Differential prediction profiles of amotivation and diminished expression in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong

Abstract

Amotivation and diminished expression (DE) are two distinct dimensions underlying negative symptom construct and may be differentially predicted by illness variables in first-episode psychosis (FEP). We aimed to examine clinical and treatment-related determinants of amotivation and DE in FEP patients in the context of a randomizedcontrolled trial (RCT) comparing 1-year extended early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI) in Hong Kong. One hundred sixty Chinese patients were recruited from a specialized program for FEP (EASY) after they had completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, clinical and treatment characteristics were conducted. Amotivation and DE scores were derived from PANSS items based on previous factor analytic studies. Correlations and independent t-tests were performed as appropriate followed by multiple linear regression analyses to determine predictors of amotivation and DE at follow-up. Data analysis was based on 156 subjects who completed follow-up assessments. Our results showed that Extended EI treatment, DE and depressive symptom ratings at intake independently predicted amotivation at 12 months (Adjusted R2=0.19, p<0.001). DE at 12-month follow-up was predicted by educational level, DE and PANSS excitement scores at intake (Adjusted R2=0.16, p<0.001). Our study revealed different predictor profiles for DE and amotivation. In particular, Extended EI predicted amotivation but not DE levels at 12-month follow-up, highlighting the presence of differential treatment responses of two negative symptom dimensions toward EI in FEP patients.