Understanding source monitoring subtypes and their relation to psychosis: a systematic review and meta-analysis
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AIMS: Source monitoring (SM) is the metacognitive ability to determine the origin of one's experiences. SM is altered in primary psychiatric psychosis, although relationships between SM subtypes, other cognitive domains and symptoms are unclear. Our aims were to synthesize evidence comparing psychosis -with and without hallucinations- and healthy controls classifying SM subtypes by source discrimination (internal/external/reality monitoring) and stimulus modality (visual/auditory/imagined/performed). METHODS: This systematic review adopted Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Meta-analyses Of Observational Studies in Epidemiology and Population, Intervention, Comparison and Outcomes guidelines. Core demographical and clinical parameters were extracted. Newcastle-Ottawa Scale was used as quality check. SM differences between (i) psychosis patients versus healthy controls and (ii) patients with versus without hallucinations were investigated via random-effect model meta-analysis. The primary effect size measure was standardized mean difference (SMD) in each SM subtype performance (error or accuracy). Heterogeneity, publication biases and meta-regressions were assessed. RESULTS: Five thousand two hundred and fifty-six records were screened to finally include 44 studies (1566 patients, 1175 controls). Mean Newcastle-Ottawa score was 7.41 out of 9. Few studies measured SM associations with cognition (n = 9) and symptoms (n = 19), with heterogeneous findings. SM performance across all measures was reduced in psychosis versus healthy controls (SMD = 0.458). Internal SM (SMD: errors = 0.513; accuracy = 0.733) and imagined stimuli (SMD: errors = 0.688; accuracy = 0.978) were specifically impaired. Patients with versus without hallucinations showed SM deficits only for externalizing (SMD = 0.410) and imagined/auditory (SMD = 0.498/0.277) errors. CONCLUSION: The proposed classifications highlight specific SM deficits for internal/imagined stimuli in psychosis, providing evidence-based indications to design and interpret future studies.
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Alterations of brain predictive mechanisms, specifically decreased precision in prior beliefs and sensory perception, may contribute to the formation of delusions and hallucinations.
“alterations of brain predictive mechanisms (i.e., decreased precision in both prior beliefs and sensory perception) may contribute to the formation of delusions and halluci nations (Damiani et al., 2022, 2024; Sterzer et al., 2018).”
From Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review. (2025) · cites this paper as Damiani et al., 2022
The Discussion section on source discrimination and stimulus modality (page unavailable) says that the predictive-coding hypothesis treats unreliable prior beliefs or perceptions as features of psychosis. The section on hallucinations links source-monitoring errors to hallucinations. But the paper does not establish decreased precision in both priors and sensory perception as a mechanism for forming both delusions and hallucinations; its Limitations section says delusions were not considered in its classification. (LLM, conf=0.86)
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Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review.
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“Consistent with previous literature, alterations of brain predictive mechanisms (i.e., decreased precision in both prior beliefs and sensory perception) may contribute to the formation of delusions and hallucinations (Damiani et al., 2022, 2024; Sterzer et al., 2018).”
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Self-citation
- Authors
- Damiani, S., Donadeo, A., Bassetti, N., Salazar‐de‐Pablo, G., Guiot, C., Politi, P., & Fusar‐Poli, P.
- Affiliations
- University of Pavia (IT)
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies Institute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- King's College London (GB)
- Corresponding author
- Damiani, Stefano
- ORCID
- Venue
- Psychiatry and Clinical Neurosciences
- Publisher
- Wiley
- Published
- 2022-03
- Volume
- 76
- Issue
- 5
- Pages
- 162-171
- ISSN
- 1323-1316 (ISSN-L)
- 1440-1819
- PMC
- PMC9313862
- OpenAlex
- W4210755278
- Cited by
- 31
- References
- 90
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 9 · 2023: 7 · 2022: 3
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychiatry and Clinical Neurosciences (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Funders
- Fundación Alicia Koplowitz
- Sunovion
- Angelini Pharma
- H. Lundbeck A/S
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- source monitoring, psychosis, hallucinations, metacognition, source discrimination, internal stimuli, auditory hallucinations, visual hallucinations
- MeSH terms
- Metacognition, Cognition, Hallucinations, Humans, Psychotic Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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