Evidence for avolition in bipolar disorder? A 30-day ecological momentary assessment comparison of daily activities in bipolar disorder and schizophrenia

•People with bipolar disorder typically have better functional outcomes than people with schizophrenia, but disability is quite common.•People with bipolar disorder were no more likely to engage in productive activities than people with schizophrenia and momentary sadness was correlated with unproductivity in both samples.•People with bipolar disorders were more likely to have done more than one activity in the recent past than people with schizophrenia, but most of their ecological momentary assessment surveys also only indicated one activity.•Negative symptoms such as avolition have been reported previously in people with bipolar disorder and it seems as though avolition occurs in the context of momentary experiences of sadness. Disability is common in bipolar disorder (BD) and predicted by persistent sadness. We used ecological momentary assessment (EMA) to examine daily activities in people with BD and schizophrenia. We classified activities as productive, unproductive, or passive recreation, relating them to momentary sadness, location, and social context. 71 people with BD and 102 people with schizophrenia were sampled 3 times/day for 30 days with an EMA survey. Each survey asked where they were, with whom, what they were doing, and if they were sad. People with BD were home more than 50% of the time. There were no differences in prevalence of activity types across diagnoses. People with BD were less likely to report only one activity since the prior survey, but the most surveys still reported only one. For both groups, sadness and being home and alone since the last survey was associated with less productive activity and more passive recreation. Participants with BD and schizophrenia manifested high levels of unproductive and passive activities, predicted by momentary sadness. These activity patterns are consistent with descriptions of avolition and they minimally differentiated people with BD and schizophrenia. Previous reports of negative symptoms in BD may have been identifying these behaviors.