Fervaha Gagan, Foussias George, Agid Ofer, Remington Gary
Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
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.
Schizophr Res. 2015 Aug;166(1-3):9-16. doi: 10.1016/j.schres.2015.04.040. Epub 2015 May 15.
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.
阴性症状，尤其是动机缺乏，被认为是精神分裂症患者功能恢复的障碍。本研究调查了疾病早期患者动机缺乏的发生率，以及这些缺乏对社区功能的影响。本研究纳入了年龄在18至35岁之间、开始抗精神病治疗5年内的精神分裂症患者（N = 166）。评估了动机和认知对同时期及纵向功能的影响。超过75%的参与者存在动机损害，且与获得社会支持无关。这些缺乏是功能结局最有力和可靠的预测因素，而神经认知与结局的关联则显著较弱。综合考虑时，动机缺乏与同时期及纵向功能存在可靠联系，而认知不具有任何独立的预测价值。此外，发现动机介导了认知与结局之间的关系。动机的变化与功能的变化相关；然而，认知表现的变化并非如此。即使在考虑了选定的人口统计学和临床特征（如阳性症状）后，动机仍是功能的重要预测因素。这些数据表明，动机缺乏在精神分裂症患者中普遍存在，即使在疾病早期也是如此，并且这些缺乏是精神分裂症患者实现功能恢复的最强大障碍之一。深入了解这些缺乏背后的机制对于有效的治疗创新至关重要。
