title: Motivational deficits in early schizophrenia: prevalent, persistent, and key determinants of functional outcome.
abstract: Negative symptoms, in particular motivational deficits, are reported as impediments to functional recovery in patients with schizophrenia. This study examined the prevalence of motivational deficits in patients early in the illness, and the impact these deficits have on community functioning. Patients with schizophrenia between the ages of 18 and 35years, and within 5years of initiating antipsychotic treatment were included in the present investigation (N=166). The impact of motivation and cognition on concurrent and longitudinal functioning was evaluated. Motivational impairments were found in more than 75% of participants, and were not associated with receipt of social support. These deficits served as the most robust and reliable predictor of functional outcome, while neurocognition demonstrated significantly weaker associations with outcome. When considered together, motivational deficits demonstrated a reliable link with concurrent and longitudinal functioning, with cognition not offering any independent predictive value. Moreover, motivation was found to mediate the relationship between cognition and outcome. Changes in motivation were linked to changes in functioning; however, this was not the case for changes in cognitive performance. Motivation emerged as a significant predictor of functioning even after selected demographic and clinical characteristics (e.g., positive symptoms) were accounted for. These data indicate that motivational deficits are prevalent in patients with schizophrenia, even in the early stages of the illness, and these deficits stand as one of the most robust barriers to people with schizophrenia achieving functional recovery. Greater understanding of the mechanisms underlying these deficits is critical to effective treatment innovation.
authors.affiliation: Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada. Electronic address: gagan.fervaha@utoronto.ca.
authors.forename: Gagan
authors.initials: G
authors.lastname: Fervaha
authors.affiliation: Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Foussias
authors.affiliation: Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Ofer
authors.initials: O
authors.lastname: Agid
authors.affiliation: Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Remington
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D009042:Motivation; D015999:Multivariate Analysis; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D020127:Recovery of Function; D012044:Regression Analysis; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Amotivation; Apathy; Avolition; Negative symptoms; Neurocognition; Psychosis; Real-world functional outcome; Social functioning