Motivation deficits significantly predict poor functional outcomes in early schizophrenia

Key message: Motivational deficits are prevalent in patients with schizophrenia, and correlate significantly with each domain of functioning examined (global functional outcome, social functioning, role functioning, and number of days worked in the past 30 days). These deficits are prevalent even in the early stages of the illness, and represent one of the most robust barriers to people with schizophrenia achieving functional recovery.^{[Fervaha et al., 2015]}

Motivation is defined as the energy, direction, persistence, and intentionality that direct biological, cognitive, and psychological functioning.^{[Sian & Tan, 2012; Ryan & Deci, 2000]}
Social amotivation is comprised of asociality and apathy, and is a core negative symptom of schizophrenia, possibly caused by a disruption in reward functioning, and characterized by reduced ability to anticipate and/or experience pleasure.^{[Horton et al., 2014; Foussias & Remington, 2010]}

Background^{[Fervaha et al., 2015]}

• This study examined the prevalence of motivational deficits in patients early in the illness, and the impact these deficits have on community functioning.
• 166 patients with schizophrenia (aged 18–35 years) and within 5 years of initiating antipsychotic treatment were included. First-episode patients were excluded. Data were collected as part of the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) schizophrenia study.
• The primary measure of interest was the Heinrichs–Carpenter Quality of Life Scale (QLS). Motivation was evaluated using the sum of 3 items from the intrapsychic foundations subscale of the QLS: curiosity, goal-directed motivation and sense of purpose.
• In the sample of patients with early schizophrenia, 15.1% experienced severe deficits in motivation and 76.5% had some degree of motivational impairment. Changes in motivation were linked to changes in functioning; however, this was not the case for changes in cognitive performance.
• Motivational deficits are prevalent in patients with schizophrenia and demonstrate a pervasive effect on patient functioning, impacting each domain of functioning examined.
• A social amotivation score was derived by summing the following items from the Positive and Negative Syndrome Scale (PANSS): emotional withdrawal, passive apathetic withdrawal and active social avoidance.
• Motivation was evaluated using the sum of 3 items from the intrapsychic foundations subscale of the QLS: curiosity, goal-directed motivation and sense of purpose.
• Neurocognition was evaluated using a battery of assessments, which were converted into standardized scores and combined to construct five domain scores: verbal memory, vigilance, processing speed, reasoning and problem-solving, and working memory. These were standardized and averaged to create a neurocognitive composite score.

References:
Fervaha G, et al. Schizophr Res. 2015; 166:9–16.

Sian PC, Tan SH. IPEDR. 2012. (56):89.

Ryan & Deci. Am Psychol. 2000; 55:68–78.

Horton LE, et al. Schizophr Res. 2014; 159(1):27–30.

Foussias & Remington. Schizophr Bull. 2010; 36(2): 359–369.