Self-reference recollection effect and its relation to theory of mind: An investigation in healthy controls and schizophrenia.

This study explores the links between the Self-Reference Effect (SRE) and Theory of Mind (ToM) in typical adults and patients with schizophrenia. Participants were assessed with a self-referential memory paradigm investigating the mnemonic effect of both semantic and episodic self-reference with a recognition task associated with the Remember/Know/Guess paradigm. They also completed a self-descriptive scale and shortened versions of the attribution of intention task and the reading the mind in the eyes test as measures of cognitive and affective ToM respectively. Unlike typical adults, the patients showed no semantic SRRE (correct recognition associated with remembering), and there was no episodic SRRE and no SRE (on the number of correct recognitions) in either group. Semantic SRRE was correlated with the affective ToM in patients and with the positivity of the self-concept in the healthy group. We discuss that patients and typical adults use different strategies during self and other-reflection.

Specific vs general cognitive remediation for executive functioning in schizophrenia: a multicenter randomized trial.

BACKGROUND: This study assesses the benefits of an individualized therapy (RECOS program) compared with the more general cognitive remediation therapy (CRT). METHODS: 138 participants took part with 65 randomized to CRT and 73 to RECOS. In the RECOS group, participants were directed towards one of five training modules (verbal memory, visuo-spatial memory and attention, working memory, selective attention or reasoning) corresponding to their key cognitive concern whereas the CRT group received a standard program. The main outcome was the total score on BADS (Behavioural Assessment of Dysexecutive Syndrome) and the secondary outcomes were: cognition (executive functions; selective attention; visuospatial memory and attention; verbal memory; working memory) and clinical measures (symptoms; insight; neurocognitive complaints; self-esteem). All outcomes were assessed at baseline (T1), week 12 (posttherapy, T2), and follow-up (week 36, i.e., 6months posttherapy, T3). RESULTS: No difference was shown for the main outcome. A significant improvement was found for BADS' profile score for RECOS at T2 and T3, and for CRT at T3. Change in BADS in the RECOS and CRT arms were not significantly different between T1 and T2 (+0.86, p=0.108), or between T1 and T3 (+0.36, p=0.540). Significant improvements were found in several secondary outcomes including cognition (executive functions, selective attention, verbal memory, and visuospatial abilities) and clinician measures (symptoms and awareness to be hampered by cognitive deficits in everyday) in both treatment arms following treatment. Self-esteem improved only in RECOS arm at T3, and working memory improved only in CRT arm at T2 and T3, but there were no differences in changes between arms. CONCLUSIONS: RECOS (specific remediation) and CRT (general remediation) globally showed similar efficacy in the present trial.

Hyperfrontality and hypoconnectivity during refreshing in schizophrenia.

Anomalous activations of the prefrontal cortex (PFC) and posterior cerebral areas have been reported in previous studies of working memory in schizophrenia. Several interpretations have been reported: e.g., neural inefficiency, the use of different strategies and differences in the functional organization of the cerebral cortex. To better understand these abnormal activations, we investigated the cerebral bases of a working memory component process, namely refreshing (i.e., thinking briefly of a just-activated representation). Fifteen patients with schizophrenia and 15 control subjects participated in this functional magnetic resonance imaging (fMRI) study. Participants were told that whenever they saw a word on the screen, they had to read it silently to themselves (read and repeat conditions), and when they saw a dot, they had to think of the just-previous word (refresh condition). The refresh condition (in comparison with the read condition) was associated with significantly increased activation in the left inferior frontal gyrus and significantly decreased connectivity within the prefrontal cortex and between the prefrontal and parietal cortices in patients with schizophrenia in comparison with control subjects. These results suggest that prefrontal dysfunctions in schizophrenia might be related to a defective ability to initiate (rather than to execute) specific cognitive processes.

Mechanisms of insight in schizophrenia and impact of cognitive remediation therapy.

The origins of poor insight in schizophrenia are still unclear. We contrasted the changes in clinical insight, basic cognitive processes, autobiographical memory and metacognition in 63 outpatients with schizophrenia pseudo-randomly assigned to one of three cognitive remediation groups: one targeting basic cognitive processes (RECOS), a second autobiographical memory (REMAu), and a third metacognitive deficits (MBCT). Three dimensions of insight (awareness of: mental illness, benefit of treatment, psychosocial consequences) improved after treatment, regardless of the group. In addition, the REMAu and MBCT showed an improvement on other dimensions of insight (symptomatic awareness and symptomatic attribution, respectively). Poor insight and its improvement after treatment were best predicted by a combination of basic cognitive, autobiographical and metacognitive measures. This study supports a multidimensional conception of insight and recommends the combination of remediation therapies to improve clinical insight in schizophrenia.

Episodic memory and impairment of an early encoding process in schizophrenia.

Investigations of memory impairment in schizophrenia have frequently revealed a strategic processing deficit at encoding. The authors studied an early encoding process, refreshing (in this case, thinking of a stimulus that has just-previously been presented), and its impact on recognition memory in schizophrenia. Following simultaneous presentation of three words or a single word in the top, middle, or bottom position of the screen, 25 patients with schizophrenia and 25 control participants saw and read a new word (read condition), or a word presented on the previous screen (repeat condition), or saw a dot indicating that they should think of and say the last word to have appeared in that position (refresh condition). Later, on a surprise test, participants were asked to recognize words seen previously and give a Remember, Know, or Guess response according to whether they recognized each on the basis of conscious recollection, familiarity, or guessing. The cognitive operation of refreshing was impaired in schizophrenia: patients were slower on 1-word trials and less accurate on 3-word trials to refresh a word, and their Remember responses did not benefit from refreshing.

Comparing effects of perceptual and reflective repetition on subjective experience during later recognition memory.

Using the Remember/Know procedure, we compared the impact of a reflective repetition by refreshing (i.e., briefly thinking of a just-seen item) and a perceptual repetition (i.e., seeing an item again) on subjective experience during recognition memory. Participants read aloud words as they appeared on a screen. Critical words were presented once (read condition), immediately repeated (repeat condition), or followed by a dot signalling the participants to think of and say the just-previous word (refresh condition). In Experiments 1 and 2, Remember responses benefited from refreshing a word (in comparison with reading it). In Experiment 2, this benefit disappeared when participants had to refresh one of three active items. Perceptual repetition increased Remember responses in Experiment 1, but not in Experiment 2 regardless of whether participants had just previously seen 1- or 3-items. These findings indicate that under some circumstances, reflective and perceptual repetition may have different consequences for later subjective experience during remembering, suggesting differences in their underlying functional mechanisms.

Neural correlates of counting of sequential sensory and motor events in the human brain.

Little is known about the ability to enumerate small numbers of successive stimuli and movements. It is possible that there exist neural substrates that are consistently recruited both to count sensory stimuli from different modalities and for counting movements executed by different effectors. Here, we identify a network of areas that was involved in enumerating small numbers of auditory, visual, and somatosensory stimuli, and in enumerating sequential movements of hands and feet, in the bilateral premotor cortex, presupplementary motor area, posterior temporal cortex, and thalamus. The most significant consistent activation across sensory and motor counting conditions was found in the lateral premotor cortex. Lateral premotor activation was not dependent on movement preparation, stimulus presentation timing, or number word verbalization. Movement counting, but not sensory counting, activated the anterior parietal cortex. This anterior parietal area may correspond to an area recruited for movement counting identified by recent single-neuron studies in monkeys. These results suggest that overlapping but not identical networks of areas are involved in counting sequences of sensory stimuli and sequences of movements in the human brain.

Assessing a minimal executive operation in schizophrenia.

The minimal cognitive operation of thinking of a just-seen stimulus (refreshing) was studied in 24 patients with schizophrenia and 24 normal controls. Verbal response times were measured when participants read a word, read a word immediately again, or refreshed a word just after it was no longer present. Patients showed equal priming as controls in reading a word for the second time and were slower than controls to say a word only in the refresh condition. On a surprise test, participants were asked to recognize the words they had seen previously and to give Remember, Know, or Guess responses according to whether they recognized words on the basis of conscious recollection, familiarity, or guessing. Although patients showed overall poorer recognition memory, the beneficial effect of refreshing on long-term memory accuracy and Remember responses was preserved, whereas they derived less benefit in familiarity from seeing an item twice than from refreshing it. These results suggest that although patients may have some difficulty engaging the refresh process, they show significant long-term memory benefits when induced to do so.