1
|
Altieri M, Maggi G, Rippa V, Santangelo G. Evaluation of apathy in non-clinical populations: validation, psychometric properties, and normative data of the Italian version of Apathy-Motivation Index (AMI). Neurol Sci 2023; 44:3099-3106. [PMID: 37012520 PMCID: PMC10415455 DOI: 10.1007/s10072-023-06774-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Evaluation of apathy in non-clinical populations is relevant to identify individuals at risk for developing cognitive decline in later stages of life, and it should be performed with questionnaires specifically designed for healthy individuals, such as the Apathy-Motivation Index (AMI); therefore, the aim of the present study was to validate the AMI in a healthy Italian population, and to provide normative data of the scale. MATERIALS AND METHODS Data collection was performed using a survey completed by 500 healthy participants; DAS, MMQ-A, BIS-15, PHQ-9, and GAD-7 were used to investigate convergent and divergent validity. Internal consistency and factorial structure were also evaluated. A regression-based procedure and receiver operating characteristics (ROC) analyses were used to evaluate the influence of socio-demographic variables on AMI scores and to provide adjusting factors and three cut-offs for the detection of mild, moderate, and severe apathy. RESULTS The Italian version of the AMI included 17 items (one item was removed because it was not internally consistent) and demonstrated good psychometric properties. The three-factor structure of AMI was confirmed. Multiple regression analysis revealed no effect of sociodemographic variables on the total AMI score. ROC analyses revealed three cut-offs of 1.5, 1.66, and 2.06 through the Youden's J statistic to detect mild, moderate, and severe apathy, respectively. CONCLUSION The Italian version of the AMI reported similar psychometric properties, factorial structure, and cut-offs to the original scale. This may help researchers and clinicians to identify people at risk and address them in specific interventions to lower their apathy levels.
Collapse
Affiliation(s)
- Manuela Altieri
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Valentina Rippa
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| |
Collapse
|
2
|
Vinckier F, Jaffre C, Gauthier C, Smajda S, Abdel-Ahad P, Le Bouc R, Daunizeau J, Fefeu M, Borderies N, Plaze M, Gaillard R, Pessiglione M. Elevated Effort Cost Identified by Computational Modeling as a Distinctive Feature Explaining Multiple Behaviors in Patients With Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1158-1169. [PMID: 35952972 DOI: 10.1016/j.bpsc.2022.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Motivational deficit is a core clinical manifestation of depression and a strong predictor of treatment failure. However, the underlying mechanisms, which cannot be accessed through conventional questionnaire-based scoring, remain largely unknown. According to decision theory, apathy could result either from biased subjective estimates (of action costs or outcomes) or from dysfunctional processes (in making decisions or allocating resources). METHODS Here, we combined a series of behavioral tasks with computational modeling to elucidate the motivational deficits of 35 patients with unipolar or bipolar depression under various treatments compared with 35 matched healthy control subjects. RESULTS The most striking feature, which was observed independent of medication across preference tasks (likeability ratings and binary decisions), performance tasks (physical and mental effort exertion), and instrumental learning tasks (updating choices to maximize outcomes), was an elevated sensitivity to effort cost. By contrast, sensitivity to action outcomes (reward and punishment) and task-specific processes were relatively spared. CONCLUSIONS These results highlight effort cost as a critical dimension that might explain multiple behavioral changes in patients with depression. More generally, they validate a test battery for computational phenotyping of motivational states, which could orientate toward specific medication or rehabilitation therapy, and thereby help pave the way for more personalized medicine in psychiatry.
Collapse
Affiliation(s)
- Fabien Vinckier
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France.
| | - Claire Jaffre
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Claire Gauthier
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Sarah Smajda
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Pierre Abdel-Ahad
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Raphaël Le Bouc
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Urgences cérébro-vasculaires, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris, Paris, France; Zurich Center for Neuroeconomics, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Jean Daunizeau
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Inserm, CNRS, Paris, France
| | - Mylène Fefeu
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Nicolas Borderies
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marion Plaze
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Raphaël Gaillard
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France; Institut Pasteur, experimental neuropathology unit, Paris, France
| | - Mathias Pessiglione
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Inserm, CNRS, Paris, France
| |
Collapse
|
3
|
Ubukata S, Ueda K, Fujimoto G, Ueno S, Murai T, Oishi N. Extracting Apathy From Depression Syndrome in Traumatic Brain Injury by Using a Clustering Method. J Neuropsychiatry Clin Neurosci 2022; 34:158-167. [PMID: 34794328 DOI: 10.1176/appi.neuropsych.21020046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression and apathy are common after traumatic brain injury (TBI), and different intervention strategies are recommended for each. However, a differential diagnosis can be difficult in clinical settings, especially given that apathy is considered to be a symptom of depression. In this study, the investigators aimed to isolate apathy from depression among patients with TBI and to examine whether apathy is exclusively associated with the amount of daily activity, as previously reported in the literature. METHODS Eighty-eight patients with chronic TBI completed the Japanese versions of the 21-item Beck Depression Inventory-II (BDI-II) and the Starkstein Apathy Scale (AS). Daily activity was measured with a 24-hour life log. A hierarchical cluster analysis was applied to divide the BDI-II data into separable components, and components' correlations with results of the AS and 24-hour life log scale were evaluated. RESULTS The BDI-II and AS revealed that 37 patients (42.0%) had both depression and apathy. BDI-II data were classified into four separate clusters (somatic symptoms, loss of self-worth, affective symptoms, and apathy symptoms). Loss of self-worth and apathy symptoms subscores were significantly positively correlated with total AS score (r=0.32, p=0.002, and r=0.52, p<0.001, respectively). The apathy symptoms subscore was significantly correlated with the amount of daily activity (r=-0.29, p=0.009). CONCLUSIONS The findings suggest that the BDI-II can differentiate between apathy and depression among patients with TBI, which is essential when selecting intervention options. Moreover, apathy symptoms predicted patients' real-life daily activity.
Collapse
Affiliation(s)
- Shiho Ubukata
- Medical Innovation Center (Ubukata, Oishi) and Department of Psychiatry (Ueda, Fujimoto, Ueno, Murai), Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keita Ueda
- Medical Innovation Center (Ubukata, Oishi) and Department of Psychiatry (Ueda, Fujimoto, Ueno, Murai), Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Gaku Fujimoto
- Medical Innovation Center (Ubukata, Oishi) and Department of Psychiatry (Ueda, Fujimoto, Ueno, Murai), Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Senkei Ueno
- Medical Innovation Center (Ubukata, Oishi) and Department of Psychiatry (Ueda, Fujimoto, Ueno, Murai), Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Medical Innovation Center (Ubukata, Oishi) and Department of Psychiatry (Ueda, Fujimoto, Ueno, Murai), Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Oishi
- Medical Innovation Center (Ubukata, Oishi) and Department of Psychiatry (Ueda, Fujimoto, Ueno, Murai), Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
4
|
Martínez-Cao C, García-Álvarez L, Bobes-Bascarán T, de la Fuente-Tomás L, Fernández-Egea E, Velasco Á, González-Blanco L, Zurrón-Madera P, Fonseca-Pedrero E, Sáiz-Martínez PA, García-Portilla MP, Bobes J. Validation of a European Spanish adaptation of the Apathy Evaluation Scale-self-rated version (AES-S) in patients with schizophrenia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:22-28. [PMID: 35256069 DOI: 10.1016/j.rpsmen.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/16/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Apathy is a negative symptom of schizophrenia and is associated with poor real world functioning. Therefore, it is important to have validated psychometric instruments to assess this symptom. This is the first study to validate the Spanish adaptation of the self-rated version of the Apathy Assessment Scale (AES-S) in patients with schizophrenia. MATERIALS AND METHODS Naturalistic, cross-sectional, validation study in 104 patients with schizophrenia evaluated using the following scales: Clinical Global Impression-Severity (CGI-S), Personal and Social Performance (PSP), Clinical Assessment Interview for Negative Symptoms (CAINS), Self-report of Negative Symptoms (SNS), Motivation and Pleasure Scale-Self-Report (MAP-SR), Calgary Depression Scale for Schizophrenia (CDSS), and Apathy Evaluation Scale-self-rated version (AES-S). RESULTS Reliability: Internal consistency (Cronbach's alpha) was 0.908. Convergent validity: The Pearson correlation coefficient between AES-S and CAINS-MAP total scores was -0.483 (p<0.001). For SNS, total and avolition subscale scores were -0.803 and -0.639 (p<0.001), respectively. With the MAP-SR, the correlation coefficient was -0.727 (p<0.001). Divergent validity: The Pearson correlation coefficient between AES-S and PSP total scores was 0.504 (p<0.001). Furthermore, with the CDSS, the correlation coefficient was -0.431 (p<0.001). Discriminant validity: The AES-S discriminated between different levels of illness severity according to CGI-S scores. Factor analysis: A three-component solution explained 57.32% of the variance. Pearson correlations between coefficients were 1-2=0.265, 1-3=0.464, and 2-3=0.060. CONCLUSION The Spanish AES-S is a reliable and valid instrument for assessing apathy in Spanish patients with schizophrenia. It seems to be appropriate for use in everyday clinical practice as a means of monitoring apathy in these patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Ángela Velasco
- Dpto. Psiquiatría, CIBERSAM, Universidad de Oviedo, Oviedo, Spain
| | | | | | | | | | | | - Julio Bobes
- Dpto. Psiquiatría, CIBERSAM, ISPA, Universidad de Oviedo, Oviedo, Spain
| |
Collapse
|
5
|
Martínez-Cao C, García-Álvarez L, Bobes-Bascarán T, de la Fuente-Tomás L, Fernández-Egea E, Velasco Á, González-Blanco L, Zurrón-Madera P, Fonseca-Pedrero E, Sáiz-Martínez PA, García-Portilla MP, Bobes J. Validation of a European Spanish adaptation of the Apathy Evaluation Scale-self-rated version (AES-S) in patients with schizophrenia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 15:S1888-9891(20)30033-1. [PMID: 32507728 DOI: 10.1016/j.rpsm.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Apathy is a negative symptom of schizophrenia and is associated with poor real world functioning. Therefore, it is important to have validated psychometric instruments to assess this symptom. This is the first study to validate the Spanish adaptation of the self-rated version of the Apathy Assessment Scale (AES-S) in patients with schizophrenia. MATERIALS AND METHODS Naturalistic, cross-sectional, validation study in 104 patients with schizophrenia evaluated using the following scales: Clinical Global Impression-Severity (CGI-S), Personal and Social Performance (PSP), Clinical Assessment Interview for Negative Symptoms (CAINS), Self-report of Negative Symptoms (SNS), Motivation and Pleasure Scale-Self-Report (MAP-SR), Calgary Depression Scale for Schizophrenia (CDSS), and Apathy Evaluation Scale-self-rated version (AES-S). RESULTS Reliability: Internal consistency (Cronbach's alpha) was 0.908. Convergent validity: The Pearson correlation coefficient between AES-S and CAINS-MAP total scores was -0.483 (p<0.001). For SNS, total and avolition subscale scores were -0.803 and -0.639 (p<0.001), respectively. With the MAP-SR, the correlation coefficient was -0.727 (p<0.001). Divergent validity: The Pearson correlation coefficient between AES-S and PSP total scores was 0.504 (p<0.001). Furthermore, with the CDSS, the correlation coefficient was -0.431 (p<0.001). Discriminant validity: The AES-S discriminated between different levels of illness severity according to CGI-S scores. Factor analysis: A three-component solution explained 57.32% of the variance. Pearson correlations between coefficients were 1-2=0.265, 1-3=0.464, and 2-3=0.060. CONCLUSION The Spanish AES-S is a reliable and valid instrument for assessing apathy in Spanish patients with schizophrenia. It seems to be appropriate for use in everyday clinical practice as a means of monitoring apathy in these patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Ángela Velasco
- Dpto. Psiquiatría, CIBERSAM, Universidad de Oviedo, Oviedo, Spain
| | | | | | | | | | | | - Julio Bobes
- Dpto. Psiquiatría, CIBERSAM, ISPA, Universidad de Oviedo, Oviedo, Spain
| |
Collapse
|
6
|
Wouts L, van Kessel M, Beekman AT, Marijnissen RM, Oude Voshaar RC. Empirical support for the vascular apathy hypothesis: A structured review. Int J Geriatr Psychiatry 2020; 35:3-11. [PMID: 31617249 PMCID: PMC6916153 DOI: 10.1002/gps.5217] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/15/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES A systematic review of the relationship between subclinical small vessel disease (SSVD) in the general population and apathy to examine the hypothesis that apathy has a vascular basis. METHODS We searched for studies on associations between apathy and SSVD, operationalized as white matter hyperintensities (WMH) or white matter diffusivity changes, lacunar infarcts, cerebral microbleeds, decreasing cortical thickness, and perivascular spaces, while also peripheral proxies for SSVD were considered, operationalized as ankle brachial pressure index (ABI), intima media thickness, arterial stiffness, cardio-femoral pulse wave velocity, hypertension, or cardiovascular disease. Only eligible retrospective and prospective observational studies conducted in the general population were included. RESULTS The 14 studies eligible for review examined the associations between apathy and hypertension (3), ABI (1), arterial stiffness (1), cardiovascular disease (2), WMH (3), white matter diffusivity (2), cerebral microbleeds (1), or cortical thickness (3). Arterial stiffness and white matter diffusivity were not related to apathy, while the associations with cortical thickness were contradictory. Cross-sectional studies in the general population did find evidence of apathy being associated with WMH, CM, cardiovascular disease, hypertension, and ABI, and cardiovascular disease was prospectively associated with apathy. The methodologies of the studies reviewed were too heterogeneous to perform meta-analyses. CONCLUSIONS Although more prospective evidence is needed and vascular depression needs to be controlled for, cardiovascular disease, hypertension, and ABI as proxies for SSVD, and WMH and cerebral microbleeds as direct measures of SSVD have been found to be associated with apathy in the general population, supporting the hypothesis of vascular apathy.
Collapse
Affiliation(s)
- Lonneke Wouts
- Pro PersonaMental Health InstituteThe Netherlands,Department of PsychiatryUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | | | - Aartjan T.F. Beekman
- GGZinGeestMental Health InstituteAmsterdamThe Netherlands,Department of PsychiatryAmsterdam University Medical CentreAmsterdamThe Netherlands
| | - Radboud M. Marijnissen
- Pro PersonaMental Health InstituteThe Netherlands,Department of PsychiatryUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | | |
Collapse
|
7
|
Abstract
Background:
Apathy is defined as diminished motivation free from altered consciousness,
cognitive impairment or emotional distress. It is a prevalent syndrome in different disorders,
which share brain system alterations despite very different underlying pathologies. However, to
date, little research has be en devoted to the subject.
Aim:
To review the concept of apathy and clarify its aetiology, structural and functional neural
bases and treatment options.
Methods:
Literature search and review, with “apathy” as a term, using all main databases (Medline,
Psychinfo, Cochrane) included in our organization’s (RSMB; Osakidetza/Basque Health Service)
Ovid search engine, together with a manual search of relevant papers.
Results:
The literature reviewed shows that apathy is a multi-dimensional clinical construct with a
current definition and validated diagnostic criteria. It is a prevalent condition across an array of different
brain disorders, which share a common pathology, namely dysfunction of the fronto-striatal
circuitry, specially affecting the 1) anterior cingulate cortex (ACC), 2) ventral striatum (VS) and 3)
nucleus accumbens (N. Acc.). Different theories have emerged regarding the role of the ACC in the
genesis of apathy. The neuromodulator dopamine is heavily implicated in 1- ACC, 2- VS, 3- in particulat
the N. Acc., and 4- the genesis of apathy, although other neurotransmitters could also be
involved to a lesser degree. There is a patent lack of RCTs on the efficiency of current therapeutic options.
Conclusion:
Further research is needed to help understand the functional neuroanatomy, neuromodulators
involved and possible treatment options of this clinical construct.
Collapse
|
8
|
Vergallo A, Giampietri L, Pagni C, Giorgi FS, Nicoletti V, Miccoli M, Libertini P, Petrozzi L, Bonuccelli U, Tognoni G. Association Between CSF Beta-Amyloid and Apathy in Early-Stage Alzheimer Disease. J Geriatr Psychiatry Neurol 2019; 32:164-169. [PMID: 30913958 DOI: 10.1177/0891988719838627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM The apathetic syndrome is a common clinical feature in patients with Alzheimer diseases (AD), from preclinical phases to late stages of dementia, and it is strongly related to major disease outcomes. Unfortunately, no specific pharmacological treatments for apathy have been accomplished so far. Translational evidences have previously shown that a link between apathy and hallmarks of AD-related pathophysiology, that is, β-amyloid (Aβ) plaques and neurofibrillary tangles, exists. However, only few studies investigated the association between core biomarkers of AD and apathy scores, finding conflicting results. METHODS Thirty-seven patients were identified as having AD dementia according to National Institute on Aging-Alzheimer Association 2011 criteria. All participants underwent an extensive diagnostic workup including cerebrospinal fluid (CSF) assessment to measure the concentrations of Aβ42, t-tau, and pTau181. To follow, they were stratified as: apathy absence, apathy mild, and apathy severe according to the Neuro Psychiatric Inventory-apathy item scores. We investigated for potential associations between apathy scores and CSF biomarkers concentrations as well as for differences in terms of clinical and CSF biomarkers data across the 3 apathy groups. RESULTS The CSF Aβ42 concentrations were negatively correlated with apathy scores. In addition, patients with severe apathy had significantly lower Aβ42 levels compared to nonapathetic ones. CONCLUSION Based on our results, we encourage further studies to untangle the potential association between the complex pathophysiological dynamics of AD and apathy which may represent an innovative reliable clinical outcome measure to use in clinical trials, investigating treatments with either a symptomatic or a disease-modifying effect.
Collapse
Affiliation(s)
- A Vergallo
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Giampietri
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Pagni
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - F S Giorgi
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - V Nicoletti
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Miccoli
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - P Libertini
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Petrozzi
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - U Bonuccelli
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Tognoni
- 1 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
9
|
Winsky-Sommerer R, de Oliveira P, Loomis S, Wafford K, Dijk DJ, Gilmour G. Disturbances of sleep quality, timing and structure and their relationship with other neuropsychiatric symptoms in Alzheimer’s disease and schizophrenia: Insights from studies in patient populations and animal models. Neurosci Biobehav Rev 2019; 97:112-137. [DOI: 10.1016/j.neubiorev.2018.09.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/31/2018] [Accepted: 09/30/2018] [Indexed: 02/06/2023]
|
10
|
Fervaha G, Takeuchi H, Foussias G, Hahn MK, Agid O, Remington G. Achievement motivation in early schizophrenia: Relationship with symptoms, cognition and functional outcome. Early Interv Psychiatry 2018; 12:1038-1044. [PMID: 28230315 DOI: 10.1111/eip.12405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/15/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals with schizophrenia engage in goal-directed activities significantly less often compared to healthy individuals in the community. There is ample evidence documenting the presence of motivational deficits in schizophrenia using observer-based ratings; however, purely self-reported accounts of patients' motivation are less well understood. This study examined subjective accounts of trait achievement motivation among relatively young, clinically stable, early-course outpatients with schizophrenia. METHODS Thirty-nine early-course patients and 39 healthy comparison subjects completed clinical and cognitive assessments in addition to a self-report inventory measuring achievement motivation. RESULTS Patients were found to endorse significantly lower levels of motivation, a mean difference which translated to a large effect size (Cohen's d = 1.1). Patients' self-reported motivation was significantly related to clinician ratings of motivational deficits which were based on behavioural output, and to vocational functioning. Within the patient sample, 33.3% of individuals were found to experience prominent or clinically significant levels of amotivation based on patients' own self-report. Self-reported achievement motivation was not associated with other clinical variables such as positive symptom severity or expressive negative symptoms. CONCLUSIONS Our results serve to highlight the occurrence and prevalence of motivational deficits in patients with schizophrenia who are in the early stages of their illness. Subjective accounts of motivation in this population were found to be related to important outcomes such as community functioning, highlighting the importance of this domain of illness. Targeting these deficits early in the course of the illness offers the potential to curb potential prospective poor outcomes and sets the stage for recovery.
Collapse
Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Hiroyoshi Takeuchi
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, 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
| | - Margaret K Hahn
- Schizophrenia Division and Campbell Family Mental Health Research Institute, 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
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, 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
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, 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
| |
Collapse
|
11
|
Faerden A, Lyngstad SH, Simonsen C, Ringen PA, Papsuev O, Dieset I, Andreassen OA, Agartz I, Marder SR, Melle I. Reliability and validity of the self-report version of the apathy evaluation scale in first-episode Psychosis: Concordance with the clinical version at baseline and 12 months follow-up. Psychiatry Res 2018; 267:140-147. [PMID: 29906681 DOI: 10.1016/j.psychres.2018.05.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 05/04/2018] [Accepted: 05/25/2018] [Indexed: 11/15/2022]
Abstract
Negative symptoms have traditionally been assessed based on clinicians' observations. The subjective experience of negative symptoms in people with psychosis may bring new insight. The Apathy Evaluation Scale (AES) is commonly used to study apathy in psychosis and has corresponding self-rated (AES-S) and clinician-rated (AES-C) versions. The aim of the present study was to determine the validity and reliability of the AES-S by investigating its concordance with the AES-C. Eighty-four first-episode (FEP) patients completed the shortened 12-item AES-S and AES-C at baseline (T1) and 12 months (T2). Concordance was studied by degree of correlation, comparison of mean scores, and change and difference between diagnostic groups. The Positive and Negative Symptom Scale (PANSS) was used to study convergent and discriminative properties. High concordance was found between AES-S and AES-C at both T1 and T2 regarding mean values, change from T1 to T2, and the proportion with high levels of apathy. Both versions indicated high levels of apathy in FEP, while associations with PANSS negative symptoms were weaker for AES-S than AES-C. Controlling for depression did not significantly alter results. We concluded that self-rated apathy in FEP patients is in concordance with clinician ratings, but in need of further study.
Collapse
Affiliation(s)
- Ann Faerden
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway.
| | - Siv Hege Lyngstad
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Carmen Simonsen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Petter Andreas Ringen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Oleg Papsuev
- Outpatient Psychiatry and Organization of Psychiatric Care Department, Moscow Research Institute of Psychiatry, Russia
| | - Ingrid Dieset
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Ole A Andreassen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
| | - Ingrid Agartz
- NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway; Diakonhjemmet Hospital, Oslo 0319, Norway
| | - Stephen R Marder
- Semel Institute for Neuroscience, University of California in Los Angeles, USA
| | - Ingrid Melle
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
| |
Collapse
|
12
|
Apathy in schizophrenia: A review of neuropsychological and neuroanatomical studies. Neuropsychologia 2018; 118:22-33. [DOI: 10.1016/j.neuropsychologia.2017.09.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/28/2017] [Accepted: 09/26/2017] [Indexed: 01/28/2023]
|
13
|
Mohammad D, Ellis C, Rau A, Ruthirakuhan M, Lanctôt KL, Herrmann N. Psychometric properties of apathy scales in Parkinson's disease: a systematic review. Neurodegener Dis Manag 2018; 8:267-282. [PMID: 30040024 DOI: 10.2217/nmt-2018-0010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Apathy is among the most prevalent neuropsychiatric symptom experienced in Parkinson's disease (PD) and can be assessed with a variety of scales. To identify which scale is most suitable for apathy assessment in PD, the psychometric properties of each scale and its sensitivity to change were analyzed. The methodological quality of the studies ranged from adequate to excellent. The Lille Apathy Rating Scale demonstrated consistently favorable psychometric properties and was used in two of four clinical trials found. The Starkstein Apathy Scale was the only other scale used in clinical trials. Further work is necessary to develop a gold standard for assessing apathy in PD.
Collapse
Affiliation(s)
- Dana Mohammad
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Courtney Ellis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Allison Rau
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Myuri Ruthirakuhan
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Sachdev PS. Post-Stroke Cognitive Impairment, Depression and Apathy: Untangling the Relationship. Am J Geriatr Psychiatry 2018; 26:301-303. [PMID: 29325929 DOI: 10.1016/j.jagp.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
| |
Collapse
|
15
|
Henstra MJ, Feenstra TC, van der Velde N, van der Mast RC, Comijs H, Stek ML, Rhebergen D. Apathy Is Associated With Greater Decline in Subjective, but not in Objective Measures of Physical Functioning in Older People Without Dementia. J Gerontol A Biol Sci Med Sci 2018; 74:254-260. [DOI: 10.1093/gerona/gly014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/01/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marieke Jantien Henstra
- Department of Internal Medicine, Geriatrics, Academic Medical Center Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, The Netherlands
| | - Thomas Christiaan Feenstra
- Department of Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research VU Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, The Netherlands
| | - Nathalie van der Velde
- Academic Medical Center, University of Amsterdam, The Netherlands
- Department of Internal Medicine, Geriatrics, Academic Medical Center Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
- Department of Psychiatry, CAPRI-University of Antwerp, Belgium
| | - Hannie Comijs
- GGZ inGeest/Department of Psychiatry, Amsterdam Public Health Research Institute, VU Medical Center, The Netherlands
| | - Max L Stek
- GGZ inGeest/Department of Psychiatry, Amsterdam Public Health Research Institute, VU Medical Center, The Netherlands
| | - Didi Rhebergen
- GGZ inGeest/Department of Psychiatry, Amsterdam Public Health Research Institute, VU Medical Center, The Netherlands
| |
Collapse
|
16
|
Gelderblom H, Wüstenberg T, McLean T, Mütze L, Fischer W, Saft C, Hoffmann R, Süssmuth S, Schlattmann P, van Duijn E, Landwehrmeyer B, Priller J. Bupropion for the treatment of apathy in Huntington's disease: A multicenter, randomised, double-blind, placebo-controlled, prospective crossover trial. PLoS One 2017; 12:e0173872. [PMID: 28323838 PMCID: PMC5360242 DOI: 10.1371/journal.pone.0173872] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/28/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of bupropion in the treatment of apathy in Huntington's disease (HD). METHODS In this phase 2b multicentre, double-blind, placebo-controlled crossover trial, individuals with HD and clinical signs of apathy according to the Structured Clinical Interview for Apathy-Dementia (SCIA-D), but not depression (n = 40) were randomized to receive either bupropion 150/300mg or placebo daily for 10 weeks. The primary outcome parameter was a significant change of the Apathy Evaluation Scale (AES) score after ten weeks of treatment as judged by an informant (AES-I) living in close proximity with the study participant. The secondary outcome parameters included changes of 1. AES scores determined by the patient (AES-S) or the clinical investigator (AES-C), 2. psychiatric symptoms (NPI, HADS-SIS, UHDRS-Behavior), 3. cognitive performance (SDMT, Stroop, VFT, MMSE), 4. motor symptoms (UHDRS-Motor), 5. activities of daily function (TFC, UHDRS-Function), and 6. caregiver distress (NPI-D). In addition, we investigated the effect of bupropion on brain structure as well as brain responses and functional connectivity during reward processing in a gambling task using magnetic resonance imaging (MRI). RESULTS At baseline, there were no significant treatment group differences in the clinical primary and secondary outcome parameters. At endpoint, there was no statistically significant difference between treatment groups for all clinical primary and secondary outcome variables. Study participation, irrespective of the intervention, lessened symptoms of apathy according to the informant and the clinical investigator. CONCLUSION Bupropion does not alleviate apathy in HD. However, study participation/placebo effects were observed, which document the need for carefully controlled trials when investigating therapeutic interventions for the neuropsychiatric symptoms of HD. TRIAL REGISTRATION ClinicalTrials.gov 01914965.
Collapse
Affiliation(s)
- Harald Gelderblom
- Department of Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tim McLean
- European Huntington’s Disease Network, Ulm, Germany
| | | | | | - Carsten Saft
- Department of Neurology, Huntington-Center NRW, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Rainer Hoffmann
- Department of Neurology, Huntington-Center NRW, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena Universityhospital, Jena, Germany
| | - Erik van Duijn
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bernhard Landwehrmeyer
- European Huntington’s Disease Network, Ulm, Germany
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Josef Priller
- Department of Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence NeuroCure, DZNE and BIH, Berlin, Germany
| |
Collapse
|
17
|
Chong TTJ, Bonnelle V, Husain M. Quantifying motivation with effort-based decision-making paradigms in health and disease. PROGRESS IN BRAIN RESEARCH 2016; 229:71-100. [PMID: 27926453 DOI: 10.1016/bs.pbr.2016.05.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Motivation can be characterized as a series of cost-benefit valuations, in which we weigh the amount of effort we are willing to expend (the cost of an action) in return for particular rewards (its benefits). Human motivation has traditionally been measured with self-report and questionnaire-based tools, but an inherent limitation of these methods is that they are unable to provide a mechanistic explanation of the processes underlying motivated behavior. A major goal of current research is to quantify motivation objectively with effort-based decision-making paradigms, by drawing on a rich literature from nonhuman animals. Here, we review this approach by considering the development of these paradigms in the laboratory setting over the last three decades, and their more recent translation to understanding choice behavior in humans. A strength of this effort-based approach to motivation is that it is capable of capturing the wide range of individual differences, and offers the potential to dissect motivation into its component elements, thus providing the basis for more accurate taxonomic classifications. Clinically, modeling approaches might provide greater sensitivity and specificity to diagnosing disorders of motivation, for example, in being able to detect subclinical disorders of motivation, or distinguish a disorder of motivation from related but separate syndromes, such as depression. Despite the great potential in applying effort-based paradigms to index human motivation, we discuss several caveats to interpreting current and future studies, and the challenges in translating these approaches to the clinical setting.
Collapse
Affiliation(s)
- T T-J Chong
- Macquarie University, Sydney, NSW, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, Australia; Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia.
| | - V Bonnelle
- University of Oxford, Oxford, United Kingdom
| | - M Husain
- University of Oxford, Oxford, United Kingdom; John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
18
|
Chau SA, Chung J, Herrmann N, Eizenman M, Lanctôt KL. Apathy and Attentional Biases in Alzheimer’s Disease. J Alzheimers Dis 2016; 51:837-46. [DOI: 10.3233/jad-151026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Sarah A. Chau
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Jonathan Chung
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, ON, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Moshe Eizenman
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Krista L. Lanctôt
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
19
|
Fervaha G, Foussias G, Takeuchi H, Agid O, Remington G. Measuring motivation in people with schizophrenia. Schizophr Res 2015; 169:423-426. [PMID: 26391283 DOI: 10.1016/j.schres.2015.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
Motivational deficits are a key determinant of poor functional outcomes in schizophrenia. These impairments are typically evaluated using various clinical rating scales; however, the degree of convergence between motivation scores derived from different instruments is not clear. In the present study, we measured motivational deficits in 62 patients with schizophrenia using 5 scores derived from 3 different instruments. We found that the scores from these different instruments were highly inter-correlated, and largely independent of severity of other symptom domains (e.g., depression). Our findings suggest that clinical ratings scales evaluating motivational deficits are tapping into a similar underlying construct.
Collapse
Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, 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
| | - Hiroyoshi Takeuchi
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, 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
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, 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
| |
Collapse
|