Roughly 30% of first-episode psychosis patients will experience apathy symptoms 10 years later, investigators reported in the April issue of Schizophrenia Research.
Moreover, the investigators’ findings suggest that "it is difficult to determine at baseline which patients will experience enduring levels of apathy," higher levels of psychopathology, and poorer functioning in this group, complicating efforts at targeted treatment (Schizophrenia Res. 2012;136:19-24).
Apathy, a common neuropsychiatric symptom in first-episode psychosis, is associated with "dysfunction of the prefrontal cortex and its subcortical connections," Dr. Julie Evensen and her colleagues wrote. The symptom has been associated with functional decline, worse disease course and outcome, and poor executive functioning among patients.
In the study, Dr. Evensen and her colleagues looked at 178 subjects from the TIPS study (Early Treatment and Intervention in Psychosis), a large, longitudinal study of first-episode psychosis patients from four Scandinavian sites.
All patients were adults aged 18-65 years with IQ scores greater than 70, and all completed the 12-item abridged self-report Apathy Evaluation Scale (AES-S-Apathy) at 10 years after the first psychotic episode.
Scores of 27 and greater were considered to be consistent with clinical apathy.
The researchers then attempted to correlate those scores with objective baseline characteristics, including symptom levels according to the Positive and Negative Syndrome Scale (PANSS).
PANSS negative component items N2 (emotional withdrawal) and N4 (passive/apathetic social withdrawal) were used as proxy measures of apathy at baseline as well as at assessments prior to the 10- year follow-up, at baseline, 3 months, 1 year, 2 years, and 5 years, wrote Dr. Evensen of the University of Oslo.
The authors found that overall, 53 patients (29.8%) showed clinical levels of self-assessed apathy at the 10-year follow-up.
The mean score of patients with self-assessed apathy was 30.9, compared with a mean score among the nonapathy group of 18.9.
Neither patient age, nor baseline years of education, nor the duration of untreated psychosis before the first episode was predictive of 10-year apathy.
Nor did scores on the premorbid assessment of functioning scale correlate with apathy status, including on the childhood academic function, last academic function, childhood social function, and the last social function domains.
Indeed, at baseline, "Only the PANSS negative symptoms component correlated significantly with AES-S-Apathy at 10 years," wrote the authors, though they added that "this variable did not, however, survive as a significant predictor of AES-S-Apathy when entered into regression analyses."
The authors did find that, using the proxy scores of PANSS items N2 (social withdrawal) and N4 (passive/apathetic withdrawal), "The nonapathy group showed a steady decrease in proxy apathy scores over the follow-up period. The apathy group, on the other hand, showed a fairly stable level."
By the 10-year mark, "Higher apathy was associated with less employment, less contact with friends and daily activities, and lower [Global Assessment of Functioning] score."
They added: "Apathy, measured by both AES-S-Apathy and PANSS items N2 and N4, showed a strong correlation with poor subjective quality of life."
Dr. Evensen postulated that one reason for the lack of any clear predictive factors for 10-year apathy could be that "the subgroup with lasting apathy becomes evident only later in the course of the illness. Our longitudinal data on proxy apathy scores support this explanation."
Another reason could be that "there might be a subgroup in our sample with enduring apathy. In this group, apathy appears to be more trait than state."
The findings showing the persistence of apathy among patients with psychotic disorders might help clinicians care for these patients, Dr. Evensen and her colleagues said. Also, they could "be a useful starting point for rehabilitative efforts."
The authors declared that they had no conflicts of interest to disclose. They wrote that the study was supported by funding from Lundbeck Pharma, Eli Lilly, and Janssen-Cilag Pharmaceuticals, and several nonprofit groups and municipalities.