The British Journal of Psychiatry (2007) 191: s58-s62. doi: 10.1192/bjp.191.51.s58
© 2007 The Royal College of Psychiatrists
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Impairment of self-monitoring: part of the endophenotypic risk for psychosis

DAGMAR VERSMISSEN, MA and INEZ MYIN-GERMEYS, MA, PhD

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University and Mondriaan Zorggroep, Section Social Cognition, Heerlen, the Netherlands

ILSE JANSSEN, MA, PhD

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, the Netherlands

NICOLAS FRANCK, MD and NICOLAS GEORGIEFF, MD, PhD

Centre Hospitalier Le Vinatier, Université Lyon I, Institut des Sciences Cognitives, Centre National de la Recherche Scientifique, France

JOOSTa CAMPO, MD, PhD

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University and Mondriaan Zorggroep, Section Social Cognition, Heerlen, the Netherlands

RON MENGELERS

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, the Netherlands

JIM VAN OS, MD, PhD

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, the Netherlands, and Division of Psychological Medicine, Institute of Psychiatry, London, UK, and Mondriaan Zorggroep, Section Social Cognition, Heerlen, the Netherlands

LYDIA KRABBENDAM, MA, PhD

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, the Netherlands

Correspondence: Dr Lydia Krabbendam, Department of Psychiatry and Neuropsychology, Maastricht University, PO BOX 616 (VIJV), 6200 MD Maastricht, the Netherlands. Tel: ++31 43 3688682; fax: ++31 43 3688689; email: l.krabbendam{at}sp.unimaas.nl

Declaration of interest None.

Background A disorder of self-monitoring may underlie the positive symptoms of psychosis. The cognitive mechanisms associated with these symptoms may also be detectable in individuals at risk of psychosis.

Aims To investigate (a) whether patients with psychosis show impaired self-monitoring, (b) to what degree this is associated with positive symptoms, and (c) whether thisis associated with liability to psychotic symptoms.

Method The sample included: individuals with a lifetime history of non-affective psychosis (n=37), a genetically defined risk group (n=41), a psychometrically defined risk group (n=40), and control group (n=49). All participants carried out an action–recognition task.

Results Number of action–recognition errors was associated with psychosis risk (OR linear trend over 3 levels:1.12, 95% CI1.04–1.20) and differential error rate was associated with the degree of delusional ideation in a dose–response fashion (OR linear trend over 3 levels:1.13, 95% CI1.00–1.26).

Conclusions Alterationsin self-monitoring are associated with psychosis with evidence of specificity for delusional ideation. In the risk state, this is expressed more as failure to recognise self-generated actions, whereasin illness failure to recognise alien sources come to the fore.