Executive dysfunctions differentially predict amotivation in first-episode schizophrenia-spectrum disorder: a prospective 1-year follow-up study

  • Wing Chung ChangEmail author
  • Jasmine Tsz Ting Liu
  • Christy Lai Ming Hui
  • Sherry Kit Wa Chan
  • Edwin Ho Ming Lee
  • Yi Nam Suen
  • Eric Yu Hai Chen
Original Paper


Amotivation is a major determinant of functional outcome in schizophrenia but it is understudied in the early course of illness. There is a paucity of longitudinal research investigating predictors of amotivation. In this study, we aimed to examine baseline cognitive and clinical predictors of amotivation at 6 and 12 months of follow-up in patients aged 18–55 years presenting with first-episode DSM-IV schizophrenia-spectrum disorder (FES). Of 145 patients recruited at intake, 116 and 113 completed assessments at 6- and 12-month follow-up, respectively. Amotivation was measured by avolition-apathy and anhedonia-asociality subscale scores of the Scale of the Assessment of Negative Symptoms. Cognitive assessment was administered at baseline. As executive dysfunction has been more consistently found to be associated with negative symptoms and amotivation in prior literature, we adopted fractionated approach to subdivide executive function into distinct components encompassing switching and flexibility, response initiation, response inhibition, planning and strategy allocation, sustained attention and working memory. Our results showed that baseline amotivation (p = 0.01) and switching and flexibility (p = 0.01) were found to independently predict amotivation at 6 months follow-up. Baseline amotivation (p < 0.01) and switching and flexibility (albeit with trend-wise significance, p = 0.06) were also retained in final multivariate regression model for 12-month amotivation prediction. No other executive components or cognitive domains predicted amotivation at follow-up. Findings of our study thus indicate amotivation at initial presentation as a critical determinant of subsequent motivational deficits over 1 year of treatment for FES patients. Cognitive flexibility might be specifically related to the development of amotivation in the early stage of illness.


Amotivation Executive function Fractionation Cognitive flexibility Switching First-episode schizophrenia 



This study was supported by the grant from Health and Medical Research Fund (SMH-47) by Food and Health Bureau, the Hong Kong SAR Government. The funding body had no involvement in any aspect of the study or manuscript preparation. We thank all the coordinating clinicians and staff from the participating hospitals, clinics and medical records departments for their kind assistance. We are also grateful to the individuals who participated in the study.

Compliance with ethical standards

Conflict of interest

Author E.Y.H.C. has participated in the paid advisory board for Otsuka, has received educational grant support from Janssen-Cilag, and has received research funding from Astra-Zeneca, Janssen-Cilag, Eli Lilly, Sanofi-Aventis and Otsuka. E.H.M.L has been a member of the paid advisory boards for Eli Lilly and AstraZeneca. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Supplementary material

406_2018_918_MOESM1_ESM.docx (168 kb)
Supplementary material 1 (DOCX 167 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Wing Chung Chang
    • 1
    • 2
    Email author
  • Jasmine Tsz Ting Liu
    • 1
  • Christy Lai Ming Hui
    • 1
  • Sherry Kit Wa Chan
    • 1
    • 2
  • Edwin Ho Ming Lee
    • 1
  • Yi Nam Suen
    • 1
  • Eric Yu Hai Chen
    • 1
    • 2
  1. 1.Department of PsychiatryThe University of Hong KongPokfulamHong Kong
  2. 2.State Key Laboratory of Brain and Cognitive SciencesThe University of Hong KongPokfulamHong Kong

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