Self-attribution bias during continuous action-effect monitoring in patients with schizophrenia

Sense of agency in schizophrenia: A reconciliation of conflicting findings through a theory-driven literature review

The sense of agency is the experience of being the author of self-generated actions and their outcomes. Both clinical manifestations and experimental evidence suggest that the agency experience and the mechanisms underlying agency attribution may be dysfunctional in schizophrenia. Yet, studies investigating the sense of agency in these patients show seemingly conflicting results: some indicated under-attribution of self-agency (coherently with certain positive symptoms), while others suggested over-attribution of self-agency. In this review, we assess whether recent theoretical frameworks can reconcile these divergent results. We examine whether the identification of agency abnormalities in schizophrenia might depend on the measure of self-agency considered (depending on the specific task requirements) and the available agency-related cues. We conclude that all these aspects are relevant to predict and characterize the type of agency misattribution that schizophrenia patients might show. We argue that one particular model, based on the predictive coding theory, can reconcile the interpretation of the multifarious phenomenology of agency manifestations in schizophrenia, paving the way for testing agency disorders in novel ways.

Abnormalities in motor adaptation to different types of perturbations in schizophreniaperturbations in schizophrenia

Schizophrenia is a mental health disorder that often includes psychomotor disturbances, impacting how individuals adjust their motor output based on the cause of motor errors. While previous motor adaptation studies on individuals with schizophrenia have largely focused on large and consistent perturbations induced by abrupt experimental manipulations, such as donning prism goggles, the adaptation process to random perturbations, either caused by intrinsic motor noise or external disturbances, has not been examined - despite its ecological relevance. Here, we used a unified behavioral task paradigm to examine motor adaptation to perturbations of three causal structures among individuals in the remission stage of schizophrenia, youth with ultra-high risk of psychosis, adults with active symptoms, and age-matched controls. Results showed that individuals with schizophrenia had reduced trial-by-trial adaptation and large error variance when adapting to their own motor noise. When adapting to random but salient perturbations, they showed intact adaptation and normal causal inference of errors. This contrasted with reduced adaptation to large yet consistent perturbations, which could reflect difficulties in forming cognitive strategies rather than the often-assumed impairments in procedural learning or sense of agency. Furthermore, the observed adaptation effects were correlated with the severity of positive symptoms across the diagnosis groups. Our findings suggest that individuals with schizophrenia face challenges in accommodating intrinsic perturbations when motor errors are ambiguous but adapt with intact causal attribution when errors are salient.

Agency in schizophrenia and autism: a systematic review

Introduction

Previous research suggests that altered experiences of agency are an underlying vulnerability in both schizophrenia and autism. Here, we explore agency as a potential transdiagnostic factor by conducting a systematic review of existing literature investigating agency in autism and schizophrenia individually and together.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted three systematic searches on PsycINFO, Embase, Medline, PubMed and Web of Science to identify studies that investigated (1) agency in schizophrenia, (2) agency in autism, and (3) agency in both schizophrenia and autism.

Results

A total of 31 articles met eligibility criteria for inclusion and data extraction, with 24 measuring agency in schizophrenia, 7 investigating agency in autism, and no articles comparing the two. Results show that, compared to control populations, agency is significantly different in every identified schizophrenia study and generally not significantly different in autism.

Discussion

Importantly, we identified a lack of studies using common tasks and a disproportionate number of studies investigating different dimensions of agency across the two conditions, resulting in limited grounds for valid comparison.

Systematic review registration

Prospero, CRD42021273373.

Time in schizophrenia: a link between psychopathology, psychophysics and technology

It has been widely demonstrated that time processing is altered in patients with schizophrenia. This perspective review delves into such temporal deficit and highlights its link to low-level sensory alterations, which are often overlooked in rehabilitation protocols for psychosis. However, if temporal impairment at the sensory level is inherent to the disease, new interventions should focus on this dimension. Beyond more traditional types of intervention, here we review the most recent digital technologies for rehabilitation and the most promising ones for sensory training. The overall aim is to synthesise existing literature on time in schizophrenia linking psychopathology, psychophysics, and technology to help future developments.

I Hear My Voice; Therefore I Spoke: The Sense of Agency Over Speech Is Enhanced by Hearing One's Own Voice

The subjective experience of causing an action is known as the sense of agency. Dysfunctional sense of agency over speech has been suggested as a cause of auditory hallucinations. However, agency over speech has not been extensively characterized in previous empirical studies. Here, we manipulated self-voice identity, an indicator of self, embedded in the acoustic quality of voice and examined implicit and explicit measures of the sense of agency. Experiment 1 (N = 29 adults) demonstrated more compression of a perceived interval between action and outcome when participants heard their undistorted voices than their pitch-distorted voices. Experiment 2 (N = 28 adults) revealed a strong top-down effect of self-voice identity: Specifically, the judgment of agency over speech was more resistant than the judgment of agency over hand/limb movement to low-level sensorimotor inconsistency. Our findings provide new insight into the sense of agency over speech and an informative perspective for understanding aberrant experience in auditory hallucinations.

Understanding source monitoring subtypes and their relation to psychosis: a systematic review and meta-analysis

AIMS

Source monitoring (SM) is the metacognitive ability to determine the origin of one's experiences. SM is altered in primary psychiatric psychosis, although relationships between SM subtypes, other cognitive domains and symptoms are unclear. Our aims were to synthesize evidence comparing psychosis -with and without hallucinations- and healthy controls classifying SM subtypes by source discrimination (internal/external/reality monitoring) and stimulus modality (visual/auditory/imagined/performed).

METHODS

This systematic review adopted Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Meta-analyses Of Observational Studies in Epidemiology and Population, Intervention, Comparison and Outcomes guidelines. Core demographical and clinical parameters were extracted. Newcastle-Ottawa Scale was used as quality check. SM differences between (i) psychosis patients versus healthy controls and (ii) patients with versus without hallucinations were investigated via random-effect model meta-analysis. The primary effect size measure was standardized mean difference (SMD) in each SM subtype performance (error or accuracy). Heterogeneity, publication biases and meta-regressions were assessed.

RESULTS

Five thousand two hundred and fifty-six records were screened to finally include 44 studies (1566 patients, 1175 controls). Mean Newcastle-Ottawa score was 7.41 out of 9. Few studies measured SM associations with cognition (n = 9) and symptoms (n = 19), with heterogeneous findings. SM performance across all measures was reduced in psychosis versus healthy controls (SMD = 0.458). Internal SM (SMD: errors = 0.513; accuracy = 0.733) and imagined stimuli (SMD: errors = 0.688; accuracy = 0.978) were specifically impaired. Patients with versus without hallucinations showed SM deficits only for externalizing (SMD = 0.410) and imagined/auditory (SMD = 0.498/0.277) errors.

CONCLUSION

The proposed classifications highlight specific SM deficits for internal/imagined stimuli in psychosis, providing evidence-based indications to design and interpret future studies.

Internalized stigma mediates the relation between psychosis-risk symptoms and subjective quality of life in a help-seeking sample

Subjective quality of life can be compromised in individuals with psychosis-risk symptoms, with poorer quality of life being associated with worse functioning and later transition to psychosis. Individuals who experience psychosis-related symptoms also tend to endorse more internalized (or self-) mental health stigma when compared to controls, potentially contributing to delays in seeking treatment and increased duration of untreated psychosis, as well as interfering with treatment engagement and retention in those already receiving care. Despite these findings, and the growing recognition for prevention in earlier phases of psychotic illness, few studies have examined the relation between psychosis-risk symptoms, internalized stigma, and subjective quality of life in a younger, help-seeking sample. The present study examined whether internalized stigma mediates the relation between psychosis-risk symptoms and subjective quality of life in a transdiagnostic sample of youth (M age = 17.93, SD = 2.90) at clinical high-risk for psychosis (CHR), with early psychosis, or with non-psychotic disorders (N = 72). Psychosis-risk symptom severity was assessed using the Structured Interview for Psychosis-Risk Syndromes (SIPS). Internalized stigma was assessed using the Internalized Stigma of Mental Illness Inventory (ISMI), and subjective quality of life was assessed using the Youth Quality of Life Instrument - Short Form (YQOL-SF). Internalized stigma fully mediated the relation between psychosis-risk symptoms and subjective quality of life across the full sample (p < .05, f² = 0.06). Findings suggest that internalized stigma may be an important target in efforts to improve quality of life for individuals in early stages of psychosis.

Disrupted Sense of Agency as a State Marker of First-Episode Schizophrenia: A Large-Scale Follow-Up Study

Background: Schizophrenia is often characterized by a general disruption of self-processing and self-demarcation. Previous studies have shown that self-monitoring and sense of agency (SoA, i.e., the ability to recognize one's own actions correctly) are altered in schizophrenia patients. However, research findings are inconclusive in regards to how SoA alterations are linked to clinical symptoms and their severity, or cognitive factors. Methods: In a longitudinal study, we examined 161 first-episode schizophrenia patients and 154 controls with a continuous-report SoA task and a control task testing general cognitive/sensorimotor processes. Clinical symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Results: In comparison to controls, patients performed worse in terms of recognition of self-produced movements even when controlling for confounding factors. Patients' SoA score correlated with the severity of PANSS-derived "Disorganized" symptoms and with a priori defined symptoms related to self-disturbances. In the follow-up, the changes in the two subscales were significantly associated with the change in SoA performance. Conclusion: We corroborated previous findings of altered SoA already in the early stage of schizophrenia. Decreased ability to recognize self-produced actions was associated with the severity of symptoms in two complementary domains: self-disturbances and disorganization. While the involvement of the former might indicate impairment in self-monitoring, the latter suggests the role of higher cognitive processes such as information updating or cognitive flexibility. The SoA alterations in schizophrenia are associated, at least partially, with the intensity of respective symptoms in a state-dependent manner.

Transsaccadic Perception Deficits in Schizophrenia Reflect the Improper Internal Monitoring of Eye Movement Rather Than Abnormal Sensory Processing

BACKGROUND

Symptoms of psychosis in schizophrenia reflect disturbances in sense of agency-difficulty distinguishing internally from externally generated sensory and perceptual experiences. One theory attributes these anomalies to a disruption in corollary discharge (CD), an internal copy of generated motor commands used to distinguish self-movement-generated sensations from externally generated stimulation.

METHODS

We used a transsaccadic shift detection paradigm to examine possible deficits in CD and sense of agency based on the ability to perceive visual changes in 31 schizophrenia patients (SZPs) and 31 healthy control subjects. We derived perceptual measures based on manual responses indicating the transsaccadic target shift direction. We also developed a distance-from-unity-line measure to quantify use of CD versus purely sensory (visual) information in evaluating visual changes in the environment after an eye movement.

RESULTS

SZPs had higher perceptual thresholds in detecting shift of target location than healthy control subjects, regardless of movement direction or amplitude. Despite producing similar hypometric saccades, healthy control subjects overestimated target location, whereas SZPs relied more on the experienced visual error and consequently underestimated the target position. We show that in SZPs the postsaccadic judgment of the initial target location was largely aligned with the measure based only on visual error, suggesting a deficit in the use of CD. This CD deficit also correlated with positive schizophrenia symptoms and disturbances in sense of agency.

CONCLUSIONS

These results provide a novel approach in quantifying abnormal use of CD in SZPs and provide a framework to distinguish deficits in sensory processing versus defects in the internal CD-based monitoring of movement.

Know thy agency in predictive coding: Meta-monitoring over forward modeling

Though the computation of agency is thought to be based on prediction error, it is important for us to grasp our own reliability of that detected error. Here, the current study shows that we have a meta-monitoring ability over our own forward model, where the accuracy of motor prediction and therefore of the felt agency are implicitly evaluated. Healthy participants (N=105) conducted a simple motor control task and SELF or OTHER visual feedback was given. The relationship between the accuracy and confidence in a mismatch detection task and in a self-other attribution task was examined. The results suggest an accuracy-confidence correlation in both tasks, indicating our meta-monitoring ability over such decisions. Furthermore, a statistically identified group with low accuracy and low confidence was characterized as higher schizotypal people. Finally, what we can know about our own forward model and how we can know it is discussed.

COMT genotype is associated with plasticity in sense of body ownership: a pilot study

The sense of body ownership constantly adapts to new environments, and awareness of a distinction between oneself and others is a fundamental ability. However, it remains unclear whether plasticity in the sense of body ownership is dependent on genetic factors. The present study investigated the influence of the catechol-O-methyltransferase (COMT) Val¹⁵⁸Met genotype on illusory learning of a sense of body ownership and dissociation. 76 healthy Japanese participants experienced the rubber hand illusion (RHI), which is produced by sensory integration of conflicting modalities, with the intent to experimentally alter objective perceived locations and subjective ownership ratings. We found that Val/Val homozygous participants had more intense RHI experiences than Val/Met heterozygous and Met homozygous participants. Furthermore, RHI sensation was correlated with a dissociative personality trait in Val/Val homozygous participants. Our findings indicate an interaction between COMT genotype, RHI sensation, and dissociative personality traits: Val/Val genotypes were associated with RHI induction and greater vulnerability to dissociation. The findings suggest that Val/Val homozygous individuals may be more flexible regarding self-attribution/body ownership and that biological factors may contribute to reduced awareness regarding the distinction between self and others.

The self-attribution bias and paranormal beliefs

The present study investigated the relation between paranormal beliefs, illusory control and the self-attribution bias, i.e., the motivated tendency to attribute positive outcomes to oneself while negative outcomes are externalized. Visitors of a psychic fair played a card guessing game and indicated their perceived control over randomly selected cards as a function of the congruency and valence of the card. A stronger self-attribution bias was observed for paranormal believers compared to skeptics and this bias was specifically related to traditional religious beliefs and belief in superstition. No relation between paranormal beliefs and illusory control was found. Self-report measures indicated that paranormal beliefs were associated to being raised in a spiritual family and to anomalous experiences during childhood. Thereby this study suggests that paranormal beliefs are related to specific cognitive biases that in turn are shaped by socio-cultural factors.

Self is "other", other is "self": poor self-other discriminability explains schizotypal twisted agency judgment

Anomalous agency has been reported clinically and empirically for people with schizophrenia. This finding is expected to contribute to understanding positive symptomatology in schizophrenia in terms of a general neurocomputational model of motor control, because anomalous agency has also been reported in schizotypal traits in the general population. However, superficially opposite conclusions have been suggested: over-attributed or under-attributed agency in patients. In this work, healthy participants (N=104) were presented continuous morphed self-other visual feedback of their reaching movements and rated the agency they felt for it. The slope of the regression line in stimuli-response coordination as a function of self-other discriminability was estimated for each participant. The estimated slopes were significantly associated with positive schizotypal symptomatology. Higher schizotypal participants exhibited a lower slope, indicating poorer discriminability between their own and others' movements. Furthermore, the estimated regression lines in the high and low groups are predicted to cross at the approximately center point in the coordinates, which should produce both over-attribution and under-attribution errors for the high group compared with low group. The pattern of schizotypal attribution error depends on the S/N (signal-to-noise) ratio of the given stimuli within our sensorimotor system where the self-originated stimulus is the signal to be detected. The current study, for the first time, suggests both over- and under-attribution within participants scoring high on schizotypy.

Instrumental Divergence and the Value of Control

A critical aspect of flexible choice is that alternative actions yield distinct consequences: Only when available action alternatives produce distinct outcome states does discrimination and selection between actions allow an agent to flexibly obtain the currently most desired outcome. Here, we use instrumental divergence - the degree to which alternative actions differ with respect to their outcome probability distributions - as an index of flexible instrumental control, and assess the influence of this novel decision variable on choice preference. In Experiment 1, when other decision variables, such as expected value and outcome entropy, were held constant, we found a significant preference for high instrumental divergence. In Experiment 2, we used an "auto- vs. self-play" manipulation to eliminate outcome diversity as a source of behavioral preferences, and to contrast flexible instrumental control with the complete absence of voluntary choice. Our results suggest that flexible instrumental control over decision outcomes may have intrinsic value.

You looking at me?: Interpreting social cues in schizophrenia

BACKGROUND

Deficits in the perception of social cues are common in schizophrenia and predict functional outcome. While effective communication depends on deciphering both verbal and non-verbal features, work on non-verbal communication in the disorder is scarce.

METHOD

This behavioural study of 29 individuals with schizophrenia and 25 demographically matched controls used silent video-clips to examine gestural identification, its contextual modulation and related metacognitive representations.

RESULTS

In accord with our principal hypothesis, we observed that individuals with schizophrenia exhibited a preserved ability to identify archetypal gestures and did not differentially infer communicative intent from incidental movements. However, patients were more likely than controls to perceive gestures as self-referential when confirmatory evidence was ambiguous. Furthermore, the severity of their current hallucinatory experience inversely predicted their confidence ratings associated with these self-referential judgements.

CONCLUSIONS

These findings suggest a deficit in the contextual refinement of social-cue processing in schizophrenia that is potentially attributable to impaired monitoring of a mirror mechanism underlying intentional judgements, or to an incomplete semantic representation of gestural actions. Non-verbal communication may be improved in patients through psychotherapeutic interventions that include performance and perception of gestures in group interactions.