Journal of the International Neuropsychological Society (2015), 21, 436–443. Copyright © INS. Published by Cambridge University Press, 2015. doi:10.1017/S1355617715000375 Motivation and Social Cognition in Patients with Schizophrenia Gagan Fervaha, 1,2 Ishraq Siddiqui, 1,2 George Foussias, 1,2,3 Ofer Agid, 1,2,3 AND Gary Remington 1,2,3 1 Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada 2 Institute of Medical Science, University of Toronto, Toronto, Canada 3 Department of Psychiatry, University of Toronto, Toronto, Canada (RECEIVED October 28, 2014; FINAL REVISION April 27, 2015; ACCEPTED April 27, 2015; FIRST PUBLISHED ONLINE July 2, 2015) Abstract Social cognition, referring to one’s ability to perceive and process social cues, is an important domain in schizophrenia. Numerous studies have demonstrated that patients with schizophrenia have poorer performance on tests assessing social cognition relative to healthy comparison participants. However, whether variables such as motivation are related to performance on these tests in patients with schizophrenia is unclear. One thousand three-hundred and seventy-eight patients with schizophrenia completed the Facial Emotion Discrimination Task as a measure of emotional processing, a key facet of social cognition. Level of motivation was also evaluated in these patients using a derived measure from the Quality of Life Scale. The relationship between motivation and task performance was examined using bivariate correla- tions and logistic regression modeling, controlling for the impact of age and overall severity of psychopathology, the latter evaluated using the Positive and Negative Syndrome Scale. Motivation was positively related to performance on the social cognition test, and this relationship remained significant after controlling for potential confounding variables such as age and illness severity. Social cognition was also related to functioning, and the relationship was mediated by level of motivation. The present study found a significant relationship between motivation and performance on a test of social cognition in a large sample of patients with schizophrenia. These findings suggest that amotivation undermines task performance, or alternatively that poor social cognitive ability impedes motivation. Future studies evaluating social cognition in patients with schizophrenia should concurrently assess for variables such as effort and motivation. (JINS, 2015, 21, 436–443) Keywords: Schizophrenia, Intrinsic motivation, Emotion processing, Cognitive performance, Interpersonal relations, Avolition-apathy INTRODUCTION Many individuals with schizophrenia experience marked impairments in their social (i.e., interpersonal) functioning (Bellack, Morrison, Wixted, & Mueser, 1990). These functional impairments are linked to deficits in patients’ ability or willingness to successfully perceive and interpret the inten- tions and behaviors of others (Couture, Penn, & Roberts, 2006; Fett et al., 2011), mental processes that are collectively referred to as social cognition (Green et al., 2008). Social cognitive ability is typically inferred through performance on various tasks designed to assess one’s knowledge of and ability to perceive and process social cues (Pinkham et al., 2014). As a group, people with schizophrenia demonstrate poorer performance on these tests compared to healthy participants (Savla, Vella, Armstrong, Penn, & Twamley, 2013). Performance on tests of social cognition, and neurocogni- tion, can potentially be influenced by a host of factors, including willingness to do well during standardized testing procedures. In schizophrenia, several studies have shown that effort and motivation are linked with performance on tests of neurocognition (Avery, Startup, & Calabria, 2009; Fervaha, Agid, Foussias, & Remington, 2014; Gorissen, Sanz, & Schmand, 2005; Hunt, Root, & Bascetta, 2014; Strauss, Morra, Sullivan, & Gold, 2015); however, less is known about the link between these variables and performance on tests of social cognition. One study reported a link between participants’ intrapsychic functioning, which encompasses motivation and hedonic experience, with performance on affect recognition tests (Poole, Tobias, & Vinogradov, 2000), and this finding has been replicated with other social cognition tests (Lysaker et al., 2013). Another study by the same group demonstrated that patients’ level of motivation in particular was significantly associated with social cognitive performance as assessed by a composite measure, which Correspondence and reprint requests to: Gagan Fervaha, Schizophrenia Division, Centre for Addiction and Mental Health, 250 College Street, Room 320, Toronto, Ontario, Canada M5T 1R8. E-mail: gagan.fervaha@utoronto.ca 436