Impaired Evidence Integration and Delusions in Schizophrenia

A bias against disconfirmatory evidence (BADE) appears to be related to delusions in schizophrenia. However, preliminary studies have either not used the most comprehensive version of the BADE task, not included a psychiatric control group, and/or have used difference score methodology instead of analyzing all available measures. In the current study a comprehensive version of the BADE task was administered to people with schizophrenia, bipolar disorder and a healthy control group. The BADE task required rating four interpretations of delusion-neutral scenarios three times (in sequence) as increasingly disambiguating information was presented. A principal component analysis (PCA) carried out on all measures determined that two independent cognitive processes appear to combine to determine all responses on the BADE task: Integration of Evidence and Conservatism, with only the former discriminating between the severely delusional schizophrenia group and all other groups. Thus, integration of evidence appears to be functioning sub-optimally in severely delusional schizophrenia patients, resulting in a bias against disconfirmatory evidence (BADE). The cognitive process theorized to be underlying this effect is hypersalience of evidence-hypothesis matches.