Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis

Abstract

BackgroundAmotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI).MethodsOne hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments.ResultsAmotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation.ConclusionOur findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation.

Inter-relationships among psychopathology, premorbid adjustment, cognition and psychosocial functioning in first-episode psychosis: a network analysis approach

“…In addition, we observed differential patterns of connections of amotivation and DE with other variables, lending support to the validity of the two-factor structure of negative symptoms (Messinger et al, 2011;Liemburg et al, 2013). For instance, in line with the literature (Strauss et al, 2013;Chang et al, 2017), our results showed that premorbid adjustment was linked to amotivation but not DE. Critically, we found that psychosocial functioning was most strongly connected to amotivation in the network, and was only weakly related to DE.…”

Implementing the Latvian Early Intervention Program (LAT-EIP) for Patients With Schizophrenia Spectrum First-Episode Psychosis: Study Protocol

“…Third, even though standard treatment and intervention treatment were ensured by different specialists, the evaluation was conducted by the same assessors, which may cause performance bias. In contrast, the effectiveness of the intervention could be biased by the short duration of the intervention treatment in this study; other studies have demonstrated the importance of extended interventions, confirming better effectiveness with prolonged early intervention in psychosis (67). Lastly, in this study, we did not include any cognitive testing which could affect clinical and functional outcomes.…”

Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression

“…Thirty-five studies comprising 3180 participants examined the severity of depressive symptoms (Binder et al ., 1998; Zalsman et al ., 2003; Kampman et al ., 2004; Bendall et al ., 2008; Arranz et al ., 2009; Chen et al ., 2009; Strous et al , 2006; Strous et al ., 2009; Barrett et al ., 2010; Cotton et al ., 2010; Roche et al ., 2010; Upthegrove et al ., 2010; Chang et al ., 2011; Pena et al ., 2011; Shoval et al ., 2011; Riedel et al ., 2012; Stowkowy et al ., 2012; Zhao et al ., 2012; Allott et al ., 2013; Tosato et al ., 2013; Arrasate et al ., 2014; Chang et al ., 2014; Stouten et al ., 2014; Chang et al ., 2015; Emsley et al ., 2015; Noto et al ., 2015; Ruggeri et al ., 2015; Sanchez-Gistau et al ., 2015; Ebdrup et al ., 2016; Garcia et al ., 2016; Pawelczyk et al ., 2016; Chang et al ., 2017; Herniman et al ., 2017; Lee et al ., 2017; Zabala et al ., 2017). Three studies reported statistics by sub-group (Binder et al ., 1998; Tosato et al ., 2013; Pawelczyk et al ., 2016), totalling 38 samples.…”