SA30. Self-Assessment of Amotivation and Insight into Patients With Schizophrenia

Abstract

Background: Schizophrenia is a disabling disorder characterized by negative and cognitive symptoms. The negative symptom domain of low motivation has recently been found to be an important determinant of functioning. Currently, motivation is frequently assessed with either self-rated or clinician-rated motivation measures. However, little is known about the overlap between self-rated and clinician-rated motivation and whether these two assessment types are differentially related to clinical variables. Therefore, this study investigated (1) the association between self-rated and clinician-rated motivation, (2) the clinical correlates of both motivation assessment types, and (3) the correlates of the discrepancy between the motivation assessments types. Methods: Fifty patients with schizophrenia spectrum disorders were assessed by trained clinicians using the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale (CDSS), and both the clinician-rated (C) and self-rated (S) versions of the Apathy Evaluation Scale (AES). Neurocognition was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Social cognition was assessed with the Hinting Task, the Relationships Across Domains measure, and the Ekman-60 emotion recognition task. Results: The AES-C and AES-S were positively correlated (r = .43; P < .05). Further, moderate, positive correlations were established between the AES-C and most of the PANSS amotivation subscale items (N2 (r = .51), N4 (r = .45)). However, a significant correlation between the AES-C and the G16 item of the PANSS amotivation subscale was not observed. The AES-S was not significantly correlated with any of the PANSS amotivation items. The AES-C did not correlate with the PANSS depression item or the CDSS total score, while moderate correlations with the AES-S were observed with both (r = .38 and r = .45, respectively). The AES-C/AES-S discrepancy score was positively correlated with the PANSS insight item (r = 0.39) and the presence of a paranoid schizophrenia diagnosis (r = .32). No significant correlations were observed between the discrepancy score and the BACS, social cognition measures, or additional demographic variables. Conclusion: While the clinician-rated AES is regarded as a sensitive instrument for the assessment of apathetic/amotivation schizophrenia symptoms, our results suggest that scores from the self-rated AES need to be interpreted carefully. Our findings also indicate that patients with schizophrenia might be less aware of primary negative (i.e., amotivation) symptoms, and when asked to self-rate negative symptoms, they rate secondary negative symptoms caused by depression. Results also suggest that reduced insight might be driving part of the discrepancy between self-rated and clinician-rated motivation. Findings should be considered when choosing motivation measures.