The relative contributions of insight and neurocognition to intrinsic motivation in schizophrenia

Claudio Brasso,Cristiana Montemagni,Paola Rocca,Simona Cardillo,Silvio Bellino,Paola Bozzatello

doi:10.1038/s41537-022-00217-z

Abstract

Intrinsic motivation was described as the mental process of pursuing a task or an action because it is enjoyable or interesting in itself and was found to play a central role in the determination of the functional outcome of schizophrenia. Neurocognition is one of the most studied determinants of intrinsic motivation in clinically stable schizophrenia while little is known about the role of insight. Following this need we decided to focus on the contribution of different aspects of insight and of neurocognition to intrinsic motivation in a large sample (n = 176) of patients with stable schizophrenia. We performed three hierarchical linear regressions from which resulted that, among different insight aspects, the ability to correctly attribute signs and symptoms to the mental disorder made the strongest contribution to intrinsic motivation. Neurocognition, also, was significantly related to intrinsic motivation when analyzed simultaneously with insight. Moreover, even after accounting for sociodemographic and clinical variables significantly correlated with intrinsic motivation, the relationship between insight and neurocognition and intrinsic motivation remained statistically significant. These findings put the emphasis on the complex interplay between insight, neurocognition, and intrinsic motivation suggesting that interventions targeting both insight and neurocognition might possibly improve this motivational deficit in stable schizophrenia should.

Highlights

People living with schizophrenia (SZ) often exhibit a lack of motivation that represents one of the most robust barriers to achieving functional recovery[1]
Our results showed that the ability to correctly attribute signs and symptoms to the mental disorder
We found that SUMD attribution of symptoms is the only insight aspect that maintains a significant relationship with intrinsic motivation (IM) when taking into account all insight variables evaluated with the SUMD

Summary

Introduction

People living with schizophrenia (SZ) often exhibit a lack of motivation that represents one of the most robust barriers to achieving functional recovery[1]. IM can be conceptualized as the product of a complex interplay among physiological mental processes and contextual variables[14] and entails abilities that are often altered in SZ like reward-seeking behavior, incentive salience, and behavioral adaptations to unmet expectations and errors[15]. This conception of IM as a dynamic result of complex interactions among multiple factors poses a challenge to the development of a clear understanding of this phenomenon in SZ. Among other illness-related factors, Hesieh et al.[23] found a significant relationship between insight, measured as a single total variable, and motivation for medication use

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