Foussias G, Siddiqui I, Fervaha G, Mann S, McDonald K, Agid O, Zakzanis K K, Remington G
Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada.
Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada.
Schizophr Res. 2015 Aug;166(1-3):276-82. doi: 10.1016/j.schres.2015.05.019. Epub 2015 May 23.
The uncertain relationship between negative symptoms, and specifically motivational deficits, with cognitive dysfunction in schizophrenia is in need of further elucidation as it pertains to the interpretation of cognitive test results. Findings to date have suggested a possible mediating role of motivational deficits on cognitive test measures, although findings from formal examinations of effort using performance validity measures have been inconsistent. The aim of this study was to examine the relationships between motivation, effort exerted during cognitive testing, and cognitive performance in schizophrenia. Sixty-nine outpatients with schizophrenia or schizoaffective disorder were evaluated for psychopathology, severity of motivational deficits, effort exerted during cognitive testing, and cognitive performance. Motivation and degree of effort exerted during cognitive testing were significantly related to cognitive performance, specifically verbal fluency, verbal and working memory, attention and processing speed, and reasoning and problem solving. Further, effort accounted for 15% of the variance in cognitive performance, and partially mediated the relationship between motivation and cognitive performance. Examining cognitive performance profiles for individuals exerting normal or reduced effort revealed significant differences in global cognition, as well as attention/processing speed and reasoning and problem solving. These findings suggest that cognitive domains may be differentially affected by impairments in motivation and effort, and highlight the importance of understanding the interplay between motivation and cognitive performance deficits, which may guide the appropriate selection of symptom targets for promoting recovery in patients.
阴性症状，尤其是动机缺陷，与精神分裂症认知功能障碍之间的不确定关系，在涉及认知测试结果的解释时需要进一步阐明。迄今为止的研究结果表明，动机缺陷在认知测试指标上可能起到中介作用，尽管使用表现效度指标对努力程度进行正式检验的结果并不一致。本研究的目的是考察精神分裂症患者的动机、认知测试过程中的努力程度与认知表现之间的关系。对69例精神分裂症或分裂情感性障碍门诊患者进行了精神病理学、动机缺陷严重程度、认知测试过程中的努力程度以及认知表现的评估。认知测试过程中的动机和努力程度与认知表现显著相关，特别是言语流畅性、言语和工作记忆、注意力和处理速度，以及推理和问题解决能力。此外，努力程度解释了认知表现中15%的变异，并部分中介了动机与认知表现之间的关系。对努力程度正常或降低的个体的认知表现概况进行检查发现，在整体认知以及注意力/处理速度和推理与问题解决能力方面存在显著差异。这些发现表明，认知领域可能受到动机和努力程度受损的不同影响，并突出了理解动机与认知表现缺陷之间相互作用的重要性，这可能指导为促进患者康复而合理选择症状靶点。
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