The cognitive, affective motivational and clinical longitudinal determinants of apathy in schizophrenia

Abstract

Apathy is a frequent and debilitating condition with few treatment options available in schizophrenia patients. Despite evidence of its multidimensional structure, most of past studies have explored apathy through a categorical approach. The main objective of this study was to identify the cognitive, emotional, motivational, and clinical factors at baseline that best predicted the three subtypes of apathy dimensions at follow-up. In a longitudinal study, 137 participants diagnosed with schizophrenia underwent different assessments including clinical, motivational, affective and cognitive measurements, at 1-month (referred to as baseline) and 12-month follow-ups. Data were analyzed using partial least squares variance-based structural equation modeling. Three latent variables representing the three previously described domains of apathy reaching consensus in the literature were extracted from the Lille Apathy Rating Scale. Results showed that in addition to baseline apathy, positive symptoms, anticipatory pleasure and sensibility to punishment at baseline predicted cognitive apathy at follow-up. Likewise, both baseline apathy and sensibility to punishment predicted emotional apathy at follow-up. Finally, baseline anhedonia and episodic memory were the main variables the predicted behavioral apathy at follow-up. This is the first study to show specific associations between apathy subtypes and clinical and cognitive motivational dysfunction in individual with schizophrenia, indicating possible distinct underlying mechanisms to these demotivational symptoms. Treatment for apathy should address both types of processes. Importantly, our results demonstrate the interest of multidimensional approaches in the understanding of apathy in schizophrenia.

Apathy in Obsessive-Compulsive Disorder and Its Psychological Correlates: Comparison With Individuals With Schizophrenia

“…Consequently, apathy and depression should be considered as distinct and separate clinical syndromes. On the other hand, as a result of the strong overlap between depression and apathy (38), some investigators have highlighted the importance of examining in detail these overlaps as well as the differences between apathy and depression rather than considering these entities as separate (12,13). To reconcile these two points of view, one could propose a distinction between primary and secondary apathy (39).…”

“…Apathy has been frequently associated with brain abnormalities, particularly disruption of the prefrontal-subcortical circuitries in both neurological disorders (9,10) and mental disorders such as schizophrenia (11). Nevertheless, other environmental, emotional, and psychological factors also appear to play a fundamental role in the development and maintenance of apathetic manifestations (11)(12)(13)(14)(15)(16).…”

Initiative apathy trait underlies individual differences in the ability to anticipate and expend cognitive effort in cost-benefit decision-making tasks

“…Initiative apathy is prevalent in many neurological, neurodegenerative, and psychiatric pathologies (Quang et al, 2021;Radakovic et al, 2016;Raffard et al, 2019) but also present in 2.5% of the healthy population (Lafond-Brina & Bonnefond, 2022). At a subclinical level, i.e., at mild degrees of dysfunction, initiative apathy has even been reported to be present in about 6% of the general population and associated with difficulties tied to daily life (Ang et al, 2017;Lafond-Brina & Bonnefond, 2022).…”