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

Published online by Cambridge University Press:  03 February 2017

W.C. Chang ,
V.W.Y. Kwong ,
G.H.K. Chan ,
O.T.T. Jim ,
E.S.K. Lau ,
C.L.M. Hui ,
S.K.W. Chan ,
E.H.M. Lee  and
E.Y.H. Chen
W.C. Chang*
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
V.W.Y. Kwong
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
G.H.K. Chan
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
O.T.T. Jim
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
E.S.K. Lau
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
C.L.M. Hui
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
S.K.W. Chan
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
E.H.M. Lee
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
E.Y.H. Chen
Affiliation:
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
*
⁎Corresponding author at: Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. Tel.: +852 22554486; fax: +852 28551345. E-mail address: changwc@hku.hk (W.C. Chang).
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Abstract

Background

Amotivation 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).

Methods

One 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.

Results

Amotivation 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.

Conclusion

Our 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.

Keywords

AvolitionMotivational impairmentNegative symptomsDiminished expressionEarly psychosis
Type
Original article
Information
European Psychiatry , Volume 41 , Issue 1 , March 2017 , pp. 37 - 41
Copyright
Copyright © European Psychiatric Association 2017

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