Dietrichkeit Mona, Grzella Karsten, Nagel Matthias, Moritz Steffen
Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany.
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Psychiatry Res. 2020 Jan 13;285:112787. doi: 10.1016/j.psychres.2020.112787.
Memory biases (e.g. overconfidence in false memories) are implicated in the pathogenesis of delusions. Virtual reality (VR) may provide an opportunity to observe such biases and improve cognitive insight in patients with psychosis via corrective feedback. Thirty-nine patients with psychosis and 20 healthy controls explored VR environments designed to elicit false memories and subsequently had to recollect items and faces. We used a randomised-controlled design where half of the sample received performance feedback on the recollection task in order to correct overconfidence. Changes in cognitive insight were measured using the Beck Cognitive Insight Scale. Regarding accuracy, patients performed worse on the social task (recollection of faces) only. Patients displayed overconfidence in false memories for emotions and gave more high-confident responses compared to healthy controls on the social task. Feedback did not improve cognitive insight. Patients rated their cognitive insight higher than healthy controls. Future research should address problems with subjective measurements for cognitive insight. To conclude, patients with psychosis showed impaired social cognition and there was evidence for impaired metacognition, as patients reported higher cognitive insight despite comparable or worse performance as well as overconfidence relative to controls.
记忆偏差（例如对错误记忆的过度自信）与妄想的发病机制有关。虚拟现实（VR）可能提供一个机会来观察此类偏差，并通过纠正反馈提高精神病患者的认知洞察力。39名精神病患者和20名健康对照者探索了旨在引发错误记忆的VR环境，随后必须回忆物品和面孔。我们采用随机对照设计，其中一半样本在回忆任务中接受表现反馈，以纠正过度自信。使用贝克认知洞察力量表测量认知洞察力的变化。在准确性方面，患者仅在社交任务（面孔回忆）上表现较差。患者对情绪的错误记忆表现出过度自信，并且在社交任务中与健康对照者相比给出了更多高置信度的回答。反馈并未改善认知洞察力。患者对自己认知洞察力的评分高于健康对照者。未来的研究应解决认知洞察力主观测量方面的问题。总之，精神病患者表现出社会认知受损，并且有元认知受损的证据，因为尽管表现相当或更差以及相对于对照者存在过度自信，但患者报告的认知洞察力更高。
