Impaired Sense of Agency and Associated Confidence in Psychosis

Abstract

The Sense of Agency (SoA), our sensation of control over our actions, is a fundamental mechanism for delineating the Self from the environment and others. SoA arises from implicit processing of sensorimotor signals as well as explicit higher-level judgments. Psychosis patients suffer from difficulties in the sense of control over their actions and accurate demarcation of the Self. Moreover, it is unclear if they have metacognitive insight into their aberrant abilities. In this pre-registered study, we examined SoA and its associated confidence judgments using an embodied virtual reality paradigm in psychosis patients and controls. Our results show that psychosis patients not only have a severely reduced ability for discriminating their actions but they also do not show proper metacognitive insight into this deficit. Furthermore, an exploratory analysis revealed that the SoA capacities allow for high levels of accuracy in clinical classification of psychosis. These results indicate that SoA and its metacognition are core aspects of the psychotic state and provide possible venues for understanding the underlying mechanisms of psychosis, that may be leveraged for novel clinical purposes.

Investigating the sense of agency and its relation to subclinical traits using a novel task

“…Studies in clinical groups often use spatial distortions, or temporal delays in paradigms investigating explicit sense of agency (e.g. psychosis- Krugwasser et al 2022;schizophrenia-Metcalfe et al 2012;Maeda et al 2012;Parkinson's disease-Saito et al 2017). Whilst these studies give insight into how sensitive a person in a given clinical group is to perturbations to their own movement, they do not inform us about how different clinical groups interpret their control over an outcome relative to an external cause.…”

Agency Deficits in a Human Genetic Model of Schizophrenia: Insights From 22q11DS Patients

“… 49 Importantly, while SoA deficits in psychosis are well established, 44 , 69 their relationship to specific symptoms has been less consistent. 40 , 67 , 70 This suggests that while SoA deficits may be a central feature of psychosis across the schizophrenia spectrum, they do not necessarily manifest in symptoms in a specific fashion across individuals. Our findings extend previous work by showing a novel report of SoA deficits in a genetic model of schizophrenia.…”

“…Mounting evidence points to SoA deficits in schizophrenia, 19 , 24 , 44 , 67 , 69 , 76 giving rise to theoretical suggestions of its role in the ontogenesis of psychosis. 7 , 77 , 78 Our current findings in a juvenile and nonpsychotic population of 22q11DS participants suggest that deficits in SoA are evident at an early stage.…”

Disentangling the Neural Correlates of Agency, Ownership and Multisensory Processing

“…Importantly, we make a distinction between SoA experiments employing non-embodied paradigms, in which the sensory outcome of an action is learned during the experiment (Aarts et al, 2005;Sato, 2009;Sidarus et al, 2013;Wen et al, 2015;Yomogida et al, 2010) and embodied SoA studies, in which the expectations are based on lifelong prior experience with sensorimotor contingencies (Kalckert & Ehrsson, 2012;Krugwasser et al, 2022;Ma & Hommel, 2015;Salomon et al, 2022;Stern et al, 2020;Tsakiris et al, 2010).…”

“…For example, when the spatial (Kannape et al, 2010; Nielsen, 1963; Salomon et al, 2022; Yomogida et al, 2010), anatomical (Krugwasser et al, 2019; Salomon, Fernandez, et al, 2016), or temporal (Farrer et al, 2008; Koreki et al, 2015; Limanowski et al, 2017; Stern et al, 2020; Wen et al, 2015) consequences of an action are deviated, this causes a reduction of SoA ratings. Importantly, we make a distinction between SoA experiments employing non-embodied paradigms, in which the sensory outcome of an action is learned during the experiment (Aarts et al, 2005; Sato, 2009; Sidarus et al, 2013; Wen et al, 2015; Yomogida et al, 2010) and embodied SoA studies, in which the expectations are based on lifelong prior experience with sensorimotor contingencies (Kalckert & Ehrsson, 2012; Krugwasser et al, 2022; Ma & Hommel, 2015; Salomon et al, 2022; Stern et al, 2020; Tsakiris et al, 2010). The neural systems underlying embodied SoA have been challenging to study due to the intricacies arising from executing, tracking, and altering bodily actions within neuroimaging environments.…”