Apathy Associated With Depressive Symptoms in Patients With Obsessive-Compulsive Disorder

Levels of apathy in patients with obsessive-compulsive disorder were primarily associated with depression, but also with dysexecutive functioning and defeatist beliefs.

Apathy was associated with depressive symptoms and deficits in executive functioning in patients with obsessive-compulsive disorder (OCD), according to study data published in the Journal of Neuropsychiatry and Clinical Neurosciences.

Investigators recruited adult patients from the University Department of Adult Psychiatry, Hôpital de la Colombière in Montpellier, France. The study cohort comprised 25 patients with OCD, 24 with schizophrenia, and 24 healthy controls. Participants were administered the Lille Apathy Rating Scale and the Beck Depression Inventory-II to capture apathy levels and depressive symptoms, respectively. Additional measures were employed to assess sensitivity to punishment and reward, the presence and intensity of dysfunctional attitudes, cognitive functioning, and executive functioning. Between-group differences in apathy were tested using one-way analysis of variance; correlational tests were conducted in the OCD group to capture associations between apathy and other clinical variables.

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Age and gender distributions were comparable between study groups. The majority of participants were men (69.9%). Each clinical group scored significantly higher than control subjects on depression (both P <.001). Individuals with OCD were significantly more sensitive to punishment compared with individuals with schizophrenia (P =.017) and healthy controls (P <.001). A significant effect of group for apathy total score was observed (P ≤.0001), with both clinical groups scoring much higher than the control subjects. Effect of group remained significant after corrections for education level and depression. In patients with OCD, apathy total score was mainly associated with depression, and also positively correlated with defeatist performance beliefs and dysexecutive function.

Per these data, apathy may play a central role in the disability caused by OCD. Given the small sample size, however, results must be extrapolated with care.

“The fact that depression is the variable most associated with apathy indicates that apathetic symptoms in patients with OCD should be considered as secondary rather than primary symptoms,” investigators noted.

“The addition of psychological interventions specifically targeting both depression and defeatist performance beliefs to exposure and prevention response could be considered as an adjunctive treatment for OCD patients with high levels of apathy,” they concluded.


Raffard S, Capdevielle D, Attal J, Novara C, Bortolon C. Apathy in obsessive-compulsive disorder and its psychological correlates: comparison with individuals with schizophrenia [published online July 3, 2019]. J Neuropsychiatry Clin Neurosci. doi:10.1176/appi.neuropsych.19010018