Motivation Disorders in Patients with Schizophrenia

Abstract

Background: increasing the number of studies in the field of motivational disorders in patients with schizophrenia in recent decades indicates the interest of specialists in various fields of science not only in substantiating its theoretical foundations, but also in the possibility of solving applied problems related to increasing motivation.Objective: to present an overview of current domestic and foreign research on the relationship between clinical, socio-psychological, neurophysiological and other causes of motivational disorders in patients with schizophrenia in order to analyze the causes and mechanisms of motivational disorders.Materials and method: we searched the MedLine/PubMed, Scopus, eLibrary, Google Scholar databases for studies using the keywords “schizophrenia, motivation, amotivation”, “negative symptoms and motivation”, “motivation and social factors”, “motivation and neurobiological aspects” and selected scientific publications for the last 10 years. Some studies of an earlier period, usually classics of psychiatry and psychology, which also paid attention to the problems of motivation and negative disorders, were found by relevant references. 83 studies meeting the search criteria were selected.Results: the data presented in the review indicate that motivational disorders in schizophrenia are part of the structure of negative symptomatology and appear already in the prodromal stage of the disease. The authors find quite different approaches to systematization of negative symptoms in schizophrenia in Russia and abroad, where dominant are five-factor, two-factor, and hierarchical model of negative symptoms in schizophrenia, where five domains — blunting of affect, anhedonia, asociality, alogia, and avolition — are extremely important for diagnosis and correction of the disorders. Data from the literature indicate that the prognosis and outcome of schizophrenia, the response to therapy, both biological and psychosocial interventions, largely depend on the state of motivation. A high level of motivation is an important predictor of remission of schizophrenia. Most authors argue that motivation, both intrinsic and extrinsic, is a dynamic result of the interaction of clinical, psychophysiological, personal and socio-environmental factors. Intrinsic motivation is of primary importance for patients with schizophrenia, whose high level forms the basis for neurocognitive improvement. The review touches upon the neurobiological mechanisms of motivational disorders and presents the results of neuroimaging studies of motivational disorders.Conclusion: an understanding the factors of impact and causes of impaired motivation in schizophrenia will enable researchers to develop effective strategies to improve it, which will generally improve the prognosis of schizophrenia and the quality of life of patients.