Metacognition in Schizophrenia: Processes Underlying Patients' Reflections on Their Own Episodic Memory

Background: The aim of the study was to explore the processes underlying schizophrenia patients' reflections on their own memory. Cognitive deficits and insight problems are considered core symptoms of schizophrenia. Even when people fail to recall a solicited target, they can provide feeling of knowing (FOK) judgments that reflect their ability to judge the accessibility of the target in memory. The metamemory approach allows for direct and experimental quantification of the correspondence between the subjective judgments and the objective measures of memory performance. According to the accessibility hypothesis, FOK evaluations rely on the accessibility of partial and/or contextual information relevant to the memory target. Methods: The accessibility of partial information relating to a memory target was investigated in 21 patients and 21 healthy comparison subjects matched for age, gender, and level of education. The material to be learned consisted of four-letter nonsense tetragrams, with each letter providing partial information about the four-letter target. Results: The results show that despite memory recall (p<.01) and recognition impairments (p=.02) and lower FOK ratings (p<.05), patients' metamemory judgments increased linearly with the amount of partial information recalled (from one letter to four letters, p<.01). The products of memory retrieval were predictive of both their FOK judgments and their subsequent memory performance. Conclusions: Schizophrenia patients are as capable as comparison subjects of relying on the products of memory retrieval to monitor accurately their awareness of what they do or do not know. The finding may be of interest for cognitive remediation.