Apathy in Obsessive-Compulsive Disorder and Its Psychological Correlates: Comparison With Individuals With Schizophrenia

Abstract

Objective: Apathy, defined as reduced goal-directed behavior, is a frequent symptom in mental and neurological disorders but has been poorly studied in individuals with obsessive-compulsive disorder (OCD). The primary aim of this study was to examine levels of apathy between individuals with OCD, healthy control subjects, and individuals with schizophrenia, a mental disorder with high levels of apathy. The second aim was to assess whether the psychological factors that have been previously shown as underlying apathy in other mental disorders were associated with apathy in patients with OCD.Methods: This exploratory study included 25 individuals with OCD, 24 individuals with schizophrenia, and 24 healthy control subjects. Apathy was assessed using the Lille Apathy Rating Scale. Measures of depression, sensibility to punishment and reward, defeatist performance beliefs, and cognitive functioning were also assessed.Results: Individuals diagnosed with OCD and schizophrenia scored significantly higher than healthy control subjects on the apathy total score. Levels of apathy among OCD patients were mainly associated with depression but also dysexecutive functioning and defeatist beliefs.Conclusions: These findings suggest that motivational deficits could play a central role in disability caused by OCD. Similar to other mental disorders, various psychological factors, including depression, defeatist beliefs, and dysexecutive functioning, are involved in apathetic manifestations. However, the fact that depression is the variable most associated with apathy indicates that apathetic symptoms in patients with OCD must be considered mainly as secondary rather than primary symptoms.

Comparative Clinical and Neuropsychological Characteristics in Schizophrenia and Schizophrenia–Obsessive-Compulsive Disorder Patients

“…Patients with schizophrenia with OCD have significantly lower quality of life. There are studies in the literature reporting that patients with OCS accompanying schizophrenia have worse quality of life (Lysaker and Whitney, 2009; Meier et al, 2014), as well as studies (Raffard et al, 2020; Sahoo et al, 2018) reporting that there was no difference between the two groups. The poor quality of life in the schizophrenia-OCD group may be explained by the fact that the symptoms of positive, negative, and general psychopathology are more severe.…”

“…Poyurovsky et al (2004) defined the spectrum of schizo-obsession, and stated that the concept of obsessive psychosis would be appropriate for patients with coexistence. However, Raffard et al (2020) have described spectrum disorders between OCD and schizophrenia. In this spectrum, psychotic symptoms increase as we move from OCD to schizophrenia (Fig.…”

“…As a result of the study, it was observed that patients with schizophrenia with OCD/OCS had worse abstract thinking ability than patients without OCD/OCS. Patients with schizophrenia with OCS had longer hospitalizations than patients with schizophrenia without OCS, and although similar antipsychotic doses were used for both groups, combined treatments with benzodiazepine and antidepressants were used more frequently; patients with schizophrenia with OCS had lower levels of functionality, especially in terms of self-care and social competence, and has been found to be weaker (Bener et al, 2018; Raffard et al, 2020; White et al, 2015).…”

Contingency-based flexibility mechanisms through a reinforcement learning model in adults with Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder

“…As well, we found that the OCD performance of the reversal block is also predicted by a lower value of reward learning rate. Studies on motivational variables in OCD have reported poor motivation and apathy in goal-directed tasks (Moritz et al, 2012, Raffard et al, 2020). This conclusion fits well into the theory that OCD patients are more motivated by loss-avoidance than reinforcement (Kaufmann et al, 2013).…”

Probing apathy in children and adolescents with the Apathy Motivation Index–Child version

“…Decreases in goal-directed behaviour (behavioural activation) are cardinal features of major depression and negative symptoms of schizophrenia (Barch et al, 2016 ), while behavioural and social apathy are comorbid in some patients with anxiety disorders (Hellström et al, 2014 ). Apathy also occurs in disorders characterised by increased compulsive engagement such as obsessive compulsive–disorder (Raffard et al, 2020 ), attention-deficit/hyperactivity disorder in children (Torrente et al, 2011 ) and addiction in adults (Verdejo-García et al, 2006 ). In healthy children and adolescents, the relationships between levels of apathy and internalising (e.g., anxiety–depression) and externalising traits (e.g., impulsivity–compulsivity) are largely unknown.…”