Delusions and metacognition in patients with schizophrenia

Introduction. The aim of the present study was to explore the basis of the strong feeling of conviction and the high resistance to change characteristic of delusions and to test whether patients with schizophrenia suffering from delusions have specific metacognitive impairments when compared to both patients without delusions and healthy controls. Methods. 14 actively delusional patients with schizophrenia, 14 nondelusional patients, and 14 healthy subjects were administered two measures assessing different aspects of metacognition: an emotional metacognitive version of the WCST adapted from Koren et al. (2004) and the Beck Cognitive Insight Scale. Results. Relative to both healthy controls and nondelusional patients, delusional participants were specifically impaired on metacognitive measures of free choice improvement and global monitoring. This was correlated with high self-certainty on the BCIS relative to nondelusional patients. Conclusions. Our results suggest that metacognitive impairments play an important role in the maintenance of delusional beliefs. It may therefore be important to adapt remediation strategies to the metacognitive profiles of patients.