Am J Psychiatry 160:10, October 20031879http://ajp.psychiatryonline.or - PDF document

Am J Psychiatry 160:10, October 20031879http://ajp.psychiatryonline.org Brief ReportDo Patients With Schizophrenia Consciously RecollectEmotional Events Better Than Neutral Events?Jean-Marie Danion, M.D.Mathilde Kazes, M.D., Ph.D.Caroline Huron, M.D., Ph.D.Nourdine Karchouni, M.D.Objective: The influence of the emotional valence of words onconscious awareness was assessed in patients with schizophrenia.Method: The remember/know procedure was used to test 24patients with schizophrenia and 24 normal comparison subjects.Results: Patients’ “remember” responses and conscious recol- (Am J Psychiatry 2003; 160:1879–1881)onscious awareness associated with recognitionmemory comprises two distinct subjective states thatmay be investigated experimentally with the remember/know procedure (1). In a recognition task, subjects areasked to report their subjective state of awareness at the 1880Am J Psychiatry 160:10, October 2003 BRIEF REPORTShttp://ajp.psychiatryonline.orgresponses. Remember and know responses were also ana-lyzed according to the model of Yonelinas et al. (5) to estimateprocesses of conscious recollection and familiarity (F). Vari-ables were subjected to separate analyses of variance (ANOVAs),with word type as a within-subject factor and group as a between-subject factor. Whenever the result of an analysis was significant,Students t tests and paired t tests were performed to localizedifferences.ResultsBoth groups discriminated among positive, negative,and neutral words (F=91.2, df=2, 88, p0.0001) and did soto the same extent, as indicated by a nonsignificant groupeffect and a nonsignificant interaction effect betweengroup and word type (Table 1). An ANOVA performed onremember responses yielded a significant group effect(F=55.4, df=1, 46, p0.0001), with patients giving fewer re-member responses than normal comparison subjects.There was a significant effect for word type (F=29.1, df=2,92, p0.0001) but no interaction between word type andgroup. In both groups, the proportion of remember re-sponses was significantly higher for positive than for neg-ative words, which in turn was significantly higher than forneutral words. For know responses, there was a signifi-cant group effect (F=5.3, df=1, 46, p0.03), with patientsgiving more know responses than comparison subjects.There was a significant effect of word type (F=11.4, df=2,92, p0.0001) and a significant interaction between wordtype and group (F=4.32, df=2, 92, p0.02). This interactionwas because for the patients, know responses did notvary as a function of word type, whereas for the normalcomparison subjects, the profile of know responses mir-rored that of remember responses.Conscious recollection paralleled the pattern of re-member responses. There was a significant effect ofgroup (F=53.5, df=1, 46, p0.0001), with conscious recol-lection being lower in the patients than in the comparisonsubjects. There was a significant effect of word type (F=27.8, df=2, 92, p0.0001) but no significant interaction be-tween word type and group. Familiarity, as indexed by Fshowed a different pattern than did the know responses.There was a significant group effect (F=4.1, df=1, 46,0.05), with familiarity slightly lower in the patients thanin the comparison subjects. Other statistical analyses didnot result in significant findings.DiscussionOur patients evaluated the emotional valence of wordsin a manner similar to that of the normal comparison sub-jects. Under these conditions, the patients, like the com-parison subjects, consciously recollected emotional wordsbetter than neutral words. Despite lower recollection lev-els, their remember responses were more frequent foremotional than for neutral words and for positive than fornegative words, with parallel variations in conscious rec-ollection. In contrast, the levels of know responses andfamiliarity were not influenced by the emotional words.Similar profiles were observed in the normal comparisonsubjects, with the exception of the know responses,which showed significant variations: know and remem- responses traded off against one another, probablybecause of a ceiling effect in overall recognition perfor-mance. The assumption that remember and know re-sponses are exclusive, whereas conscious recollection andfamiliarity are independent, explains why normal com-parison subjects exhibited different profiles of know re-sponses and familiarity. The impact of emotional wordson conscious recollection may be preserved because theevaluation of the emotional valence of words can occurautomatically or with minimal strategic processes (5).Whether this impact is preserved with all types of emo-tional stimuli remains to be established.TABLE 1. Memory Performance as a Function of Emotional Valence of Words in Patients With Schizophrenia and NormalComparison SubjectsItem From the Remember/Know ParadigmScore by Emotional Valence of WordsPatients With Schizophrenia (N=24)Comparison Subjects (N=24)Positive(rating=67.5)Neutral(rating=56.9)Negative(rating=32.2)Positive(rating=70.6)Neutral(rating=52.8)Negative(rating=28.3)MeanSDMeanSDMeanSDMeanSDMeanSDMeanSDStudied words“Remember”0.310.160.200.140.260.160.680.180.500.200.560.18“Know”0.360.200.400.180.380.130.180.170.360.220.290.15New words“Remember”0.010.020.010.020.010.030.020.040.000.010.020.04“Know”0.030.060.020.030.040.070.020.040.020.040.030.06Conscious recollection0.310.160.190.150.250.160.670.180.490200.550.18Familiarity2.000.932.140.682.000.672.161.252.660.892.651.08Subjects rated emotional valence of words on a 100-mm visual analogue scale.Subjects were asked to give a “remember” response if they consciously recollected something that they experienced when they learned theitem and to give a “know” response if recognition was accompanied by familiarity without recollection.Conscious recollection (Rec) was an estimate of how often words were correctly recollected relative to the number of opportunities the par-ticipants had to do so.Familiarity (F) was derived from the participants’ tendencies to give a correct “know” response to old words and an incorrect “know” re-sponse to new words (5). Am J Psychiatry 160:10, October 20031881 BRIEF REPORTShttp://ajp.psychiatryonline.orgEmotions are closely related to adaptive behavior at anautomated level. But because emotions enhance con-scious recollection, they also offer the flexibility of re-sponse based on memory for emotional events from thesubjects personal past. Evidence of a preserved effect ofemotional stimuli on conscious recollection thereforesuggests that patients may still benefit from such flexibil-ity, at least in some situations. Other clinical implicationsmay be more negative. Since emotion is the consequenceof how people construe situations, some neutral events orexperiences may become emotional by virtue of false be-liefs or delusions. Because these events are more easily re-called later and, hence, more richly and vividly experi-enced in memory, they could contribute to the persistenceand/or the enrichment of delusional experiences. Received July 25, 2002; revision received Feb. 14, 2003; acceptedMarch 6, 2003. From INSERM Unité 405, Département de Psychiatrie,Hôpitaux Universitaires. Address reprint requests to Dr. Danion,INSERM Unité 405, Département de Psychiatrie, Hôpitaux Universi-taires, 1 place de l’Hôpital, BP 426, 67091 Strasbourg Cedex, France; danion@alsace.u-strasbg.fr (e-mail).References1.Tulving E: Memory and consciousness. Can Psychol 1985; 26:2.Ochsner KN: Are affective events richly recollected or simply fa-miliar? The experience and process of recognizing feelingspast. J Exp Psychol Gen 2000; 2:2423.Huron C, Danion J-M, Giacomoni F, Grang D, Robert P, Rizzo L:Impairment of recognition memory with, but not without,conscious recollection in schizophrenia. Am J Psychiatry 1995;152:173717424.Taylor SF, Liberzon I: Paying attention to emotion in schizo-phrenia. Br J Psychiatry 1999; 174:65.Yonelinas AP, Kroll NEA, Dobbins I, Lazzara M, Knight RT: Rec-ollection and familiarity deficits in amnesia: convergence of re-member-know, process dissociation, and receiver operatingcharacteristic data. Neuropsychology 1998; 12:3233396.Koh SD, Szoc R, Peterson RA: Short-term memory scanning inschizophrenic young adults. J Abnorm Psychol 1977; 5:4514607.Andreasen NC: Scale for the Assessment of Positive Symptoms(SAPS). Iowa City, University of Iowa, 19848.Andreasen NC: Scale for the Assessment of Negative Symptoms(SANS). Iowa City, University of Iowa, 1983 Brief ReportAre Impairments of Action Monitoring and Executive Control True Dissociative Dysfunctions in Patients With Schizophrenia?And U. Turken, Ph.D.Patrik Vuilleumier, M.D.Daniel H. Mathalon, Ph.D., M.D.Diane Swick, Ph.D.Judith M. Ford, Ph.D.Objective: Impaired self-monitoring is considered a criticaldeficit of schizophrenia. The authors asked whether this is aspecific and isolable impairment or is part of a global distur-bance of cognitive and attentional functions.Method: Internal monitoring of erroneous actions, as well asthree components of attentional control (conflict resolution, setswitching, and preparatory attention) were assessed during per-formance of a single task by eight high-functioning patientswith schizophrenia and eight comparison subjects.Results: The patients exhibited no significant dysfunction of at-tentional control during task performance. In contrast, theirability to correct errors without external feedback and, by infer-ence, to self-monitor their actions was markedly compromised.Conclusions: This finding suggests that dysfunction of self-monitoring in schizophrenia does not necessarily reflect a gen-eral decline in cognitive function but is evidence of dispropor-tionately pronounced impairment of action monitoring, whichmay be mediated by a distinct subsystem within the brainecutive attention networks. (Am J Psychiatry 2003; 160:18811883)elf-monitoring, the ability to control self-initiated ac-tions and cognitive processes, is affected by schizophrenia4). An important neurocognitive theory of schizophre-nia (1) holds that disturbances of internal monitoring maylead to an inability to distinguish between self-generatedand externally triggered activities, which in turn underlie avariety of the symptoms of schizophrenia. These theoreti-cal considerations motivated further investigation of self-monitoring problems in schizophrenia and their relationto general cognitive functioning. The ability to detect andcorrect ones errors, a task that demands attention to oneaction, has been linked to problems of internal monitor-