Selective attention impairment in schizophrenia

Can it explain source monitoring failure?

Abdelaziz Ferchiou, MD (1,2,3,4), Franck Schrhoff, MD PhD (1,2,3,4), E !ulzacka (1,2,3,4),
Marion "ebo#er, MD PhD (1,2,3,4), Andre$ Sz%ke, MD PhD (1,2,3,4)
(1) &'SE(M, ) *++, &n,-i-u- Mondor de (echerche, !io./dicale, (&M(!), d/0ar-e.en- de
1/no.i2ue M/dicale, /2ui0e de P,#chia-rie 1/n/-i2ue, 3r/-eil, F4*4555, France6
(2) )ni7er,i-/ Pari, 8 E,-, Facul-/ de M/decine, &F(15, 3r/-eil, F4*4555, France6
(3) AP49P, 9:0i-al 9enri Mondor 4 Alber- 3hene7ier, P:le de P,#chia-rie, 3r/-eil, F4*4555,
France6
(4) Fonda-ion FondaMen-al, Fonda-ion de 3oo0/ra-ion Scien-ifi2ue

3orre,0ndin; au-hor < Abdelaziz FE(39&=)
1rou0e 9o,0i-alo 8 )ni7er,i-aire Mondor 8 3hene7ier, 0:le de 0,#chia-rie
9:0i-al Alber- 3hene7ier, 0a7illon 9ar-.ann
45 rue de Me,l#
*4555 3(E>E&" F(A'3E
>/l < ? 33 (5)1 4* @1 32 *5
E.ail < azizferchiouAin,er.fr
Abstract: &.0air.en-, in ,elec-i7e a--en-ion ha7e been 0ro0o,ed a, an eB0lana-ion for -he
,ource .oni-orin; defici-, in ,chizo0hrenia Ce -e,-ed -hi, h#0o-he,i, b# eBa.inin;
correla-ion, be-Deen ,ource .oni-orin; 7ariable, and a .ea,ure of ,elec-i7e a--en-ion (fro.
-he S-roo0 >e,-) in +4 ,chizo0hrenic ,ubEec-, and 42 nor.al con-rol, Ce did no- find
,i;nifican- correla-ion, be-Deen ,ource .oni-orin; .ea,ure, and ,elec-i7e a--en-ion Selec-i7e
a--en-ion i.0air.en-, do no- eB0lain ,ource .oni-orin; defici-, ob,er7ed in ,chizo0hrenia
Source .oni-orin; defici-, de,er7e con-inued effor-, -o elucida-e -heir cau,e, and
con,e2uence,
Keywords: ,ource .oni-orin;, ,elec-i7e a--en-ion, ,chizo0hrenia, 0o,i-i7e ,#.0-o.,
(J Nerv Ment Dis 2010 Oct;198(10):779-81 )
Introduction
Source .oni-orin; refer, -o -he abili-# -o di,cri.ina-e be-Deen ,e7eral 0o,,ible ,ource, of
.e.orie, >he Source .oni-orin; fra.eDork 0ro0o,ed b# Fohn,on e- al (1**3) di,-in;ui,he,
3 differen- -#0e, of ,ource .oni-orin;< in-ernal, eB-ernal and reali-# .oni-orin; (ie,
di,cri.ina-ion be-Deen in-ernal and eB-ernal ,ource,) Source .oni-orin; error, ha7e been
0ro0o,ed a, 0o-en-ial eB0lana-ion for -he 0o,i-i7e ,#.0-o., in ,chizo0hrenia So.e, bu- no-
all, ,-udie, len- ,u00or- -o -hi, h#0o-he,i, For eBa.0le, ,o.e au-hor, found a correla-ion
be-Deen ;lobal 0o,i-i7e ,#.0-o.a-olo;# and ,ource .oni-orin; defici- in ,chizo0hrenic
0a-ien-,

(!r/bion e- al 25526 S-irlin; e- al, 2551) >hi, correla-ion ,ee., -o be .ore ,0ecific
of 0ar-icular 0o,i-i7e ,#.0-o., ,uch a, hallucina-ion,, -hou;h- in-ru,ion, or alien con-rol
(Fri-h and Done, 1*@*6 Geefe e- al, 2552) >here i, al,o ,o.e ,0ecifici-# of -he ,ource
.oni-orin; error, 0roduced b# -he,e 0a-ien-, For eBa.0le, 0a-ien-, Di-h hallucina-ion, ,ee.
-o 0roduce .ore Hfal,e alar.,I (ie, -akin; a neD e7en- for an old one) and .ore
.i,a--ribu-ion, of ,elf ;enera-ed e7en-, -o an eB-ernal ,ource -han 0a-ien-, Di-h no
hallucina-ion,

(!en-all e- al 1**16 !r/bion e- al, 25556 !runelin e- al, 255J6 CoodDard e-
al, 255K)
>hu,, under,-andin; -he .echani,., underl#in; ,ource .oni-orin; defici-, could lead
-o a be--er under,-andin; of ,chizo0hrenic ,#.0-o., and 0erha0, -o .ore ,0ecific and
,ucce,,ful -hera0eu-ic ,-ra-e;ie, !r/bion e- al

(1**J) ,u;;e,-ed -ha-, in ,chizo0hrenic
,ubEec-,, ,ource .oni-orin; defici-, are -he con,e2uence of i.0air.en-, in ,elec-i7e a--en-ion
>he,e au-hor, a,,e,,ed ,elec-i7e a--en-ion u,in; -he S-roo0 Cord 3olor >e,- (SC3>) and
,ource .oni-orin; 0erfor.ance, in ,chizo0hrenic ,ubEec-, (nL32) and nor.al con-rol, (nL32)
>he# found -ha- ,e7eral .ea,ure, of ,ource .oni-orin; (nu.ber of fal,e alar., and
oralM0ic-ure di,cri.ina-ion) Dere correla-ed Di-h ,elec-i7e a--en-ion .ea,ure, (SC3>
in-erference ,core) in ,chizo0hrenic ,ubEec-, (bu- no- in nor.al con-rol,) !a,ed on -he,e
re,ul-,, -he au-hor, ,u;;e,-ed -ha- ,ource .oni-orin; failure Da, -he con,e2uence of defici-,
in ,elec-i7e a--en-ion >hi, findin;, if confir.ed, H.i;h- be rele7an- for clinical re,earch and
-rea-.en- (of ,chizo0hrenia)I

(!r/bion e- al, 1**J) in -ha- i- ,u;;e,-, -ha- .ore effor-, ha7e -o
be de7o-ed -o -he ,-ud# of ,elec-i7e a--en-ion (and le,, -o -he ,-ud# of ,ource .oni-orin;) &n a
,.all .iBed ,a.0le of ,chizo0hrenic, and nor.al con-rol, (nL35), 9en2ue- e- al

(255+),
u,in; a differen- ,ource .oni-orin; -e,-, found onl# 0ar-ial ,u00or- for -hi, h#0o-he,i,
9oDe7er, -o da-e, -he,e re,ul-, ha7e been nei-her confir.ed nor clearl# con-radic-ed in lar;er
,a.0le,
1i7en -he -heore-ical and 0rac-ical i.0or-ance of -he h#0o-he,i, of !r/bion e- al
(1**J), De decided -o -e,- i- in 2 ,a.0le, of ,ubEec-, (,chizo0hrenic ,ubEec-, and con-rol,)
Dhich Dere a,,e,,ed for ,ource .oni-orin; 0erfor.ance, Di-h a ,i.ilar -a,k, and for ,elec-i7e
a--en-ion Di-h -he SC3>
ethods
Subjects
Ce included +4 ,chizo0hrenic ,ubEec-, and 42 nor.al con-rol, Pa-ien-, recrui-ed .ee-
DSM4&N

(A.erican P,#chia-ric A,,ocia-ion, 1**4) cri-eria for ,chizo0hrenia or
,chizoaffec-i7e di,order Dia;no,e, Dere confir.ed u,in; -he D&1S (Dia;no,-ic &n-er7ieD for
1ene-ic S-udie,)

('urnber;er e- al, 1**4) Pa-ien-, ha7e a .ean a;e of 33@ #ear, (SDL*+),
and 25 of -he. (3KO) ha7e a hi;h ,chool le7el Mo,- of -he ,chizo0hrenic ,ubEec-, Dere
in0a-ien-, a- -he -i.e of -he ,-ud# All Dere on re;i.en, of ei-her -#0ical or a-#0ical
an-i0,#cho-ic, and Dere recei7in; fiBed do,e, a- -e,-in; Pa-ien-, had .ild ,#.0-o.,
accordin; -o -he Si;n, and S#.0-o., of P,#cho-ic &llne,, ,cale

("iddle e- al, 2552)< a .ean
0o,i-i7e di.en,ion ,core of 2+K (SDL24K), a .ean ne;a-i7e di.en,ion ,core of 31J
(SDL35@), and a .ean di,or;ani,a-ion di.en,ion ,core of 1+J (SDL1+*)
9eal-h# con-rol, Dere blood donor, a- -he HE-abli,,e.en- FranPai, du ,an;I in 3r/-eil
3on-rol, Dere included af-er bein; in-er7ieDed Di-h -he D&1S and -he F&1S (Fa.il#
&n-er7ieD for 1ene-ic S-udie,)

(MaBDell, 1**2) -o confir. -he ab,ence of 0er,onal or fa.il#
hi,-or# of 0,#chia-ric di,order, >he# ha7e a .ean a;e of 41+ (SDL134J) and 3+ of -he.
(@33O) ha7e a 9i;h ,chool le7el
All ,ubEec-, ha7e no hi,-or# of neurolo;ical di,ea,e or curren- ,ub,-ance abu,e
Cri--en infor.ed con,en- Da, ob-ained for each ,ubEec-
Measurements
All ,ubEec-, Dere -e,-ed Di-h a ,ource .oni-orin; -a,k and -he SC3>
>he ,ource .oni-orin; -a,k Da, deri7ed fro. !r/bion e- al

(1**J) ,-ud# >he -a,k i,
de,cribed in de-ail el,eDhere

(Sz%ke e- al, 255*) Ce defined four ,e.an-ic ca-e;orie,<
-e.0era-e cli.a-e frui-,, =l#.0ic ,0or-,, Euro0ean coun-rie, and nu.ber, fro. +5 -o K5
Each 0o,,ible eBa.0le fro. -he,e ca-e;orie, Da, 0rin-ed on a uni2ue card A- -he fir,- ,-a;e
of -he -e,-, 12 i-e., Dere ,elec-ed fro. each ca-e;or#< J Dere ;enera-ed b# -he ,ubEec- (ei-her
,0on-aneou,l#, b# readin; aloud or readin; ,ilen-l#), 2 Dere read aloud b# -he eBa.iner and 4
Dere added fro. -he re.ainin; card, (HneDI i-e.,) >he reco;ni-ion ,-a;e -ook 0lace af-er
-he ,ubEec- underDen- -he SC3> and onl# a- -hi, -i.e of -he -a,k -he ,ubEec- Da, infor.ed
-ha- heM,he had -o iden-if# -he ,ource of i-e., 0roduced and differen-ia-e -he. fro. neD
i-e., Ce u,ed -he ,a.e ,ource .oni-orin; indice, -han !r/bion e- al

(1**J) (old4neD
di,cri.ina-ion, o.i,,ion,, fal,e alar., and ,elf4eB-ernal di,cri.ina-ion) Di-h -he eBce0-ion of
-he oralM0ic-ure di,cri.ina-ion indeB (becau,e -here Dere no 0ic-orial i-e., in our -a,k) >he
old4neD di,cri.ina-ion indeB i, -he 0ro0or-ion of i-e., 0ro0erl# iden-ified a, old or neD ou-
of all i-e., =.i,,ion, are -he 0re7iou,l# ,een i-e., no- reco;nized a, ,uch Fal,e alar., are
neD i-e., Dron;l# reco;nized a, old one, Finall#, ,elf4eB-ernal di,cri.ina-ion indeB i, -he
0ro0or-ion of i-e., correc-l# a--ribu-ed ei-her -o one,elf or -o an eB-ernal ,ource of -he i-e.,
0ro0erl# reco;nized a, old
A, !r/bion e- al

(1**J) did, De u,ed -he S-roo0 Cord 3olor >e,- -o .ea,ure ,elec-i7e
a--en-ion >he SC3> con,i,-ed of -hree -rial, of 4+ ,econd, each, in Dhich -he ,ubEec-
,ucce,,i7el# read, aloud -he na.e, of color, -ha- are 0rin-ed in black, na.e, -he color Di-h
Dhich ,-rin;, of HQI, are 0rin-ed and finall# na.e, -he color Di-h Dhich -he na.e of a
differen- color i, 0rin-ed (eB (ED 0rin-ed in blue 8 correc- an,Der blue) &n -he 0re,en-
anal#,i,, -o .a-ch -he anal#,i, done b# !r/bion e- al

(1**J), De u,ed -he nu.ber of i-e.,
fro. -he 2 la,- -rial,
Statistical analysis
>o a,,e,, correla-ion be-Deen ,ource .oni-orin; 7ariable, and ,elec-i7e a--en-ion De
u,ed -he .e-hod de,cribed b# !r/bion e- al

(1**J) For -hi,, De calcula-ed -he Pear,on
correla-ion, be-Deen ,ource .oni-orin; 7ariable, and -he nu.ber of i-e., in -he la,- -rial of
-he S3C> af-er 0ar-iallin; ou- -he nu.ber of i-e., in -he na.in; condi-ion of -he S3C>
(,econd -rial) >he,e anal#,e, Dere done u,in; -he SAS N* ,of-Dare
!esults
&n co.0ari,on -o nor.al con-rol,, ,chizo0hrenic ,ubEec-, a00eared -o be ,i;nifican-l#
i.0aired on -o-al nu.ber of correc- i-e.,, and ,elf di,cri.ina-ion indeB in -he ,ource
.oni-orin; a,,e,,.en- >he# Dere al,o ,i;nifican-l# i.0aired on -o-al i-e., and in-erference
,core indice, in -he S-roo0 -e,- R>able 1S
All correla-ion, be-Deen ,ource .oni-orin; and ,elec-i7e a--en-ion .ea,ure, Dere le,,
-han 53 and non ,i;nifican- (0T55+) R>able 2S
"able # Mean ,core, in ,ource .oni-orin; and S-roo0 -e,- in ,chizo0hrenic ,ubEec-, and
nor.al con-rol,
Schizo0hrenic
SubEec-,
'or.al
3on-rol,
Source
Moni-orin;
RMean (SD)S
=ld4'eD di,cri.ina-ion 5KKJ (55*J)
U
5@3@ (55+@)
=.i,,ion, KJ* (+1+)
U
+5K (2J+)
Fal,e Alar., 35J (415) 2@3 (2@K)
Self4EB-ernal di,cri.ina-ion 5*12 (5152)
U
5*J4 (5541)
S-roo0 -e,-
RMean (SD)S
>o-al i-e., 34+J (*25)
U
4KJK (155+)
&n-erference Score

5JK (5+5)
U
543 (51@)
U
0 LV 555@ (,i;nificance -hre,hold af-er !onferroni correc-ion for ,iB co.0ari,on,) co.0ared Di-h con-rol,
SD indica-e, ,-andard de7ia-ion
"able $ 3orrela-ion, be-Deen ,elec-i7e a--en-ion and ,ource .oni-orin; indice,
Correlations
Schizophrenic
Subjects
(N=54)
Controls
(N=42)
R p R p
Selective attention / old-ne
discri!ination "#$$ "#4% -"#$& "#2%
Selective attention / o!issions -"#$4 "#%2 "#"2 "#&"
Selective attention / 'alse alar!s "#"5 "#(2 "#$( "#%"
Selective attention / sel'-e)ternal
discri!ination -"#$5 "#%" -"#"% "#*+
( indica-e, Pear,on correla-ion
%iscussion
Al-hou;h our .e-hodolo;# Da, 7er# ,i.ilar -o -ha- u,ed b# !r/bion e- al

(1**J), De
failed -o re0lica-e -heir findin;, of a ,i;nifican- correla-ion be-Deen ,elec-i7e a--en-ion and
,ource .oni-orin; 7ariable, in ,chizo0hrenic 0a-ien-, A, -o da-e -here i, no ,-andardized -a,k
for .ea,urin; ,ource .oni-orin;, ,o.e difference, eBi,- be-Deen -he .e-hod, u,ed in -he -Do
,-udie, and could eB0lain 0ar- of -he difference, (for eBa.0le our ,ource .oni-orin; -a,k did
no- include 0ic-orial i-e.,) Ano-her 0o,,ible eB0lana-ion i, -he inclu,ion of differen-
,chizo0hrenic ,ubEec-, ,a.0le, Al-hou;h our ,a.0le and -he ,a.0le de,cribed in -he ,-ud# of
!r/bion e- al

(1**J) Dere co.0o,ed of 0a-ien-, Di-h .ild ,#.0-o.,, o-her difference, could
eBi,- (for eBa.0le in -#0e, and do,e, of an-i0,#cho-ic, u,ed, or in -he ,0ecific 0a--ern of
,#.0-o.,) and eB0lain -he di,cordan- findin;,
=ur re,ul-, are concordan- Di-h -he fac- -ha-, Dhen clinical4co;ni-i7e correla-ion, are
eBa.ined, -he -Do defici-, (in ,elec-i7e a--en-ion and in ,ource .oni-orin;) are a,,ocia-ed
Di-h differen- ,#.0-o.a-ic di.en,ion, Selec-i7e a--en-ion correla-e, Di-h -he di,or;ani,a-ion
di.en,ion

(!aB-er and "iddle, 1**@) al-hou;h, a, .en-ioned before, ,ource .oni-orin; i,
linked -o -he 0o,i-i7e ,#.0-o.a-olo;#
Conclusions
=ur re,ul-, ,u;;e,- -ha- -he ,-ud# of ,ource .oni-orin; defici-,, Dhich on one hand are
no- -he re,ul- of ,elec-i7e a--en-ion defici-, and on -he o-her hand are a.on; -he 7er# rare
co;ni-i7e defici-, -o ,hoD an a,,ocia-ion Di-h -he 0o,i-i7e di.en,ion of 0,#cho,i,, de,er7e -o
be 0ur,ued
Ac&nowledgements
The authors thank MJ !ereira-"o#es an$ % &'a$ie (or technica) assistance
The authors a)so thank *on$aMenta) (oun$ation (or technica) su++ort
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di,order in -he cen-ral .oni-orin; of ac-ion !s1cho) Me$ 1*<3+*43J3
9en2ue- 3, Grabbenda. ", Dau-zenber; F, Folle, F, Merckelbach 9 (255+) 3onfu,in;
-hou;h-, and ,0eech< ,ource .oni-orin; and 0,#cho,i, !s1chiatr1 .es 133<+K4J3
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114<342@
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"iddle PF, ';an E>3, Duffield 1, Gho G, Carren AF (2552) Si;n, and S#.0-o., of
P,#cho-ic &llne,, (SSP&)< a ra-in; ,cale /r J !s1chiatr1 1@5<4+4+5
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/ranch3 4ntra#ura) .esearch !ro2ra#< '&M9
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0o,i-i7e ,#.0-o., of ,chizo0hrenia !s1cho+atho)o21 34<1*@4252
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hallucina-ion, 0o2nitive Neuro+s1chiatr112<4KK44*4