Improving motivation in psychotic disorders

Project: People diagnosed with schizophrenia suffer with delusions and hallucinations, but also experience other symptoms, which are more relevant for the long-term functioning, recovery and independence. These so-called negative symptoms (because it refers to function loss) include low motivation (‘apathy’) and decrease in emotional life (‘decrease mimic, gesture and voice expression’).

 

Progress has been achieved in understating apathy, but knowledge has not been translated into better interventions. To date, no medication or intervention (psychology, etc..) have shown efficacy in improving motivation. We know that the brain mechanisms for the psychosis (voices/delusions) mirror those involved in poor motivation, converging all in the brain chemical called ‘dopamine’. In a nutshell, an excess of dopamine in mid brain triggers psychosis, whereas a decrease dopamine activity in forebrain cause apathy. The dilemma is that treating psychosis with dopamine blockers (antipsychotics) improve delusions but worsen negative symptoms.

 

The proposal here is to test a medication that could be added to the usual treatment in order to improve motivation. The study design is a feasibility and pilot study, that is: small number of volunteers (about 20-30) taking this medication for a limited time (8-12 weeks typically) so we can gather enough information for a future larger trial. There are four main options with regards medication, to be discussed with the group: antidepressant, alert-improving medication and two pro-dopaminergic medications. All these medications are safe as they are already licenced for the treatment of other disorders. However, our previous research and scientific literature suggests it has the potential to help with motivation too.

 

Researcher: Emilio Fernandez-Egea, Consultant Psychiatrist, CPFT

 

Involvement: The researcher is interested in working with people with lived experience of schizophrenia or psychosis to shape this project. The project is at initial stages and people could be involved as much or as little as they want. Initially we will have 1-2 virtual meetings to discuss the study aims and objectives and the four pharmacological options. The group could then meet to discuss the study design. Feedback can be provided verbally during the meetings and/or in writing.

 

Time commitment: 2-4 hours to initiate discussions on the topic. The researcher is hoping that experts by experience will be interested in continuing involved throughout the project.

 

Payment: Members will receive £10 per hour for their time and contribution. Please note, this income may have implications for those claiming benefits. All income must be declared to the Inland Revenue.

 

Contact: If you are interested in this project please let Iliana know as soon as possible by emailing iliana.rokkou@cpft.nhs.uk

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