Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies ( = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy.

中文翻译：

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动机在精神分裂症谱系疾病的临床表现、治疗参与和反应中的作用：系统评价


精神分裂症是一种使人衰弱的精神疾病，对社会和职业功能有长期影响。虽然阴性症状，特别是缺乏积极性，被认为是不良预后因素，但患者动机（自主动机）的积极力量仍未得到充分探索。这项系统评价以自我决定理论 (SDT) 为指导，研究了动机对精神分裂症谱系疾病的临床表现、治疗参与和反应的影响。使用 23 种不同动机量表的 55 项独立研究 (= 6897) 符合纳入标准。结果分为自主动机的横向和纵向相关性以及动机干预的效果。从横截面来看，自主动机与社会/职业功能呈正相关，与阴性和阳性症状严重程度呈负相关。在纵向研究中，基线自主动机预测了对社会/职业治疗的参与和反应，而认知干预的结果好坏参半。在 16 项随机对照试验 (RCT) 中，最常见的动机干预措施是个性化目标设定和目标实现支持，其次是通过挑战失败主义信念来提高能力感，并通过增加接触时间来增强关联性。动机干预持续增加自主动机、治疗参与度和反应。需要更多的研究，特别是监测治疗期间动机的研究：近期评估可以促进识别影响动机和参与度的治疗要素，并为治疗修改提供信息，以增强患者体验并提高治疗效果。