Metamemory in patients with schizophrenia measured by the feeling of knowing

Cognitive awareness in patients with schizophrenia is crucial for clinical management of cognitive deficits. Traditional approaches using self-report inventories have questionable validity and reliability. Using the Feeling-of-Knowing (FOK) procedure to measure metamemory might overcome such weakness. A cross-sectional study comparing 40 patients and 40 demographically matched normal controls, using a recall-judgment-recognition (RJR) procedure and the Hamann coefficient was conducted to examine whether patients with schizophrenia have FOK deficits and what neurocognitive mechanism might account for these deficits. General IQ, executive function, and memory tests were also assessed. The results show that as a group, patients with schizophrenia had impaired FOK ability and evidenced a disposition to underestimate their memory performance. However, patient's FOK ability was variable, with 42.5% of patients exhibited a below chance level performance. There were marked relationships between FOK and set formation and visual recognition abilities in healthy controls, while such feature was not evident in patient group. These findings are in line with the prefrontal cortex dysfunction, reduced intrapsychic monitoring ability, and impaired utilization of mental resources noticed in patients with schizophrenia. A routine evaluation of metamemory function by FOK might be helpful for designing customized cognitive rehabilitation programs considering their missed estimation of memory capacity.