Recruitment started in October 2020 until July 2023.

Accepted published paper - OA

CASES - Criteria of Apathy in Schizophrenia - European Study

In this study, our main aimed was to explore whether non-schizophrenia scales for quantifying (AMI - apathy motivational index) and categorizing (DCA - diagnostic criteria for apathy) apathy, measure a similar motivational construct as schizophrenia-based scales, such as BNSS_MAP or PANSS_negative.

We did not define a gold standard measure; instead, we adopted a theory-neutral approach, using convergent validity to examine whether the scales that are theoretically expected to correlate are indeed related.

The study had other secondary aims, including a) comparing clinician-rated outcome measures (CROM) and patient-rated outcome measures (PROMs) for the same construct, b) exploring the factor structure of AMI, which has not been used before in schizophrenia, and c) finding cut-off points for clinically significant apathy in schizophrenia. To date, PANSS, AMI, and BNSS (total or MAP) have no cut-off points for pathological apathy. We used DCA dichotomous classification to explore these cut-off points.


  • Six sites participated in this project: Hospital del Mar Medical Research Institute (Barcelona; Spain), University of Cambridge (United Kingdom), Università della Campania Luigi Vanvitelli (Italy), University Côte d’Azur (France), Université de Genève (Switzerland) and University of Rennes (France). All sites obtained independent local ethical approval for conducting the studies, with another overarching ethical approval (Cambridge; REC reference 20/EM/0230) for the coordinating site that analysed the data. The study was named CASES, namely Criteria of Apathy in Schizophrenia – a European Study.

  • The inclusion criteria were aimed to be representative of people diagnosed with schizophrenia: 1) MINI criteria for Schizophrenia (ICD-10 F20.XX) for more than one year; 2) Age 18 to 60 years; 3) Antipsychotic monotherapy or single antipsychotic augmentation; 4) Outpatient setting; 5) No change in antipsychotic, antidepressant, or mood stabilizer in the previous four weeks; 6) No comorbid neurological or major psychiatric disorders recorded in the clinical notes; 7) No active use of illegal substances or criteria of abuse/dependence/harmful use of alcohol by clinical interview; and 8) Preserved capacity to consent to participate.

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