Self-monitoring in patients with schizophrenia

BACKGROUND: The present study investigated whether a failure of self-monitoring contributes to core syndromes of schizophrenia. METHOD: Three groups of patients with a DSM-IV diagnosis of schizophrenia (n = 27), with either prominent paranoid hallucinatory or disorganization syndrome, or without these symptoms, and a matched healthy control group (n = 23) drew circles on a writing pad connected to a PC monitor. Subjects were instructed to continuously monitor the relationship between their hand movements and their visual consequences. They were asked to detect gain changes in the mapping. Self-monitoring ability and the ability to automatically correct movements were assessed. RESULTS: Patients with either paranoid-hallucinatory syndrome or formal thought disorder were selectively impaired in their ability to detect a mismatch between a self-generated movement and its consequences, but not impaired in their ability to automatically compensate for the gain change. CONCLUSIONS: These results support the claim that a failure of self-monitoring may underlie the core symptoms of schizophrenia.