Fondation FondaMental, Créteil, France.
Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France.
World J Biol Psychiatry. 2022 Nov;23(9):703-714. doi: 10.1080/15622975.2022.2031286. Epub 2022 Feb 1.
In people with schizophrenia, major areas of everyday life are impaired, including independent living, productive activities, social relationships and overall quality of life. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes.
The goal of the present study was to identify factors associated with motivation deficits in real-life schizophrenia, and to assess its contribution to impaired functioning and quality of life.
Based on previous literature and clinical experience, several factors were selected and grouped into factors potentially explaining motivation deficits. Some of these variables were never investigated before in relationship with motivation deficits.
In 561 patients with schizophrenia of the national FACE-SZ cohort living in the community, 235 (41.9%) reported severe motivation deficits. These deficits were found to be significantly associated with impaired socially useful activities, psychological and physical quality of life (in almost all domains), alcohol use disorder (aOR = 2.141, = 0.021), severe nicotine dependence (aOR = 2.906, < 0.001) independently of age and sex. No significant association was found for body mass index, metabolic syndrome or physical activity level. In the second model, we identified the following modifiable factors associated with motivation deficits: history of suicide attempt (aOR = 2.297, = 0.001), positive symptoms (aOR = 1.052, = 0.006), current major depressive episode (aOR = 2.627, < 0.001), sleep disorders (aOR = 1.474, = 0.024) and lower medication adherence (aOR = 0.836, = 0.001) independently of gender, current alcohol use disorder, second-generation antipsychotics and akathisia. No significant association was found for negative symptoms, childhood trauma and inflammation. These results were maintained after removing patients with schizoaffective disorders or those with major depressive disorder.
Motivation deficits are frequent and remain persistent unmet need in real-world schizophrenia that should be addressed in future guidelines. Based on our results, literature and clinical experience, we recommend to address in priority major depression, sleep, suicide, positive symptoms (when present and as early as possible) and medication adherence to improve motivation deficits of schizophrenia.
在精神分裂症患者中，日常生活的主要领域受到损害，包括独立生活、生产活动、社会关系和整体生活质量。深入了解阻碍现实生活功能的因素对于将治疗转化为更积极的结果至关重要。
本研究的目的是确定与现实生活中精神分裂症动机缺陷相关的因素，并评估其对功能障碍和生活质量的影响。
基于以往的文献和临床经验，选择了一些因素，并将其分为可能解释动机缺陷的因素。其中一些变量以前从未在与动机缺陷的关系中进行过调查。
在全国 FACE-SZ 队列中居住在社区的 561 名精神分裂症患者中，235 名（41.9%）报告存在严重的动机缺陷。这些缺陷与社会有益活动、心理和身体生活质量（几乎所有领域）受损、酒精使用障碍（优势比[OR] = 2.141， = 0.021）以及严重的尼古丁依赖（OR = 2.906， < 0.001）显著相关，独立于年龄和性别。体重指数、代谢综合征或身体活动水平与动机缺陷无显著相关性。在第二个模型中，我们确定了与动机缺陷相关的以下可修改因素：自杀未遂史（OR = 2.297， = 0.001）、阳性症状（OR = 1.052， = 0.006）、当前重性抑郁发作（OR = 2.627， < 0.001）、睡眠障碍（OR = 1.474， = 0.024）和较低的药物依从性（OR = 0.836， = 0.001），独立于性别、当前酒精使用障碍、第二代抗精神病药物和静坐不能。阴性症状、儿童创伤和炎症与动机缺陷无显著相关性。这些结果在去除精神分裂症谱系障碍或重性抑郁障碍患者后仍然成立。
动机缺陷在现实世界中的精神分裂症中很常见，且仍然是未满足的需求，这在未来的指南中应予以解决。基于我们的结果、文献和临床经验，我们建议优先解决重性抑郁、睡眠、自杀、阳性症状（如果存在且尽早）和药物依从性，以改善精神分裂症的动机缺陷。
