A meta-analysis of context integration deficits across the schizotypy spectrum using AX-CPT and DPX tasks

Schizotypy and schizophrenia involve disrupted context integration (CI), the ability to assimilate internal and external information into coherent mental representations. Research has primarily examined patients with schizophrenia, with fewer studies assessing CI in schizotypy-spectrum groups. The literature shows overall CI deficits, but mixed results for specific performance patterns and associations with clinical symptoms. Furthermore, conclusions are limited by small samples and heterogeneity across studies. To examine CI deficits across the schizotypy spectrum using AX-Continuous Performance Task (CPT) and Dot Pattern Expectancy task (DPX) performance. Systematic review involved searching 4 databases and 12 journals, examining key references, and contacting 227 researchers for published and unpublished data. Search terms included AX-CPT/DPX/dot pattern expectancy task/CNTRACs/context* integration/context* processing and schizo*/prodromal/high risk/psychosis; context* and ultra high risk. Independent data from studies with diagnostically or psychometrically assessed schizotypy-spectrum groups and AX-CPT/DPX tasks with 10+ trials and 60+% AX trials were included. Articles were independently coded by two authors using predefined coding schemes with good agreement. Meta-analyses pooled outcomes using random-effects models. Forty-one studies met inclusion criteria. CI impairment was present across the schizotypy spectrum. CI deficits in schizophrenia were substantial and associated with disorganized and negative symptoms. Outcomes were comparable between patients with chronic and first-episode schizophrenia. At-risk groups demonstrated moderate CI impairment. Results were robust across task parameters and there was no evidence that reporting biases grossly impacted outcomes. Findings lend support to theories suggesting that CI is a stable vulnerability factor for schizophrenia. (PsycINFO Database Record (c) 2018 APA, all rights reserved).