Systematic review and meta-analysis of the calibration of confidence judgments in individuals with schizophrenia spectrum disorders

Abstract

BackgroundMetacognitive deficits are well documented in schizophrenia spectrum disorders as a decreased capacity to adjust confidence to first-order performance in a cognitive task. Because metacognitive ability directly depends on first-order performance, observed metacognitive deficits might be driven by lower first-order performance. We aimed to determine the extent to which individuals with schizophrenia experience specific deficits when producing confidence judgments and examined whether studies controlling for first-order performance found metacognitive deficits of smaller magnitude.MethodElectronic databases were searched for studies published until April 24th 2020. We conducted a Bayesian meta-analysis of 43 studies comparing the calibration of confidence in 1458 individuals with schizophrenia compared to 1337 matched controls. Group analyses and meta-regressions quantified how metacognitive deficits depended on task performance, cognitive domains, clinical severity, and antipsychotic dosage.OutcomesWe found a global metacognitive deficit in schizophrenia (g = -0.57, 95% CrI [-0.71, -0.43]), which was driven by studies which did not equate first-order performance between groups (g = -0.64, 95% CrI [-0.77, -0.51]), and inconclusive among controlled-studies (g = -0.28, 95% CrI [-0.63, 0.07], BF01 = 1.3). Plus, the metacognitive deficit in non-controlled studies was correlated with first-order performance. No correlation was found between metacognitive deficit and clinical features of schizophrenia.InterpretationWe provide evidence for the existence of a deficit in the calibration of confidence judgments in schizophrenia, which is inflated due to non-equated first-order performance. Thus, efforts should be made to develop experimental protocols accounting for lower first-order performance in schizophrenia.

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

“…Deficits in metacognitive capabilities are thought to be a central aspect of schizophrenia, 52 , 53 but see, 73 and have been related to reduced neurocognitive capabilities and social functioning. 74 While recent findings have suggested that schizophrenia patients have comparable metacognitive abilities for low level perceptual decisions 73 , 75 the current deficit in metacognition for SoA judgments most likely relates to a meta-executive level in which the sensorimotor conflict induces a conscious and explicit assessment of the authorship of the action. 64 This is in line with the prominent meta-executive deficits in schizophrenia as found for insight into illness and hallucinations.…”

Reverse engineering of metacognition

“…Expected metacognitive sensitivity thus strongly depends on type 1 performance. Indeed, the importance of such type 1 performance confounds has been demonstrated in a recent meta-analysis of metacognitive performance aberrancies in schizophrenia ( Rouy et al, 2020 ). The authors found that a previously claimed metacognitive deficit in schizophrenia was present only in studies that did not control for type 1 performance.…”

Impaired Sense of Agency and Associated Confidence in Psychosis

“…Deficits of metacognitive capacities are well documented across the schizophrenia spectrum and has been related to poorer outcomes (Dietrichkeit et al, 2020;Hasson-Ohayon et al, 2018;Koren et al, 2006;Lysaker et al, 2011). However, recent work on perceptual metacognition indicates that when task difficulty is stringently controlled, metacognitive deficits in schizophrenia are small or even absent (Faivre, Roger, et al, 2020;Powers et al, 2017;Rouy et al, 2021). The current study examining embodied SoA in patients, found an extensive deficit in SoA discrimination, combined with high confidence in their judgments pointing to a considerable deficit in metacognition for SoA (although, one must take into account that first order performance was not equated here, which may account for some of the differences between the groups, see Rouy et al, 2021).…”

“…However, recent work on perceptual metacognition indicates that when task difficulty is stringently controlled, metacognitive deficits in schizophrenia are small or even absent (Faivre, Roger, et al, 2020;Powers et al, 2017;Rouy et al, 2021). The current study examining embodied SoA in patients, found an extensive deficit in SoA discrimination, combined with high confidence in their judgments pointing to a considerable deficit in metacognition for SoA (although, one must take into account that first order performance was not equated here, which may account for some of the differences between the groups, see Rouy et al, 2021). This suggests that in contrast to low-level perceptual metacognitive capacities which may be preserved, metacognition of SoA involving the integration of sensorimotor signals and higher-order constructs such as beliefs and intentions is severely impaired.…”

“…Metacognitive deficits, involving lack of insight into their condition, are commonly found in psychosis and are associated with poorer prognosis (Koren et al, 2006;Lysaker et al, 2005;Lysaker & Dimaggio, 2014). However, recent research has shown that metacognitive capacities for some simple perceptual tasks do not seem to be deficient in schizophrenia patients (Faivre, Roger, et al, 2020;Rouy et al, 2021). Awareness of control over our actions, is critical for meaningful interactions with the world.…”