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Thai H, Audet ÉC, Koestner R, Lepage M, O'Driscoll GA. The role of motivation in clinical presentation, treatment engagement and response in schizophrenia-spectrum disorders: A systematic review. Clin Psychol Rev 2024; 113:102471. [PMID: 39111125 DOI: 10.1016/j.cpr.2024.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/28/2024] [Accepted: 07/27/2024] [Indexed: 09/09/2024]
Abstract
Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies (N = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy.
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Affiliation(s)
- Helen Thai
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Élodie C Audet
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Richard Koestner
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Martin Lepage
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
| | - Gillian A O'Driscoll
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Siddiqui I, Remington G, Saperia S, Da Silva S, Fletcher PJ, Voineskos AN, Zakzanis KK, Foussias G. Behavioural phenotypes of intrinsic motivation in schizophrenia determined by cluster analysis of objectively quantified real-world performance. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:85. [PMID: 36271094 PMCID: PMC9587030 DOI: 10.1038/s41537-022-00294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
Intrinsic motivation deficits are a prominent feature of schizophrenia that substantially impacts functional outcome. This study used cluster analysis of innate real-world behaviours captured during two open-field tasks to dimensionally examine heterogeneity in intrinsic motivation in schizophrenia patients (SZ) and healthy controls (HC). Wireless motion capture quantified participants' behaviours aligning with distinct aspects of intrinsic motivation: exploratory behaviour and effortful activity in the absence of external incentive. Cluster analysis of task-derived measures identified behaviourally differentiable subgroups, which were compared across standard clinical measures of general amotivation, cognition, and community functioning. Among 45 SZ and 47 HC participants, three clusters with characteristically different behavioural phenotypes emerged: low exploration (20 SZ, 19 HC), low activity (15 SZ, 8 HC), and high exploration/activity (10 SZ, 20 HC). Low performance in either dimension corresponded with similar increased amotivation. Within-cluster discrepancies emerged for amotivation (SZ > HC) within the low exploration and high performance clusters, and for functioning (SZ < HC) within all clusters, increasing from high performance to low activity to low exploration. Objective multidimensional characterization thus revealed divergent behavioural expression of intrinsic motivation deficits that may be conflated by summary clinical measures of motivation and overlooked by unidimensional evaluation. Deficits in either aspect may hinder general motivation and functioning particularly in SZ. Multidimensional phenotyping may help guide personalized remediation by discriminating between intrinsic motivation impairments that require amelioration versus unimpaired tendencies that may facilitate remediation.
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Affiliation(s)
- Ishraq Siddiqui
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Gary Remington
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Sarah Saperia
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto Scarborough, Toronto, ON Canada
| | - Susana Da Silva
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Paul J. Fletcher
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto, Toronto, ON Canada
| | - Aristotle N. Voineskos
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Konstantine K. Zakzanis
- grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto Scarborough, Toronto, ON Canada
| | - George Foussias
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
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Dehn LB, Driessen M, Beblo T. Patients with major depression show greater memory improvement if motivation is increased: An exploratory study under real-life-like conditions. J Clin Exp Neuropsychol 2020; 42:307-318. [DOI: 10.1080/13803395.2020.1711874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Lorenz B. Dehn
- Clinic for Psychiatry and Psychotherapy, Evang. Klinikum Bethel, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Martin Driessen
- Clinic for Psychiatry and Psychotherapy, Evang. Klinikum Bethel, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Clinic for Psychiatry and Psychotherapy, Evang. Klinikum Bethel, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Choi KH, Kang J, Kim SM, Lee SH, Park SC, Lee WH, Choi S, Park K, Hwang TY. Cognitive Remediation in Middle-Aged or Older Inpatients with Chronic Schizophrenia: A Randomized Controlled Trial in Korea. Front Psychol 2018; 8:2364. [PMID: 29467684 PMCID: PMC5807907 DOI: 10.3389/fpsyg.2017.02364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background: Accumulating evidence indicates that cognitive remediation (CR) is effective for improving various cognitive deficits in adult patients with schizophrenia. Although reports of brain plasticity in older adults and the service needs for chronic patients with schizophrenia are increasing, very few randomized controlled trials of CR have been conducted in middle-aged or older inpatients with chronic schizophrenia. We investigated the efficacy of individualized CR on the cognitive impairments of middle-aged or older inpatients with chronic schizophrenia within the context of comprehensive psychiatric rehabilitation (PR) by comparing the results obtained with PR only and treatment as usual (TAU). Method: Fifty-seven middle-aged and older individuals with chronic schizophrenia and mild to moderate cognitive deficits were enrolled. Thirty-eight who were undergoing PR were randomly assigned to CR + PR (N = 19) or PR-only (N = 19) groups. Nineteen participants who were undergoing TAU without CR or PR were evaluated pre- and post-treatment. Results: CR was easily provided and well received (drop-out rates = 5.3%) by middle-aged or older psychiatric inpatients. Compared to the PR-Only or TAU patients, patients in the CR + PR group showed greater improvement in executive functioning. Compared to TAU patients, CR + PR and PR-only patients showed greater improvement in logical memory. More patients in the CR + PR group improved clinically significantly in executive functioning and logical memory, compared with the PR-only and TAU patients. Conclusions: These results suggested that CR improved some cognitive deficits in middle-aged or older inpatients with chronic schizophrenia and that it was effective as an adjunctive treatment to the usual PR services provided in inpatient settings. Clinical Registration: KCT0002609.
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Affiliation(s)
- Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, South Korea
| | - Jinsook Kang
- Department of Psychology, Korea University, Seoul, South Korea
| | - Sun-Min Kim
- Department of Psychology, Korea University, Seoul, South Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University College of Medicine and Ilsan Paik Hospital, Goyang, South Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, South Korea
| | - Won-Hye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, South Korea
| | - Sun Choi
- Department of Clinical Psychology, Yongin Mental Hospital, Yongin, South Korea
| | - Kiho Park
- Department of Psychology, Korea University, Seoul, South Korea
| | - Tae-Yeon Hwang
- Division of Mental Health Service and Planning, National Center for Mental Health and Yongin WHO Collaborating Center for Psychosocial Rehabilitation and Community Mental Health, Seoul, South Korea
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