Skip to main content
SpringerLink
Log in

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

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bowie CR, Reichenberg A, Patterson TL, Heaton RK, Harvey PD (2006) Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry 163:418–425

    Article  PubMed  Google Scholar 

  2. Messinger JW, Tremeau F, Antonius D (2011) Avolition and expressive deficits capture negative symptom phenomenology: implications for DSM-5 and schizophrenia research. Clin Psychol Rev 31:161–168

    Article  PubMed  Google Scholar 

  3. Fervaha G, Foussias G, Agid O, Remington G (2015) Motivational deficits in early schizophrenia: prevalent, persistent, and key determinants of functional outcome. Schizophr Res 166:9–16

    Article  PubMed  Google Scholar 

  4. Norman RMG, Manchanda R, Harricharan R, Northcott S (2015) The course of negative symptoms over the first five years of treatment: data from an early intervention program for psychosis. Schizophr Res 169:412–417

    Article  PubMed  Google Scholar 

  5. Faerden A, Finset A, Friis S et al (2010) Apathy in first-episode psychosis patients: one year follow-up. Schizophr Res 116:20–26

    Article  PubMed  Google Scholar 

  6. Foussias G, Mann S, Zakzanis KK, van Reekum R, Agid O, Remington G (2011) Prediction of longitudinal functional outcomes in schizophrenia: the impact of baseline motivational deficits. Schizophr Res 132:24–27

    Article  CAS  PubMed  Google Scholar 

  7. Barrett EA, Barrett EA, Nesvåg R et al (2013) Apathy, poor verbal memory and male gender predict lower psychosocial functioning one year after the first treatment of psychosis. Psychiatry Res 210:55–61

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fervaha G, Foussias G, Agid O, Remington G (2014) Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia. Acta Psychiatr Scand 130:290–299

    Article  CAS  PubMed  Google Scholar 

  9. Galderisi S, Rossi A, Rocca P et al Italian Network For Research on Psychoses (2014) The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 13:275–287

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chang WC, Hui CLM, Chan SKW, Lee EHM, Chen EYH (2016) Impact of avolition and cognitive impairment on functional outcome in first-episode schizophrenia-spectrum disorder: a prospective one-year follow-up study. Schizophr Res 170:318–321

    Article  PubMed  Google Scholar 

  11. Chang WC, Kwong VWY, Hui CLM, Chan SKW, Lee EHM, Chen EYH (2017) Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: a structural equation modeling approach. Psychol Med 47:755–765

    Article  CAS  PubMed  Google Scholar 

  12. Heinrichs RW, Zakzanis KK (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12:426–445

    Article  CAS  PubMed  Google Scholar 

  13. Dominguez MDG, Viechtbauer W, Simons CPJ, van Os J, Krabbendam L (2009) Are psychotic psychopathology and neurocognition orthogonal? A systematic review of their associations. Psychol Bull 135:157–171

    Article  Google Scholar 

  14. Nieuwenstein MR, Aleman A, de Haan EHF (2001) Relationship between symptom dimensions and neurocognitive functioning in schizophrenia: a meta-analysis of WCST and CPT studies. J Psychiatr Res 35:119–125

    Article  CAS  PubMed  Google Scholar 

  15. Dibben CRM, Rice C, Laws K, McKenna PJ (2009) Is executive impairment associated with schizophrenic syndromes? A meta-analysis. Psychol Med 39:381–392

    Article  CAS  PubMed  Google Scholar 

  16. Norman DA, Shallice T (1986) Attention to action: willed and automatic control of behavior. In Davidson RJ, Schwartz GE, Shapiro D (eds) Consciousness and self-regulation: advances in research and theory. Plenum, New York, pp 1–18

    Google Scholar 

  17. Shallice T (1988) From neuropsychology to mental structure. Cambridge University Press, Cambridge

    Book  Google Scholar 

  18. Gilbert SJ, Burgess PW (2008) Executive function. Curr Biol 18:110–114

    Article  CAS  Google Scholar 

  19. Donohoe G, Robertson IH (2003) Can specific deficits in executive functioning explain the negative symptoms of schizophrenia? A review. Neurocase 9:97–108

    Article  CAS  PubMed  Google Scholar 

  20. Chan RCK, Toulopoulou T (2006) Fractionation of executive function in schizophrenia: relationships to clinical and neurological manifestations. In: French DP (ed) Schizophrenic psychology: new research. Nova Science, New York, pp 1–39

    Google Scholar 

  21. Cella M, Preti A, Edwards C, Dow T, Wykes T (2017) Cognitive remediation for negative symptoms of schizophrenia: a network meta-analysis. Clin Psychol Rev 52:43–51

    Article  PubMed  Google Scholar 

  22. Farreny A, Augado J, Ochoa S, Haro JM, Usall J (2013) The role of negative symptoms in the context of cognitive remediation for schizophrenia. Schizophr Res 150:58–63

    Article  PubMed  Google Scholar 

  23. Mezquida G, Cabrera B, Bioque M et al (2017) The course of negative symptoms in first-episode schizophrenia and its predictors: a prospective two-year follow-up study. Schizophr Res 189:84–90

    Article  PubMed  Google Scholar 

  24. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  25. So E, Kam I, Leung CM, Chung D, Liu Z, Fong S (2003) The Chinese-bilingual SCID-I/P Project: Stage 1: reliability for mood disorders and schizophrenia. HK J Psychiatry 13:7–18

    Google Scholar 

  26. Hafner H, Riecher-Rossler A, Hambrecht M et al (1992) IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophr Res 6:209–223

    Article  CAS  PubMed  Google Scholar 

  27. Kay SR, Opler LA, Fiszbein A (1987) Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    Article  CAS  PubMed  Google Scholar 

  28. Emsley R, Rabinowitz J, Torreman M, the RIS-INT-35 Early Psychosis Global Working Group (2003) The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis. Schizophr Res 61:47–57

    Article  PubMed  Google Scholar 

  29. Andreasen NC (1984) Scale for the assessment of negative symptoms (SANS). University of Iowa, Iowa City

    Google Scholar 

  30. Foussias G, Mann S, Zakzanis KK, van Reekum R, Remington G (2009) Motivational deficits as the central link to functioning in schizophrenia: a pilot study. Schizophr Res 115:333–337

    Article  CAS  PubMed  Google Scholar 

  31. Hong Kong Psychological Society (1989) The Wechsler Adult Intelligence Scale-revised (Cantonese version). Hong Kong Psychological Society, Hong Kong

    Google Scholar 

  32. Hong Kong Psychological Society (1989) The Wechsler Adult Memory Scale-revised (Cantonese version). Hong Kong Psychological Society, Hong Kong

    Google Scholar 

  33. Gold JM, Carpenter C, Randolph C, Goldberg TE, Weinberger DR (1997) Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Arch Gen Psychiatry 54:159–165

    Article  CAS  PubMed  Google Scholar 

  34. Wilkins AJ, Shallice T, McCarthy R (1987) Frontal lesions and sustained attention. Neuropsychologia 25:359–365

    Article  CAS  PubMed  Google Scholar 

  35. Chan ELS, Chen EYH, Chan RCK (2005) Three-subtest short form of the Wechsler Adult Intelligence Scale for patients with psychotic disorders: a preliminary report. HK J Psychiatry 15:39–42

    Google Scholar 

  36. Nelson HE (1976) A modified card sorting test sensitive to frontal lobe defects. Cortex 12:313–324

    Article  CAS  PubMed  Google Scholar 

  37. Reitan RM (1955) The relation of the Trail Making Test to organic brain damage. J Couns Psychol 10:330–340

    Google Scholar 

  38. Burgess PW, Shallice T (1996) Response suppression, initiation and strategy use following frontal lobe lesions. Neuropsychologia 34:263–273

    Article  CAS  PubMed  Google Scholar 

  39. Burgess PW, Alderman N, Evans J, Wilson B, Emslie H, Shallice T (1996) Modified six elements test. In: Wilson BA, Alderman PW, Burgess PW, Emslie H, Evans JJ (eds) Behavioral assessment of the dysexecutive syndrome. Thames Valley Test Company, Bury St. Edmunds

    Google Scholar 

  40. Chan RCK, Chen EYH, Law CW (2006) Specific executive dysfunction in patients with first-episode medication-naive schizophrenia. Schizophr Res 81:51–64

    Article  Google Scholar 

  41. Liu KC, Chan RC, Chan KK et al (2011) Executive function in first-episode schizophrenia: a three-year longitudinal study of an ecologically valid test. Schizophr Res 126:87–92

    Article  PubMed  Google Scholar 

  42. Chan KKS, Xu J, Liu K, Hui CL, Wong GH, Chen EY (2012) Executive function in first-episode schizophrenia: a three-year longitudinal study of the Hayling Sentence Completion Test. Schizophr Res 135:62–67

    Article  PubMed  Google Scholar 

  43. Mesholam-Gately RI, Giuliano AJ, Goff KP, Faraone SV, Seidman LJ (2009) Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology 23:315–336

    Article  PubMed  Google Scholar 

  44. Cana J, Quesada JF, Antoli A, Fajardo I (2003) Cognitive flexibility and adaptability to environmental changes in dynamic complex problem-solving tasks. Ergonomics 46:482–501

    Article  Google Scholar 

  45. Dajani DR, Uddin LQ (2015) Demystifying cognitive flexibility: implications for clinical and developmental neuroscience. Trends Neurosci 38:571–578

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Minzenberg MJ, Laird A, Thelen S, Carter CS, Glahn DC (2009) Meta-analysis of 41 functional neuroimaging studies of executive function in schizophrenia. Arch Gen Psychiatry 66:811–822

    Article  PubMed  PubMed Central  Google Scholar 

  47. Eisenberg DP, Berman KF (2010) Executive function, neural circuitry, and genetic mechanisms in schizophrenia. Neuropsychopharmacology 35:258–277

    Article  PubMed  Google Scholar 

  48. Chua SE, Wright IC, Poline JB et al (1997) Grey matter correlates of syndromes in schizophrenia. A semi-automated analysis of structural magnetic resonance images. Br J Psychiatry 170:406–410

    Article  CAS  PubMed  Google Scholar 

  49. Roth RM, Flashman LA, Saykin AJ, McAllister TW, Vidaver R (2004) Apathy in schizophrenia: reduced frontal lobe volume and neuropsychological deficits. Am J Psychiatry 161:157–159

    Article  PubMed  Google Scholar 

  50. Mørch-Johnsen L, Nesvåg R, Faerden A et al (2015) Brain structure abnormalities in first-episode psychosis patients with persistent apathy. Schizophr Res 164:59–64

    Article  PubMed  Google Scholar 

  51. Leeson VC, Robbins TW, Matheson E et al (2009) Discrimination learning, reversal, and set-shifting in first-episode schizophrenia: stability over six years and specific associations with medication type and disorganization syndrome. Biol Psychiatry 66:586–593

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ergul C, Ucok A (2015) Negative symptom subgroups have different effects on the clinical course of schizophrenia after the first episode: a 24-month follow up study. Eur Psychiatry 30:14–19

    Article  CAS  PubMed  Google Scholar 

  53. Hartmann-Riemer MN, Hager OM, Kirschner M et al (2015) The association of neurocognitive impairment with diminished expression and apathy in schizophrenia. Schizophr Res 169:427–432

    Article  PubMed  Google Scholar 

  54. Lim J, Lee SA, Lam M et al (2016) The relationship between negative symptom subdomains and cognition. Psychol Med 46:2169–2177

    Article  CAS  PubMed  Google Scholar 

  55. Brebion G, Bressan RA, Pilowsky LS, David AS (2009) Depression, avolition, and attention disorders in patients with schizophrenia: associations with verbal memory efficiency. J Neuropsychiatry Clin Neurosci 21:206–215

    Article  PubMed  Google Scholar 

  56. Faerden A, Vaskinn A, Finset A et al (2009) Apathy is associated with executive functioning in first episode psychosis. BMC Psychiatry 9:1

    Article  PubMed  PubMed Central  Google Scholar 

  57. Konstantakopoulos G, Ploumpidis D, Lulis P, Patrikelis P, Soumani A, Papadimitriou GN, Politis AM (2011) Apathy, cognitive deficits and functional impairment in schizophrenia. Schizophr Res 133:193–198

    Article  PubMed  Google Scholar 

  58. Raffard S, Gutierrez LA, Yazbek H et al (2016) Working memory deficit as a risk factor for severe apathy in schizophrenia: a 1-year longitudinal study. Schizophr Bull 42:642–651

    Article  PubMed  PubMed Central  Google Scholar 

  59. Greenwood KE, Morris R, Sigmundsson T, Landau S, Wykes T (2008) Executive functioning in schizophrenia and the relationship with symptom profile and chronicity. J Int Neuropsychol Soc 14:782–792

    Article  PubMed  Google Scholar 

  60. Kirkpatrick B, Strauss GP, Nguyen L et al (2011) The Brief Negative Symptom Scale: psychometric properties. Schizophr Bull 37:300–305

    Article  PubMed  Google Scholar 

  61. Kring AM, Gur RE, Blanchard JJ, Horan WP, Reise SP (2013) The Clinical Assessment Interview for Negative Symptoms (CAINS): final development and validation. Am J Psychiatry 170:165–172

    Article  PubMed  PubMed Central  Google Scholar 

  62. Kirkpatrick B, Fenton WS, Carpenter WT, Marder SR (2006) The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 32:214–219

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong

    Wing Chung Chang, Jasmine Tsz Ting Liu, Christy Lai Ming Hui, Sherry Kit Wa Chan, Edwin Ho Ming Lee, Yi Nam Suen & Eric Yu Hai Chen

  2. State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong

    Wing Chung Chang, Sherry Kit Wa Chan & Eric Yu Hai Chen

Authors
  1. Wing Chung Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jasmine Tsz Ting Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christy Lai Ming Hui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sherry Kit Wa Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edwin Ho Ming Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yi Nam Suen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eric Yu Hai Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wing Chung Chang.

Ethics declarations

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 167 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, W.C., Liu, J.T.T., Hui, C.L.M. et al. Executive dysfunctions differentially predict amotivation in first-episode schizophrenia-spectrum disorder: a prospective 1-year follow-up study. Eur Arch Psychiatry Clin Neurosci 269, 887–896 (2019). https://doi.org/10.1007/s00406-018-0918-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-018-0918-y

Keywords

Search

Navigation