Differential relationships of amotivation and diminished expression with clinical and cognitive variables in individuals with at-risk mental state for psychosis in Hong Kong

Abstract

Negative symptoms are a multi-dimensional construct which is consistently shown to comprise two distinct domains in psychotic disorders, namely amotivation and diminished expression (DE). We aimed to examine whether these two negative symptom domains could be replicated in individuals with at-risk mental state (ARMS) for psychosis, and their differential relationships with clinical, cognitive and functional characteristics. One hundred four Chinese individuals aged 15–40 years who fulfilled ARMS criteria by Comprehensive Assessment of At Risk Mental State (CAARMS) were recruited from a pilot ARMS screening program in Hong Kong. Assessments on pathway to care, clinical profiles, cognition, functioning and quality of life were administered. Principal Component Analysis with oblimin rotation was performed on Brief Negative Symptom Scale (BNSS) items. Two distinct factors denoting amotivation and DE were identified, explaining 61.2% of the variance. DE score was correlated with age at entry, education attainment, help-seeking duration, and performance on letter-number-span, verbal fluency and monotone counting. Amotivation score was correlated with depressive symptom severity and digit-symbol measure. Multiple regression analyses revealed that verbal fluency and help-seeking duration independently predicted DE (R2=0.27, p=0.001), while depression level predicted amotivation (R2=0.32, p<0.001). DE was associated with RF: social ratings, while amotivation was significantly related to RF: role ratings and SF12 mental health summary score. Consistent with the literature in psychotic disorders, our results indicate amotivation and DE as two independent dimensions underlying negative symptoms in ARMS samples. Further, we demonstrate that amotivation and DE differentially relate to clinical, cognitive and functional variables.