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Apathy and Functioning in First-Episode Psychosis

Dr. Faerden is affiliated with the Department of Psychiatry, Ullevål University Hospital, Building 49, Oslo 0407, Norway (e-mail: ann.farden{at}medisin.uio.no). Dr. Friis and Dr. Melle are with the Department of Psychiatry, Ullevål University Hospital, and with the Institute of Psychiatry, University of Oslo. Dr. Agartz is with the Department of Psychiatry, Diakonhjemmet Hospital, Oslo, where Dr. Nesvåg is affiliated, and with the Institute of Psychiatry, University of Oslo. Dr. Barrett is with the Department of Psychiatry, Aker University Hospital, Oslo. Dr. Finset is with the Institute of Behavioral Sciences in Medicine, University of Oslo.

OBJECTIVE: This study aimed to determine which patient characteristics are associated with higher levels of apathy, to what degree first-episode psychosis patients are apathetic compared with a healthy control group, and to what degree apathy and other symptoms (including negative subsymptoms) influence functioning in first-episode psychosis. METHODS: The Norwegian Thematically Organized Psychosis research study included 103 first-episode psychosis patients and a healthy control group of 62 persons. Apathy was assessed with the clinician-rated abridged version of the Apathy Evaluation Scale (AES-C-Apathy). Other clinical symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). The PANSS five-factor model was used in the subsequent analyses. Functioning was assessed with the split version of the Global Assessment of Functioning scale (GAF). RESULTS: More than 50% of first-episode psychosis patients were clinically apathetic compared with the healthy group. Of all clinical variables, only premorbid childhood social functioning, change in social functioning, and disorganized symptoms (PANSS disorganized component) had a significant association with AES-C-Apathy, explaining 18% of the variance. Multiple regression analysis revealed that of the five PANSS components, only PANSS positive made a significant independent contribution to the GAF-F score, as did the AES-C-Apathy score, explaining 37% of the variance. The same regression model indicated that among the PANSS negative symptoms, only flat affect made an independent significant contribution to functioning. CONCLUSIONS: Apathy is a prevalent symptom in first-episode psychosis and has a significant association with everyday functioning; the presence and consequences of apathy should thus be evaluated at the start of treatment.

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