Psychological Medicine

Original Articles

Memory and metamemory in schizophrenia: a liberal acceptance account of psychosis

S. Moritza1, T. S. Woodwarda2a3 c1, L. Jelineka1 and R. Klingea1

a1 Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

a2 Department of Research, Riverview Hospital, Coquitlam, BC, Canada

a3 Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada


Background In previous studies we suggested that liberal acceptance (LA) represents a fundamental cognitive bias in schizophrenia and may explain why patients are more willing to accept weak response alternatives and display overconfidence in incorrect responses. The aim of the present study was to test a central assumption of the LA account: false alarms in schizophrenia should be particularly increased when the distractor–target resemblance is weak relative to a control group.

Method Sixty-eight schizophrenia patients were compared to 25 healthy controls on a visual memory task. At encoding, participants studied eight complex displays, each consisting of a unique pairing of four stimulus attributes: symbol, shape, position and colour. At recognition, studied items were presented along with distractors that resembled the targets to varying degrees (i.e. the match between distractors and targets ranged from one to three attributes). Participants were required to make old/new judgements graded for confidence.

Results The hypotheses were confirmed: false recognition was increased for patients compared to controls for weakly and moderately related distractors only, whereas strong lure items induced similar levels of false recognition for both groups. In accordance with prior research, patients displayed a significantly reduced confidence gap and enhanced knowledge corruption compared to controls. Finally, higher neuroleptic dosage was related to a decreased number of high-confident ratings.

Conclusions These data assert that LA is a core mechanism contributing to both enhanced acceptance of weakly supported response alternatives and metamemory deficits, and this may be linked to the emergence of positive symptomatology.

(Received August 14 2007)

(Revised November 16 2007)

(Accepted November 22 2007)

(Online publication January 21 2008)


c1 Address for correspondence: Dr T. S. Woodward, Department of Research, Riverview Hospital, 2601 Lougheed Highway, Coquitlam, BC, Canada. (Email: