meyer-Lindenberg, A, Kirsch, P, Zink, M (2015). Reduced activation in ventral striatum during probabilistic decision-making in ‘at-risk mental state’ patients. Journal of Psychiatry and Neuroscience 40, 163173.
Reitan, RM, Wolfson, D (1993). The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation, 2nd edn. Neuropsychology Press: Tucson, AZ.
Roediger, HL III, McDermott, KB (1995). Creating false memories: remembering words not presented in lists. Journal of Experimental Psychology: Learning, Memory, and Cognition 21, 803814.
Ruhrmann, S, Schultze-Lutter, F, Salokangas, RKR, Heinimaa, M, Linszen, D, Dingemans, P, Birchwood, M, Patterson, P, Juckel, G, Heinz, A, Morrison, A, Lewis, S, von Reventlow, HG, Klosterkötter, J (2010). Prediction of psychosis in adolescents and young adults at high risk: results from the prospective european prediction of psychosis study. Archives of General Psychiatry 67, 241251.
Saß, H., Wittchen, H, Zaudig, M (2000). Diagnostisches und statistisches Manual psychischer Störungen DSM-IV. Hogrefe: Göttingen, Germany.
Scheyer, R, Reznik, N, Apter, A, Seidman, LJ, Koren, D (2014). Metacognition in non-psychotic help-seeking adolescents: associations with prodromal symptoms, distress and psychosocial deterioration. Israel Journal of Psychiatry and related Sciences 51, 3443.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 2233.
So, SH, Freeman, D, Dunn, G, Kapur, S, Kuipers, E, Bebbington, P, Fowler, D, Garety, PA (2012). Jumping to conclusions, a lack of belief flexibility and delusional conviction in psychosis: a longitudinal investigation of the structure, frequency, and relatedness of reasoning biases. Journal of Abnormal Psychology 121, 129139.
Souchay, C, Isingrini, M, Clarys, D, Taconnat, L, Eustache, F (2004). Executive functioning and judgment-of-learning versus feeling-of-knowing in older adults. Experimental Aging Research 30, 4762.
Uchida, T, Matsumoto, K, Ito, F, Ohmuro, N, Miyakoshi, T, Ueno, T, Matsuoka, H (2014). Relationship between cognitive insight and attenuated delusional symptoms in individuals with at-risk mental state. Psychiatry Research 217, 2024.
Versmissen, D, Myin-Germeys, I, Janssen, I, Franck, N, Georgieff, N, Campo, J, Mengelers, R, van, OJ, Krabbendam, L (2007). Impairment of self-monitoring: part of the endophenotypic risk for psychosis. British Journal of Psychiatry (Suppl.) 51, s58s62.


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

  • S. Eisenacher (a1), F. Rausch (a1), F. Ainser (a1), D. Mier (a2), R. Veckenstedt (a3), F. Schirmbeck (a1) (a4), A. Lewien (a1), S. Englisch (a1), C. Andreou (a3), S. Moritz (a3), A. Meyer-Lindenberg (a1), P. Kirsch (a2) and M. Zink (a1)...


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