People with schizophrenia, a serious and long-lasting mental illness, have problems with perception, cognition, emotion, and behavior that make it hard for them to work and socialize. Schizophrenia is now commonly recognized as a disorder characterized by cognitive impairment, alongside the established clinical manifestations of hallucinations, delusions, and disorganized thinking. Thinking clearly is a big part of the disease, and it can happen at any time. It can even persist with individuals after their physical symptoms have gone away [1-3]. Self-monitoring is the ability to tell the difference between your own thoughts, actions, or speech and those that come from outside sources. It is an important cognitive skill that is not working well in people with schizophrenia. To maintain your sense of agency and capacity to assess reality, self-monitoring is essential. Problems with this mechanism may make positive symptoms of schizophrenia worse, like hearing voices and having delusions of control [4-6]. Experimental and cognitive studies indicate that individuals with schizophrenia have a higher incidence of errors in self-monitoring tasks, such as misattributing their speech or behaviors to others. These deficiencies are linked to irregularities in the temporal and frontal lobes of the brain, which are important for sensory prediction and executive control. Consequently, substantial insights into the cognitive underpinnings of schizophrenia may be derived by comprehending the nature and extent of impairments in self-monitoring [7, 8]. There is a lack of information from clinical settings, particularly in countries with low or medium incomes, despite increasing data from studies. To address this information gap, cross-sectional studies performed in hospitals can evaluate the effectiveness of self-monitoring in individuals with schizophrenia in real-world contexts. Potential implications of these findings encompass the advancement of more accurate techniques for cognitive repair and rehabilitation, as well as the expedited identification of cognitive abnormalities [9, 10]. This study aimed to assess the performance of a clinical cohort of individuals with schizophrenia on a self-monitoring test and to identify any observable patterns of impairment. The study aims to improve our comprehension of cognitive impairment associated with schizophrenia by focusing on self-monitoring capabilities.

This was a hospital-based, cross-sectional study carried out in the psychiatric outpatient and inpatient departments of a tertiary care teaching hospital. This study was conducted at the Department of Psychiatry, Narayana Medical College, Nellore, Andhra Pradesh, India between January 2023 to November 2023. The research was conducted within a specified timeframe following approval from the Institutional Ethics Committee. The study comprised 40 patients diagnosed with schizophrenia, who were continuously recruited from psychiatric facilities throughout the study duration. Diagnostic Criteria and Assessment Tools: Making a diagnosis of schizophrenia based on the criteria outlined by the ICD-10 was the method used. The data was gathered using a systematic proforma that included socio-demographic and clinical details. In order to evaluate self-monitoring ability, participants were asked to distinguish between stimuli that were created internally and those that were created outside. This activity was part of a standardized self-monitoring battery. An individual's efficiency was evaluated by looking at their accuracy scores and error rates. In a peaceful clinical environment, eligible patients were evaluated one-on-one. We followed the established protocols when giving the self-monitoring task. To keep patients from getting too tired, we made sure they got plenty to sleep and only assessed them when they were in a stable clinical state. Inclusion Criteria: • Patients aged 18–60 years. • Diagnosed cases of schizophrenia as per ICD-10 criteria. • Clinically stable patients capable of understanding and performing the task. • Patients who provided informed written consent. Exclusion Criteria: • Presence of comorbid psychiatric disorders other than schizophrenia. • History of neurological illness, head injury, or intellectual disability. • Current substance dependence. • Severe sensory impairment that could interfere with task performance. Statistical Analysis: Microsoft Excel was used for data entry, and the right statistical programs were used for analytical purposes. Clinical and socio-demographic characteristics were summarized using descriptive statistics. For continuous variables, the results were put out as the mean plus or minus the standard deviation. For categorical variables, the results were given as the frequencies and percentages. Where relevant, appropriate statistical tests were used to investigate relationships between self-monitoring performance and clinical characteristics such duration of illness. A p-value less than 0.05 was deemed statistically significant.

The study comprised a total of forty individuals who had been diagnosed with schizophrenia. Five tables detailing the results are provided, detailing the socio-demographic profile, clinical features, and self-monitoring task performance. Table 1: Socio-demographic characteristics of the study participants Variable Category Number (n) Percentage (%) Age (years) 18–30 12 30.0 31–40 16 40.0 41–50 9 22.5 >50 3 7.5 Gender Male 26 65.0 Female 14 35.0 Marital status Married 21 52.5 Unmarried 17 42.5 Separated/Widowed 2 5.0 Table 1 shows that there were more males than females among the patients. Those between the ages of 18 and 30 made up 30% of the sample, while those between the ages of 31 and 40 made up 40%. The percentage of married patients was over 50%. Table 2: Clinical profile of patients with schizophrenia Variable Category Number (n) Percentage (%) Duration of illness ≤5 years 18 45.0 >5 years 22 55.0 Treatment status On regular treatment 29 72.5 Irregular treatment 11 27.5 Predominant symptoms Positive symptoms 19 47.5 Negative symptoms 13 32.5 Mixed symptoms 8 20.0 According to Table 2, more than half of the patients had been sick for more than five years. Almost half of the patients had positive symptoms, and 72.5% were on regular treatment. Table 3: Overall performance on self-monitoring task Performance category Number (n) Percentage (%) Impaired performance 28 70.0 Preserved performance 12 30.0 Total 40 100 The self-monitoring task revealed that 70% of patients had reduced performance, suggesting that people with schizophrenia had considerable deficiencies in this skill (Table 3). Table 4: Accuracy scores on self-monitoring task Accuracy score (%) Number (n) Percentage (%) <50% 9 22.5 50–69% 19 47.5 ≥70% 12 30.0 Mean ± SD 62.4 ± 11.3 Results for the self-monitoring task's accuracy distribution are shown in Table 4. Only 30% of patients were able to attain accuracy scores of 70% or higher, while nearly half (47.5%) scored between 50-69%. The lower task performance was shown by the mean accuracy score of 62.4 ± 11.3%. Table 5: Association between duration of illness and self-monitoring performance Duration of illness Impaired n (%) Preserved n (%) Total ≤5 years (n = 18) 10 (55.6) 8 (44.4) 18 >5 years (n = 22) 18 (81.8) 4 (18.2) 22 Total 28 12 40 Patients with a longer period of disease (>5 years) were more likely to have poor self-monitoring performance (81.8% vs. 55.6%, respectively), as indicated in Table 5.

The majority of the forty schizophrenia patients surveyed in this cross-sectional study had substantial impairment in the cognitive domain of self-monitoring, according to the results. Important clinical phenomena including hallucinations and delusions of control are believed to be underlying fundamental cognitive abnormalities in schizophrenia, which are being more acknowledged as core deficiencies in self-monitoring [11-13]. The self-monitoring task was problematic for 70% of patients in this study, with an average accuracy score of 62.4%, well below the expected normative values. These results corroborate previous studies that shown schizophrenia patients' inability to differentiate between stimuli that originate internally and those that originate outside the brain. These deficiencies provide credence to the idea that pleasant symptoms can result from defective self-monitoring, which in turn causes a person to misattribute their internal feelings [14-16]. A higher prevalence of impairment (81.8%) was seen in individuals whose illnesses had lasted longer than five years compared to those whose illnesses had lasted shorter than five years, indicating a definite relationship between disease length and self-monitoring impairment. This may indicate a gradual decline in cognitive abilities as the disease progresses or as a result of the cumulative impacts of long-term mental health issues. A higher degree of cognitive dysfunction was associated with longer-term schizophrenia, according to earlier research [17-19]. Males with schizophrenia are more likely to seek treatment or have more severe functional impairment, which may explain why 65% of the study's participants were male. The current study did not specifically compare the performance of the sexes on the task, but prior research has shown that cognitive impairments in schizophrenia are not gender-specific but may be affected by the severity and length of the disease [20, 21]. When asked to keep tabs on themselves, patients who reported more pleasant symptoms were more likely to make mistakes attributing them to outside sources. This discovery provides more evidence in favor of cognitive models of schizophrenia, which state that the disorder is caused by malfunctions in the brain's systems for self-monitoring. It is possible to attribute one's own ideas or behaviors to other forces if one has trouble identifying them as such [22]. The fact that self-monitoring deficiencies continued even though most patients were taking their medication as prescribed suggests that traditional pharmaceutical treatment may not be sufficient for dementia. This highlights the importance of supplementary treatments like cognitive remediation therapy and focused psychosocial therapies to enhance executive skills associated with self-monitoring [23]. There are several restrictions on the study. The inability to establish causal linkages is a result of the cross-sectional nature of the study. Normative performance cannot be directly compared due to the lack of a healthy control group. Findings may also not be applicable outside of the hospital setting due to the small sample size and research approach [24].

The results of this study show that self-monitoring abilities are severely impaired in many people with schizophrenia. Patients with more severe positive symptoms and those who had been sick for longer had these deficiencies to a greater extent, indicating a correlation between the basic psychopathology of schizophrenia and malfunction in self-monitoring. It appears that medication alone may not be sufficient to correct cognitive problems, as self-monitoring impairments continued after ongoing pharmaceutical treatment. The cognitive impairment that underlies schizophrenia, as well as the onset and development of symptoms, can be better understood by evaluation of self-monitoring functions. Cognitive performance and functional results could be enhanced with the use of psychosocial therapies that emphasize self-monitoring and incorporate targeted cognitive retraining. If we want to know more about how self-monitoring deficiencies play a role in schizophrenia, we need more longitudinal research with bigger samples that include healthy control groups. Funding None Conflict of Interest: None

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