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Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: a structural equation modeling approach

Published online by Cambridge University Press:  21 November 2016

W. C. Chang ,
V. W. Y. Kwong ,
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
V. W. Y. Kwong
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
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
*
*Address for correspondence: Dr W. C. Chang, Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. (Email: [email protected])
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Abstract

Background

Better understanding of the complex interplay among key determinants of functional outcome is crucial to promoting recovery in psychotic disorders. However, this is understudied in the early course of illness. We aimed to examine the relationships among negative symptoms, neurocognition, general self-efficacy and global functioning in first-episode psychosis (FEP) patients using structural equation modeling (SEM).

Method

Three hundred and twenty-one Chinese patients aged 26–55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing symptom profiles, functioning, perceived general self-efficacy and a battery of neurocognitive tests were conducted. Negative symptom measurement was subdivided into amotivation and diminished expression (DE) domain scores based on the ratings in the Scale for the Assessment of Negative Symptoms.

Results

An initial SEM model showed no significant association between functioning and DE which was removed from further analysis. A final trimmed model yielded very good model fit (χ2 = 15.48, p = 0.63; comparative fit index = 1.00; root mean square error of approximation <0.001) and demonstrated that amotivation, neurocognition and general self-efficacy had a direct effect on global functioning. Amotivation was also found to mediate a significant indirect effect of neurocognition and general self-efficacy on functioning. Neurocognition was not significantly related to general self-efficacy.

Conclusion

Our results indicate a critical intermediary role of amotivation in linking neurocognitive impairment to functioning in FEP. General self-efficacy may represent a promising treatment target for improvement of motivational deficits and functional outcome in the early illness stage.

Keywords

Diminished expressionfunctional outcomegeneral self-efficacymotivational deficitsnegative symptomsneurocognitive impairment
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 4 , March 2017 , pp. 755 - 765
Copyright
Copyright © Cambridge University Press 2016 

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