Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored.
The aims of the study were twofold: 1) to examine prevalence and predictors of apathy at 10 years, and 2) to examine the relationship between apathy at 10 years and concurrent symptoms, functioning and outcome, including subjective quality of life.
Three-hundred-and-one patients with FEP were included at baseline, 186 participated in the 10 year follow-up. Of these, 178 patients completed the Apathy Evaluation Scale (AES-S-Apathy). Patients were classified as having apathy (AES-S-Apathy≥27) or not. The relationship between apathy and baseline variables (Demographics, Diagnosis, Duration of Untreated Psychosis), measures of symptomatology (Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning Scale, Strauss Carpenter Level of Functioning Scale) and subjective quality of life (Lehman's Quality of Life Interview) were estimated through correlation analyses and blockwise multiple hierarchical regression analysis.
Nearly 30% of patients met the threshold for being apathetic at follow-up. No baseline variables predicted apathy significantly at 10 years. Apathy was found to contribute independently to functioning and subjective quality of life, even when controlling for other significant correlates.
Apathy is a common symptom in a FEP cohort 10 years after illness debut, and its presence relates to impaired functioning and poorer subjective quality of life.
"All versions of AES are brief and easy to complete, provide a quantitative assessment of general loss of motivation, and also include three specific subscores relative to cognitive, behavioral, and emotional aspects of apathy. These characteristics make AES particularly suitable for assessing changes in the manifestation of apathy over time and in response to specific treatment  . However, applicability of AES in MS has not been tested yet. "
[Show abstract][Hide abstract] ABSTRACT: Results AES-S was easy to administer and acceptable, and showed fair internal consistency (Cronbach's alpha, α = 0.87). The factorial analysis identified three factors, representing the cognitive dimension (α = 0.87), a general aspect of apathy (α = 0.84), and the behavioral-emotional aspects (α = 0.74), respectively. The factors were significantly correlated with the total AES score (all rrho ≥ 0.73, p < 0.001). The total AES score showed fair convergent validity (rrho = 0.38) and discriminant validity when compared to Expanded Disability Status Scale (rrho = 0.38), Mini Mental State Examination (rrho = - 0.17), and Hamilton Depression Rating Scale (rrho = 0.37). Receiver-operating characteristic curve analysis demonstrated that a cutoff > 35.5 can identify clinically significant apathy with good sensitivity (88%) and specificity (72%); such a cutoff identified apathy in 35.7% of our sample of non-demented MS patients. Total AES score was significantly correlated with reduced global cognitive efficiency and more severe frontal executive dysfunctions.
Journal of the Neurological Sciences 10/2014; 347(1-2). DOI:10.1016/j.jns.2014.10.027 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Affective flattening has been described as enduring, but long term follow-up studies of first episode psychosis patients are lacking.
The aim of this study was to follow the symptom development of flat affect (FA), over a 10 year follow-up period, with focus on prevalence, predictors and outcome factors including social functioning.
Three-hundred-and-one patients with FEP were included at baseline, 186 participated in the 10 year follow-up. These were followed on PANSS item N1 (FA) from baseline through 5 follow-up assessments over 10 years. Patients were grouped as having never-present, improving, deteriorating, fluctuating or enduring FA. The groups were compared on baseline variables, variables at 10 year follow-up, and social functioning throughout the follow-up period.
Twenty nine percent never displayed FA, 66% had improving, deteriorating or fluctuating FA, while 5% of patients had enduring FA. Premorbid social function predicted enduring FA. The patients with enduring, fluctuating and deteriorating FA did poorer on all outcome variables, including remission and recovery rates. The enduring FA group did significantly poorer in social functioning over the 10 year period.
FA is expressed at some point of time in the majority of FEP patients in a 10 year follow-up period, and appears more fluctuant than expected from the relevant literature. FA is associated with poorer outcome after 10 years, and enduring FA to poorer social function at all points of assessment.
Schizophrenia Research 05/2012; 139(1-3):99-104. DOI:10.1016/j.schres.2012.04.019 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The field of therapeutics in schizophrenia is redefining optimal outcome, moving beyond clinical remission to a more comprehensive model that also includes functional recovery. The Quality of Life Scale (QLS) has been adopted by many large clinical trials, including CATIE and CUtLASS, as a measure of functioning. The QLS is a 21-item semi-structured interview that takes approximately 45min to administer. Although the QLS is considered comprehensive, its length limits its applicability across studies. To circumvent this issue, short scales of the QLS have been created that estimate total scores with high accuracy. However, these abbreviated measures have not been adequately cross-validated in a large enough sample to allow for subsample estimations nor has its predictive ability been compared to the full scale. Here, we used data from the CATIE trial (n=1460) to demonstrate the validity and utility of an abbreviated 7-item QLS. The shortened QLS was robust in estimating total scores (r=0.953, p<0.001) across subsamples and demonstrated predictive ability similar to the full QLS in multiple regression models. The abridged QLS is recommended as a surrogate measure of psychosocial functioning, especially in cases where functioning is not the primary outcome.
European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 12/2012; 23(9). DOI:10.1016/j.euroneuro.2012.11.009 · 4.37 Impact Factor
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