Amotivation and functional outcomes in early schizophrenia
Introduction
Since the early writings of Emil Kraepelin, avolition (i.e. amotivation/apathy) has been considered to be core to the schizophrenic syndrome and its course (Kraepelin, 1919). These symptoms are persistent, refractory to current treatments and contribute significantly to functional decline (Kirkpatrick et al., 2006).
Within the negative symptom domain, amotivation or apathy (terms are used interchangeably) has figured a prominent role in predicting outcomes (Foussias and Remington, 2010). Recent investigations have confirmed a key role of amotivation/apathy in predicting functional outcomes (both cross-sectionally and longitudinally) in first-episode (Faerden et al., 2009, Faerden et al., 2010) and chronic populations (Kiang et al., 2003, Foussias et al., 2011, Konstantakopoulos et al., 2011). These reports are in line with previous findings indicating negative symptoms in general predict functional outcomes over and above the contributions of other symptoms such as psychosis, depression and cognition (Pogue-Geile and Harrow, 1985, Ho et al., 1998, Milev et al., 2005, Evensen et al., 2012, Rabinowitz et al., 2012). However, these studies have not yet explored the relationship between amotivation specifically and functional outcomes in stable early course schizophrenia patients. Although negative symptoms can be validly assessed in patients with first-episode psychosis (Faerden et al., 2008), there are nonetheless some conceptual challenges; for example, apathy within a first-episode psychosis sample seems to differ based on diagnosis (e.g. schizophrenia-spectrum versus psychosis not-otherwise-specified) (Faerden et al., 2009), is quite unstable during the initial year of treatment (Chang et al., 2011), and is an unreliable predictor of apathy during clinical stability (Evensen et al., 2012).
Studying early course rather than chronic, patients also indirectly minimises potential confounds such as chronic disease effects, extended institutionalisation and stigma to name a few (Grant and Beck, 2009, Lysaker et al., 2009). Hence, we set out examine the impact of amotivation in predicting functional outcomes, while controlling for other clinical variables, in patients with schizophrenia early in the disease course.
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Participants
Seventeen outpatients with a DSM-IV-TR diagnosis of schizophrenia, confirmed using medical records and the Mini International Neuropsychiatric Interview – Plus edition (Sheehan et al., 1998), participated in the present study. Patients were recruited from outpatients clinics at the Centre for Addiction and Mental Health, Toronto, Canada. All patients were tested while on a stable dose of antipsychotic medication, with no changes for at least four weeks. Patients were included in the study if
Results
Demographic and clinical information of the study sample are reported in Table 1. Bivariate correlations between the functioning measures and AES-C are depicted in Fig. 1, while relationships with other clinical variables are reported in Table 2. Partial correlations between apathy and functioning, controlling for duration of illness and AES-C rater, did not alter the results (QLS-A: r=−0.65, p=0.01; SOFAS: r=−0.56, p=0.03). Furthermore, restricting our sample to individuals whose duration of
Discussion
The present study examined the impact of amotivation on functional outcomes in individuals with schizophrenia who are relatively early in their disease course. Our results reveal amotivation as the chief predictor of functioning, consistent with and partially replicating previous findings from first-episode (Faerden et al., 2009, Faerden et al., 2010) and chronic samples (Kiang et al., 2003, Foussias et al., 2011, Konstantakopoulos et al., 2011). This suggests that apathy is intimately tied
Acknowledgements
The authors thank the clinical staff at the Centre for Addiction and Mental Health for assistance with participant recruitment.
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2019, European NeuropsychopharmacologyCitation Excerpt :Of course, this implication needs further testing. As to the impact of negative symptoms on patients’ functional outcome, several studies confirmed that in particular the avolition\asociality factor (including all or some of the domains of avolition, asociality and anhedonia) is a stronger predictor than the expressive deficit factor, which includes alogia and blunted affect (Fervaha et al., 2013; Galderisi et al., 2014; Green et al., 2012; Harvey et al., 2017; Rocca et al., 2014; Ventura et al., 2015). However, the factor extracted using the PANSS often included items which are not core negative symptoms and might overlap with positive and disorganization dimensions or cognitive dysfunctions (e.g., G16-Active social avoidance that rates the avoidance of social contacts due to positive symptoms or anxiety, or G13-Avolition which rates the indecisiveness in engaging in goal-directed action due to disorganization or cognitive impairment).