Neurocognitive predictors of confabulation in Schizophrenia

A systematic and quantitative review


  • Kyrsten M Grimes University of Toronto Scarborough
  • Konstantine K Zakzanis University of Toronto Scarborough



Confabulations, or false memories, are observed in various disorders, including schizophrenia. In forensic psychiatric assessment, this is problematic, particularly when garnering a clinical history and detailed account of the index offense(s) from the individual being charged. This study sought to quantitatively synthesize the existing literature regarding the frequency of confabulations in schizophrenia and its neurocognitive correlates. The keywords “schizophrenia” and “psychosis” were systematically canvassed in combination with “confabulation,” “false memory,” and “false memories” on PsycINFO, PubMed, and Scopus. Inclusion criteria included the following: (1) Participant samples that included the patients with schizophrenia and healthy controls; (2) commercially available neuropsychological test measures were employed (i.e., no experimental paradigms were considered); (3) quantitative data (i.e., means and standard deviations) was available so that an effect size could be computed; (4) published findings in peer-reviewed academic journals and written in English. Studies examining high-risk or first-episode psychosis groups were excluded. Five studies were included in the final analysis. Effect sizes in terms of Cohen’s d were calculated for number of confabulations made. When available, the correlations between confabulation and neurocognitive variables were recorded. The findings suggest that patients with schizophrenia confabulated more than healthy controls for new information if it was related to old information. The relationship between confabulations and neurocognitive variables was inconsistent. Together, the results from this quantitative review has important implications for interviewing techniques in forensic psychiatric assessment. Specifically, the assessor should take great care not to ask leading questions or introduce unverified, contextual information into the interview, as it may result in a confabulation, rather than a more accurate account of the event.


Kramer S, Bryan KL, Frith CD. ‘Confabula-tion’ in narrative discourse by schizophrenic patients. Int J Lang Commun Disord 1998;33(sup1):202-7

Lee J, Folley BS, Gore J, Park S. Origins of spatial working memory deficits in schizo-phrenia: An event-related fMRI and near-infrared spectroscopy study. Plos One 2008;3(3):1-10

Moritz S, Woodward TS. Memory confidence and false memories in schizophrenia. J Nerv Ment Dis 2002;190(9):641-3

Pernot-Marino E, Schuster C, Hedelin G, Berna F, Zimmermann MA, Danion JM. (2010). True and false autobiographical mem-ories in schizophrenia: Preliminary results of a diary study. Psychiatry Res 2010;179(1):1-5

Eifler S, Rausch F, Schirmbeck F, Vecken-stedt R, Mier D, Esslinger C et al. Metamemory in schizophrenia: Retrospective confidence ratings interact with neurocogni-tive deficits. Psychiatry Res 2015;225(3):596-603

Elvevåg B, Fisher JE, Weickert TW, Wein-berger DR, Goldberg TE. Lack of false recognition in schizophrenia: A consequence of poor memory? Neuropsychologia 2004;42(4):546–54

Moritz S, Woodward TS, Rodriguez-Raecke R. Patients with schizophrenia do not pro-duce more false memories than controls but are more confident in them. Psychol Med 2006;36(5):659-67

Roediger HL, McDermott KB. Creating false memories: Remembering words not present-ed in lists. J Exp Psychol Learn Mem Cogn 1995;21(4):803–14

Deese J. On the prediction of occurrence of particular verbal intrusions in immediate re-call. J Exp Psychol 1959;58(1):17–22

Vinogradov S, Willis-Shore J, Poole JH, Mar-ten E, Ober BA, Shenaut GK. Clinical and neurocognitive aspects of source monitoring errors in schizophrenia. Am J Psychiatr 1997; 154(11):1530-7

Moritz S, Woodward TS, Cuttler C, Whitman JC, Watson JM. False memories in schizo-phrenia. Neuropsychol 2004;18(2):276-83

Paz-Alonso PM, Ghetti S, Ramsay I, Solo-mon M, Yoon J, Carter CS et al. Semantic processes leading to true and false memory formation in schizophrenia. Schizophr Res 2013;147(2): 320-5

Peters MJV, Cima MJ, Smeets T, de Vos M, Jelicic M, Merckelbach H. Did I say that word or did you? Executive dysfunctions in schizophrenic patients affect memory effi-ciency, but not source attributions. Cogn Neuropsychiatry 2007;12(5):391-411

Moritz S, Woodward TS, Ruff CC. Source monitoring and memory confidence in schizo-phrenia. Psychol Med 2003;33(1):131-9

Mammarella N, Altamura M, Padalino FA, Petito A, Fairfield B, Bellomo A. False memo-ries in schizophrenia? An imagination inflation study. Psychiatry Res 2010;179(3):267-73

Moritz S, Woodward TS, Jelinek L, Klinge R. Memory and metamemory in schizophrenia: A liberal acceptance account of psychosis. Psychol Med 2008;38(6):825-32

Brébion G, David AS, Ohlsen R, Jones HM, Pilowsky LS. Visual memory errors in schizo-phrenic patients with auditory and visual hal-lucinations. J Int Neuropsychol Soc 2007; 13(5):832–8

Peters MJV, Hauschildt M, Moritz S, Jelinek L. Impact of emotionality on memory and me-ta-memory in schizophrenia using video se-quences. J Behav Ther Exp Psychiatry 2013; 44(1):77-83

Nienow TM, Docherty NM. Internal source monitoring and thought disorder in schizo-phrenia. J Nerv Ment Dis 2004;192(10):696-700

Lorente-Rovira E, Pomarol-Clotet E, McCar-thy RA, Berrios GE, McKenna PJ. Confabula-tion in schizophrenia and its relationship to clinical and neuropsychological features of the disorder. Psychol Med 2007;37(10):1403-12

Lorente-Rovira E, Santos-Gomez JL, Moro M, Villagran JM, McKenna PJ. Confabulation in schizophrenia: A neuropsychological study. J Int Neuropsychol Soc 2010;16(6):1018-26

Moritz S, Woodward TS, Whitman JC, Cut-tler C. Confidence in errors as a possible ba-sis for delusions in schizophrenia. J Nerv Ment Dis 2005;193(1):9-16

Salazar-Fraile J, Tabares-Seisdedos R, Sel-va-Vera G, Balanza-Martinez V, Martınez-Arn A, Catalan J et al. Recall and recognition confabulation in psychotic and bipolar disor-ders: Evidence for two different types without unitary mechanisms. Compr Psychiatry 2004;45(4): 281-8

Brebion G, Gorman JM, Malaspina D, Ama-dor X. A model of verbal memory impair-ments in schizophrenia: Two systems and their associations with underlying cognitive processes and clinical symptoms. Psychol Med 2005;35(1): 133-42

Weiss AP, Goff DC, Duff M, Roffman JL, Schacter DL. Distinguishing familiarity-based from source-based memory performance in patients with schizophrenia. Schizophr Res 2008; 99(1):208-17

Geisler D, Walton E, Naylor M, Roessner V, Lim KO, Schulz SC, et al. Ehrlich S. Brain structure and function correlates of cognitive subtypes in schizophrenia. Psychiatry Res 2015;234(1):74-83

Erol A, Bayram S, Kosger F, Mete L. Execu-tive functions in patients with familial versus sporadic schizophrenia and their parents. Neuropsychobiology 2012;66(2):93-9

Corigliano V, De Carolis A, Trovini G, Dehning J, Di Pietro S, Curto M et al. Com-parelli A. Neurocognition in schizophrenia: From prodrome to multi-episode illness. Psy-chiatry Res 2014; 220(1-2):129-34

Jahshan C, Heaton RK, Golshan S, Caden-head KS. Course of neurocognitive deficits in the prodrome and first episode of schizophre-nia. Neuropsychology 2010;24(1):109-20

Lezak MD. IQ: R.I.P. J Clin Exp Neuropsy-chol 1988;10(3):351-61

Cohen J. Statistical Power Analysis for the Behavioural Sciences (2nd ed). Hillsdale, NJ: Lawrence Erlbaum Associates, 1988

Zakzanis KK. Statistics to tell the truth, the whole truth, and nothing but the truth: Formu-lae, illustrative numerical examples, and heu-ristic interpretation of effect size analyses for neuropsychological researchers. Arch Clin Neuropsychol 2001;16(7):653–67

Huron C, Danion JM. Impairment of con-structive memory in schizophrenia. Int Clin Psychopharmacol 2002;17(3):127-33

Huron C, Danion JM, Giacomoni F, Grangé D, Robert P, Rizzo L. Impairment of recogni-tion memory with, but not without, conscious recollection in schizophrenia. Am J Psychia-try 1995;152(12):1737-42




How to Cite

Grimes, K. M., & Zakzanis, K. K. (2018). Neurocognitive predictors of confabulation in Schizophrenia: A systematic and quantitative review. International Journal of Risk and Recovery, 1(2), 23-31.