Self-monitoring in schizophrenia revisited.

According to a widespread theory, the first-rank symptoms such as delusions of control or thought insertion met in schizophrenia result from a failure in predicting the consequences of an action on the basis of a forward model based of the intended motor commands (efference copy). This assumption of an impairment in the central monitoring of their own actions is inferred from experiments showing that it is more difficult for schizophrenic patients than for controls to correct erroneous movements in the absence of visual feedback. In our study, 19 schizophrenic patients (10 with Schneiderian symptoms and nine without) and 19 paired control subjects were subjected to a sensorimotor adjustment task to reassess this hypothesis. We show that the patients who succeeded the task not differently from the control subjects were those who were aware of the manual correction (n = 9). Surprisingly, most of them presented Schneiderian symptoms. This suggests that the experience of alien control observed in certain schizophrenic patients cannot be directly related to an underlying cognitive deficit in the conscious monitoring of their own actions.