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Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis

Published online by Cambridge University Press:  03 February 2017

W.C. Chang ,
V.W.Y. Kwong ,
G.H.K. Chan ,
O.T.T. Jim ,
E.S.K. Lau ,
C.L.M. Hui ,
S.K.W. Chan ,
E.H.M. Lee  and
E.Y.H. Chen
W.C. Chang*
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
V.W.Y. Kwong
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
G.H.K. Chan
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
O.T.T. Jim
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
E.S.K. Lau
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
C.L.M. Hui
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
S.K.W. Chan
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
E.H.M. Lee
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
E.Y.H. Chen
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
*
⁎Corresponding author at: Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. Tel.: +852 22554486; fax: +852 28551345. E-mail address: changwc@hku.hk (W.C. Chang).
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Abstract

Background

Amotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI).

Methods

One hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments.

Results

Amotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation.

Conclusion

Our findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation.

Keywords

AvolitionMotivational impairmentNegative symptomsDiminished expressionEarly psychosis
Type
Original article
Information
European Psychiatry , Volume 41 , Issue 1 , March 2017 , pp. 37 - 41
Copyright
Copyright © European Psychiatric Association 2017

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References

Malaspina, D.Walsh-Messinger, J.Gaebel, W.Smith, L.M.Gorun, A.Prudent, V.et al.Negative symptoms, past and present: a historical perspective and moving to DSM-5. Eur Neuropsychopharm 2014;24:710–724.CrossRefGoogle ScholarPubMed
Milev, P.Ho, B.C.Arndt, S.Andreasen, N.C.Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry 2005;162:495–506.CrossRefGoogle ScholarPubMed
Austin, S.F.Mors, O.Secher, R.G.Hjorthoj, C.R.Albert, N.Bertelsen, M.et al.Predictors of recovery in first episode psychosis: the OPUS cohort at 10 years follow-up. Schizophr Res 2013;150:163–168.CrossRefGoogle Scholar
Messinger, J.W.Tremeau, F.Antonius, D.Avolition and expressive deficits capture negative symptom phenomenology: implications for DSM-5 and schizophrenia research. Clin Psychol Rev 2011;31:161–168.CrossRefGoogle ScholarPubMed
Kelley, M.E.Haas, G.L.van Kammen, D.P.Longitudinal progression of negative symptoms in schizophrenia: a new look at an old problem. Schizophr Res 2008;105:188–196.CrossRefGoogle Scholar
Fervaha, G.Foussias, G.Agid, O.Remington, G.Motivational deficits in early schizophrenia: prevalent, persistent, and key determinants of functional outcome. Schizophr Res 2015;166:9–16.CrossRefGoogle ScholarPubMed
Norman, R.M.G.Manchanda, R.Harricharan, R.Northcott, S.The course of negative symptoms over the first five years of treatment: data from an early intervention program for psychosis. Schizophr Res 2015;169:412–417.CrossRefGoogle Scholar
Foussias, G.Mann, S.Zakzanis, K.K.van Reekum, R.Remington, G.Motivational deficits as the central link to functioning in schizophrenia: a pilot study. Schizophr Res 2009;115:333–337.CrossRefGoogle ScholarPubMed
Foussias, G.Mann, S.Zakzanis, K.K.van Reekum, R.Agid, O.Remington, G.Prediction of longitudinal functional outcomes in schizophrenia: the impact of baseline motivational deficits. Schizophr Res 2011;132:24–27.CrossRefGoogle ScholarPubMed
Konstantakopoulos, G.Ploumpidis, D.Oulis, P.Patrikelis, P.Soumani, A.Papadimitriou, G.N.et al.Apathy, cognitive deficits and functional impairment in schizophrenia. Schizophr Res 2011;133:193–198.CrossRefGoogle Scholar
Strauss, G.P.Horan, W.P.Kirkpatrick, B.Fischer, B.A.Keller, W.R.Miski, P.et al.Deconstructing negative symptoms of schizophrenia: avolition-apathy and diminished expression clusters predict clinical presentation and functional outcome. J Psychiatr Res 2013;47:783–790.CrossRefGoogle ScholarPubMed
Fervaha, G.Foussias, G.Agid, O.Remington, G.Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia. Acta Psychiatr Scand 2014;130:290–299.CrossRefGoogle Scholar
Galderisi, S.Rossi, A.Rocca, P.et al.The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 2014;13:275–287.CrossRefGoogle ScholarPubMed
Faerden, A.Friis, S.Agartz, I.Barrett, E.A.Nesvåg, R.Finset, A.et al.Apathy and functioning in first-episode psychosis. Psychiatr Serv 2009;60:1495–1503.CrossRefGoogle ScholarPubMed
Faerden, A.Barrett, E.A.Nesvag, R.Agartz, I.Barrett, E.A.Nesvåg, R.et al.Apathy, poor verbal memory and male gender predict lower psychosocial functioning one year after the first treatment of psychosis. Psychiatry Res 2013;210:55–61.CrossRefGoogle ScholarPubMed
Chang, W.C.Hui, C.L.M.Chan, S.K.W.Lee, E.H.M.Chen, E.Y.N.Impact of avolition and cognitive impairment on functional outcome in first-episode schizophrenia-spectrum disorder: a prospective one-year follow-up study. Schizophr Res 2016;170:318–321.CrossRefGoogle ScholarPubMed
Wunderink, L.Sytema, S.Nienhuis, F.J.Wiersma, D.Clinical recovery in first-episode psychosis. Schizophr Bull 2009;35:362–369.CrossRefGoogle ScholarPubMed
Chang, W.C.Tang, J.Y.M.Hui, C.L.M.Lam, M.M.Chan, S.K.Wong, G.H.et al.Prediction of remission and recovery in young people presenting with first-episode psychosis in Hong Kong: a 3-year follow-up study. Aust N Z J Psychiatry 2012;46:100–108.CrossRefGoogle Scholar
Chang, W.C.Hui, C.L.M.Tang, J.Y.M.Wong, G.H.Lam, M.M.Chan, S.K.et al.Persistent negative symptoms in first-episode schizophrenia: a prospective three-year follow-up study. Schizophr Res 2011;133:22–28.CrossRefGoogle ScholarPubMed
Ventura, J.Subotnik, K.L.Gitlin, M.J.Negative symptoms and functioning during the first year after a recent onset of schizophrenia and 8 years later. Schizophr Res 2015;161:407–413.CrossRefGoogle ScholarPubMed
Foussias, G.Remington, G.Negative symptoms in schizophrenia: avolition and Occam's razor. Schizophr Bull 2010;36:359–369.CrossRefGoogle ScholarPubMed
Faerden, A.Finset, A.Friis, S.et al.Apathy in first episode psychosis patients: one year follow up. Schizophr Res 2010;116:20–26.CrossRefGoogle ScholarPubMed
Evensen, J.Rossberg, J.I.Barder, H.Haahr, U.Hegelstad, W.Joa, I.et al.Apathy in first episode psychosis patients: a ten-year longitudinal follow-up study. Schizophr Res 2012;136:19–24.CrossRefGoogle ScholarPubMed
Tang, J.Y.M.Wong, G.H.Y.Hui, C.L.M.Lam, M.M.Chiu, C.P.Chan, S.K.et al.Early intervention for psychosis in Hong Kong: the EASY programme. Early Interv Psychiatry 2010;3:214–219.CrossRefGoogle Scholar
Chang, W.C.Chan, G.H.K.Jim, O.T.T.Lau, E.S.K.Hui, C.L.M.Chan, S.W.K.et al.Optimal duration of an early intervention programme for first-episode psychosis: randomised controlled trial. Br J Psychiatry 2015;206:492–500.CrossRefGoogle ScholarPubMed
Melau, M.Jeppesen, P.Thorup, A.Bertelsen, M.Petersen, L.Gluud, C.et al.The effect of five years versus two years of specialized assertive intervention for first episode psychosis: OPUS II: study protocol for a randomized controlled trial. Trials 2011;12:72.CrossRefGoogle ScholarPubMed
Lutgens, D.Iyer, S.Joober, R.Brown, T.G.Norman, R.Latimer, E.et al.A five-year randomized parallel and blinded clinical trial of an extended specialized early intervention vs. regular care in the early phase of psychotic disorders: study protocol. BMC Psychiatry 2015;15:22.CrossRefGoogle ScholarPubMed
Chang, W.C.Kwong, V.W.Y.Chan, G.H.K.Jim, O.T.T.Lau, E.S.K.Hui, C.L.M.et al.Prediction of functional remission in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong. Schizophr Res 2016;173:79–83.CrossRefGoogle ScholarPubMed
So, E.Kam, I.Leung, C.M.Chung, D.Liu, Z.Fong, S.The Chinese-bilingual SCID-I/P Project: Stage 1: reliability for mood disorders and schizophrenia. HK J Psychiatry 2003;13:7–18.Google Scholar
Cannon-Spoor, H.E.Potkin, S.G.Wyatt, R.J.Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull 1982;8:470–484.CrossRefGoogle ScholarPubMed
Hafner, H.Riecher-Rossler, A.Hambrecht, M.Maurer, K.Meissner, S.Schmidtke, A.et al.IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophr Res 1992;6:209–223.CrossRefGoogle ScholarPubMed
Kay, S.R.Opler, L.A.Fiszbein, A.Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.CrossRefGoogle Scholar
Addington, D.Addington, J.Schissel, B.A depression rating scale for schizophrenics. Schizophr Res 1990;3:247–251.CrossRefGoogle ScholarPubMed
Lam, M.Rashid, N.A.A.Lee, S.A.Lim, J.Foussias, G.Fervaha, G.et al.Baseline social amotivation predicts 1-year functioning in UHR subjects: a validation and prospective investigation. Eur Neuropsychopharm 2015;25:2187–2196.CrossRefGoogle ScholarPubMed
Thompson, K.Kulkarni, J.Sergejew, A.A.Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res 2000;42:241–247.CrossRefGoogle ScholarPubMed
Hair, J.F.Black, W.C.Babin, B.J.Anderson, R.E.Multivariate data analysis, 7th ed., Upper Saddle River, New Jersey: Prentice Hall; 2010.Google Scholar
Thorup, A.Petersen, L.Jeppesen, P.Ohlenschlaeger, J.Christensen, T.Krarup, G.et al.Integrated treatment ameliorates negative symptoms in first episode psychosis: results from the Danish OPUS trial. Schizophr Res 2005;79:95–105.CrossRefGoogle ScholarPubMed
Fusar-Poli, P.Papanastasiou, E.Stahl, D.Stahl, D.Rocchetti, M.Carpenter, W.et al.Treatment of negative symptoms in schizophrenia: meta-analysis of 160 randomized placebo-controlled trials. Schizophr Bull 2015;41:892–899.CrossRefGoogle Scholar
Green, M.Hellemann, G.Horan, W.P.Lee, J.Wynn, J.K.From perception to functional outcome in schizophrenia: modeling the role of ability and motivation. Arch Gen Psychiatry 2012;69:1216–1224.CrossRefGoogle ScholarPubMed
Ventura, J.Subotnik, K.L.Ered, A.Gretchen-Doorly, D.Hellemann, G.S.Vaskinn, A.et al.The relationship of attitudinal beliefs to negative symptoms, neurocognition, and daily functioning in recent-onset schizophrenia. Schizophr Bull 2014;40:1308–1318.CrossRefGoogle ScholarPubMed
Blanchard, J.J.Cohen, A.S.The structure of negative symptoms within schizophrenia: implications for assessment. Schizophr Bull 2006;32:238–245.CrossRefGoogle ScholarPubMed
Malla, A.K.Takhar, J.J.Norman, R.M.G.Manchanda, R.Cortese, L.Haricharan, R.et al.Negative symptoms in first episode non-affective psychosis. Acta Psychiatr Scand 2002;105:431–439.CrossRefGoogle ScholarPubMed
Ergul, C.Ucok, A.Negative symptom subgroup have different effects on the clinical course of schizophrenia after the first episode: a 24-month follow up study. Eur Psychiatry 2015;30:14–19.CrossRefGoogle Scholar
Marin, R.S.Biedrzycki, R.C.Firinciogullari, S.Reliability and validity of the Apathy Evaluation Scale. Psychiatry Res 1991;38:143–162.CrossRefGoogle ScholarPubMed
Roth, R.M.Flashman, L.A.Saykin, A.J.McAllister, T.W.Vidaver, R.Apathy in schizophrenia: reduced frontal lobe volume and neuropsychological deficits. Am J Psychiatry 2004;161:157–159.CrossRefGoogle ScholarPubMed
Grant, P.M.Beck, A.T.Defeatist belief as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophr Bull 2009;35:798–806.CrossRefGoogle Scholar
Marder, S.R.Davis, J.M.Chouinard, G.The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American Trials. J Clin Psychiatry 1997;58:538–546CrossRefGoogle ScholarPubMed
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