In Schizophrenia, Motivation Drives Cognitive Performance

For schizophrenia patients, there is a connection between deficits in cognition and motivation related to their illness, according to research published online in JAMA Psychiatry.

Currently, schizophrenia-associated indicators are characterized as “positive,” “negative,” and “cognitive.” Positive symptoms include distortions in reality and hallucinations, while negative manifestations result in social withdrawal and a decrease in motivation. Although cognitive impairments are defined as affecting memory, attention, and planning, they are harder to detect, according to a statement from the Centre for Addiction and Mental Health (CAMH) in Toronto.

Existing medications are geared to treat psychosis, a symptom that afflicts many schizophrenia patients, and emerging research has highlighted cognitive symptoms. However, the motivational impairment’s effects on cognition have been neglected, according to CAMH.

In a cross-sectional and 6-month prospective follow-up study, researchers at the center and the University of Toronto (UOFT) evaluated cognition and intrinsic motivation in 431 schizophrenic patients undergoing a stable treatment regimen. At the time of the study, the researchers also assessed the participants’ illness severity and functional status.

The researchers discovered subjects with higher levels of motivation also had better cognitive test scores (correlation range, 0.20-0.34; P&thinsp;<&thinsp;.001). Their findings were verified after adjusting for symptom severity (P&thinsp;<&thinsp;.05), functioning status (P&thinsp;<&thinsp;.001), and medication dosage (P&thinsp;<&thinsp;.05). During the 6-month follow-up, the investigators reported an improvement in motivation also significantly increased cognitive performance (P&thinsp;<&thinsp;.05).

Based on their discovery, lead author Gagan Fervaha, a researcher at CAMH and a PhD candidate at the UOFT, recommended motivation be taken into account when analyzing a schizophrenic patient’s cognitive ability. Currently, motivation and cognition in schizophrenia are considered 2 separate domains of the illness.

“You can imagine that if you [schizophrenia patients] are told to remember something and that, because of the illness, you’re not really motivated to remember it, it will be more difficult to remember than if you were highly motivated to do so,” Fervaha explained.

Based on their findings, the authors suggest that future studies assessing the cognition of schizophrenia patients should consider variables such as effort and motivation.