Avolition

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Avolition or amotivation, as a symptom of various forms of psychopathology, is the decrease in the ability to initiate and persist in self-directed purposeful activities. [1] [2] Such activities that appear to be neglected usually include routine activities, including hobbies, going to work or school, and most notably, engaging in social activities. A person experiencing avolition may stay at home for long periods of time, rather than seeking out work or peer relations. It is a disorder of diminished motivation.

Contents

Psychopathology

People with avolition often want to complete certain tasks but lack the ability to initiate behaviors necessary to complete them. Avolition is most commonly seen as a symptom of some other disorder, but might be considered a primary clinical disturbance of itself (or as a coexisting second disorder) related to disorders of diminished motivation. In 2006, avolition was identified as a negative symptom of schizophrenia by the National Institute of Mental Health (NIMH), [3] and has been observed in patients with bipolar disorder as well as resulting from trauma.

Avolition is sometimes mistaken for other, similar symptoms also affecting motivation, such as abulia, anhedonia and asociality, or strong general disinterest. For example, abulia is also a restriction in motivation and initiation, but characterized by an inability to set goals or make decisions and considered a disorder of diminished motivation. [4] In order to provide effective treatment, the underlying cause of avolition (if any) has to be identified and it is important to properly differentiate it from other symptoms, even though they might reflect similar aspects of mental illness.

Social and clinical implications

Implications from avolition often result in social deficits. Not being able to initiate and perform purposeful activities can have many implications for a person with avolition. By disrupting interactions with both familiar and unfamiliar people, it jeopardizes the patient's social relations. When part of a severe mental illness, avolition has been reported, in first person accounts, to lead to physical and mental inability to both initiate and maintain relationships, as well as work, eat, drink or even sleep. [5]

Clinically, it may be difficult to engage an individual experiencing avolition in active participation of psychotherapy. Patients are also faced with the stresses of coping with and accepting a mental illness and the stigma that often accompanies such a diagnosis and its symptoms. Regarding schizophrenia, the American Psychiatric Association reported in 2013 that there currently are "no treatments with proven efficacy for primary negative symptoms" [6] (such as avolition). Together with schizophrenia's chronic nature, such facts added to the outlook of never getting well, might further implicate feelings of hopelessness and similar in patients as well as their friends and family.

Treatment

Antipsychotics are less effective in the treatment of negative symptoms of schizophrenia such as avolition than for positive symptoms. [7] Low dose amisulpride has shown to be more effective than placebo for treating the negative symptoms of schizophrenia, which includes avolition. It works by blocking pre-synaptic dopamine receptors, causing a release of dopamine into the synapse. [8]

Compared with social skills training (SST), cognitive behavioural therapy (CBT) shows more promise in treating the negative symptoms of schizophrenia, including avolition. [9]

According to a 2015 article, aripiprazole may be useful for treatment of apathy syndrome (avolition). However, its role and efficacy in treatment of apathy requires further investigation in clinical trials. [10] A comparison to amisulpride published in 2022, found that aripiprazole was effective in treating negative symptoms, while amisulpride was not. [11] [ non-primary source needed ]

According to a 2020 study, mitragynine contained in kratom may have the ability to reduce avolition. [12]

See also

Related Research Articles

<span class="mw-page-title-main">Antipsychotic</span> Class of medications

Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder.

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized variously by hallucinations, delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially mood disorders, anxiety disorders, and obsessive–compulsive disorder.

<span class="mw-page-title-main">Atypical antipsychotic</span> Class of pharmaceutical drugs

The atypical antipsychotics (AAP), also known as second generation antipsychotics (SGAs) and serotonin–dopamine antagonists (SDAs), are a group of antipsychotic drugs largely introduced after the 1970s and used to treat psychiatric conditions. Some atypical antipsychotics have received regulatory approval for schizophrenia, bipolar disorder, irritability in autism, and as an adjunct in major depressive disorder.

Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

<span class="mw-page-title-main">Anhedonia</span> Inability to feel pleasure

Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers to refer to reduced motivation, reduced anticipatory pleasure (wanting), reduced consummatory pleasure (liking), and deficits in reinforcement learning. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anhedonia is a component of depressive disorders, substance-related disorders, psychotic disorders, and personality disorders, where it is defined by either a reduced ability to experience pleasure, or a diminished interest in engaging in previously pleasurable activities. While the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) does not explicitly mention anhedonia, the depressive symptom analogous to anhedonia as described in the DSM-5 is a loss of interest or pleasure.

<span class="mw-page-title-main">Aripiprazole</span> Atypical antipsychotic

Aripiprazole, sold under the brand names Abilify and Aristada, among others, is an atypical antipsychotic. It is primarily used in the treatment of schizophrenia and bipolar disorder; other uses include as an add-on treatment in major depressive disorder and obsessive–compulsive disorder (OCD), tic disorders, and irritability associated with autism. Aripiprazole is taken by mouth or via injection into a muscle. A Cochrane review found low-quality evidence of effectiveness in treating schizophrenia.

<span class="mw-page-title-main">Apathy</span> State of indifference, or the suppression of emotions

Apathy, also referred to as indifference, is a lack of feeling, emotion, interest, or concern about something. It is a state of indifference, or the suppression of emotions such as concern, excitement, motivation, or passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical, virtual, or physical life and the world. Apathy can also be defined as a person's lack of goal orientation. Apathy falls in the less extreme spectrum of diminished motivation, with abulia in the middle and akinetic mutism being more extreme than both apathy and abulia.

Amotivational syndrome is a chronic psychiatric disorder characterized by signs that are linked to cognitive and emotional states such as detachment, blunted emotion and drives, executive functions like memory and attention, disinterest, passivity, apathy, and a general lack of motivation. This syndrome can be branched into two subtypes: marijuana amotivational syndrome, or cannabis-induced amotivational syndrome, which is caused by usage of or dependency on that substance, and is primarily associated with long-term effects of cannabis use, and SSRI-induced amotivational syndrome or SSRI-induced apathy, caused by the intake of SSRI medication dosage. According to the Handbook of Clinical Psychopharmacology for Therapists, amotivational syndrome is listed as a possible side effect of SSRIs in the treatment of clinical depression. It is a disorder of diminished motivation.

In neurology, abulia, or aboulia, refers to a lack of will or initiative and can be seen as a disorder of diminished motivation. Abulia falls in the middle of the spectrum of diminished motivation, with apathy being less extreme and akinetic mutism being more extreme than abulia. The condition was originally considered to be a disorder of the will, and aboulic individuals are unable to act or make decisions independently; and their condition may range in severity from subtle to overwhelming. In the case of akinetic mutism, many patients describe that as soon as they "will" or attempt a movement, a "counter-will" or "resistance" rises up to meet them.

<span class="mw-page-title-main">Dopamine antagonist</span> Drug which blocks dopamine receptors

A dopamine antagonist, also known as an anti-dopaminergic and a dopamine receptor antagonist (DRA), is a type of drug which blocks dopamine receptors by receptor antagonism. Most antipsychotics are dopamine antagonists, and as such they have found use in treating schizophrenia, bipolar disorder, and stimulant psychosis. Several other dopamine antagonists are antiemetics used in the treatment of nausea and vomiting.

<span class="mw-page-title-main">Dopaminergic</span> Substance related to dopamine functions

Dopaminergic means "related to dopamine", a common neurotransmitter. Dopaminergic substances or actions increase dopamine-related activity in the brain.

<span class="mw-page-title-main">Amisulpride</span> Atypical antipsychotic and antiemetic medication

Amisulpride, sold under the brand names Solian and Barhemsys, is a medication used in the treatment of schizophrenia, acute psychotic episodes, depression, and nausea and vomiting. It is specifically used at lower doses intravenously to prevent and treat postoperative nausea and vomiting; at low doses by mouth to treat depression; and at higher doses by mouth to treat psychosis.

Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time, but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

Neuroleptic-induced deficit syndrome (NIDS) is a psychopathological syndrome that develops in some patients who take high doses of an antipsychotic for an extended time. It is most often caused by high-potency typical antipsychotics, but can also be caused by high doses of many atypicals, especially those closer in profile to typical ones (that have higher D2 dopamine receptor affinity and relatively low 5-HT2 serotonin receptor binding affinity), like paliperidone and amisulpride.

Simple-type schizophrenia is a sub-type of schizophrenia included in the International Classification of Diseases (ICD-10), in which it is classified as a mental and behaviour disorder. It is not included in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the upcoming ICD-11, effective 1 January 2022. Simple-type schizophrenia is characterized by negative ("deficit") symptoms, such as avolition, apathy, anhedonia, reduced affect display, lack of initiative, lack of motivation, low activity; with absence of hallucinations or delusions of any kind.

<span class="mw-page-title-main">Brilaroxazine</span> Experimental atypical antipsycotic

Brilaroxazine, also known as oxaripiprazole, is an investigational atypical antipsychotic which is under development by Reviva Pharmaceuticals for the treatment of neuropsychiatric and inflammatory disorders. It has currently completed the first of two phase III clinical trials for schizophrenia. Reviva Pharmaceuticals also intends to investigate brilaroxazine for the treatment of bipolar disorder, major depressive disorder, attention deficit hyperactivity disorder (ADHD), irritability in autism, tics, psychosis/agitation associated with Alzheimer's disease, Parkinson's disease psychosis, as well as the inflammatory disorders pulmonary arterial hypertension (PAH), idiopathic pulmonary fibrosis (IPF), and psoriasis. The FDA granted brilaroxazine orphan drug designation for the treatment of PAH and IPF.

Disorders of diminished motivation (DDM) are a group of disorders involving diminished motivation and associated emotions. Many different terms have been used to refer to diminished motivation. Often however, a spectrum is defined encompassing apathy, abulia, and akinetic mutism, with apathy the least severe and akinetic mutism the most extreme.

<span class="mw-page-title-main">Motivation-enhancing drug</span> Drug increasing motivation in humans

A motivation-enhancing drug, also known as a pro-motivational drug, is a drug which increases motivation. Drugs enhancing motivation can be used in the treatment of motivational deficits, for instance in depression, schizophrenia, and attention deficit hyperactivity disorder (ADHD). They can also be used in the treatment of disorders of diminished motivation (DDMs), including apathy, abulia, and akinetic mutism, disorders that can be caused by conditions like stroke, traumatic brain injury (TBI), and neurodegenerative diseases. Motivation-enhancing drugs are used non-medically by healthy people to increase motivation and productivity as well, for instance in educational contexts.

References

  1. ↑ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (fifth ed.). Arlington, VA: American Psychiatric Association. p.  818. doi:10.1176/appi.books.9780890425596. hdl:2027.42/138395. ISBN   978-0-89042-554-1.
  2. ↑ Lee JS, Jung S, Park IH, Kim JJ (2015). "Neural Basis of Anhedonia and Amotivation in Patients with Schizophrenia: The Role of Reward System". Curr Neuropharmacol. 13 (6): 750–9. doi:10.2174/1570159x13666150612230333. PMC   4759314 . PMID   26630955.
  3. ↑ Castonguay L, Oltmanns T (2013). "General Issues in Understanding and Treating Psychopathology". In Castonguay L, Oltmanns T (eds.). Psychopathology: From Science to Clinical Practice. New York: Guildford Publications. pp. 5–6. ISBN   978-1-4625-2881-3.
  4. ↑ Marin RS, Wilkosz PA (2005). "Disorders of diminished motivation" (PDF). The Journal of Head Trauma Rehabilitation. 20 (4): 377–88. doi:10.1097/00001199-200507000-00009. PMID   16030444. S2CID   11938168. Archived (PDF) from the original on 2015-08-11. Retrieved 2015-07-18.
  5. ↑ Morrison B (2012). "Suicide: Disease, Loneliness, Social Isolation, Suicide, Negative Thoughts ...". In LeCroy CW, Holschuh J (eds.). First Person Accounts of Mental Illness and Recovery. Hoboken, New Jersey: John Wiley & Sons, Inc. pp. 53–57. ISBN   978-0-470-44452-8.
  6. ↑ Kring A, Smith D (2013). "The Negative Symptoms of Schizophrenia". In Castonguay L, Oltmanns T (eds.). Psychopathology: From Science to Clinical Practice. New York, NY: Guildford Publications. pp. 370–388. ISBN   978-1-4625-2881-3.
  7. ↑ Carson VB (2000). Mental health nursing: the nurse-patient journey (2nd ed.). Philadelphia: W.B. Saunders. p. 638. ISBN   978-0-7216-8053-8. Archived from the original on 2016-11-25. Retrieved 2016-05-06.
  8. ↑ Krause M, Zhu Y, Huhn M, Schneider-Thoma J, Bighelli I, Nikolakopoulou A, Leucht S (October 2018). "Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis" (PDF). European Archives of Psychiatry and Clinical Neuroscience. 268 (7): 625–639. doi:10.1007/s00406-018-0869-3. PMID   29368205. S2CID   24569827.
  9. ↑ Elis O, Caponigro JM, Kring AM (December 2013). "Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions". Clinical Psychology Review. 33 (8): 914–28. doi:10.1016/j.cpr.2013.07.001. PMC   4092118 . PMID   23988452.
  10. ↑ Monga, V.; Padala, P. R. (2015). "Aripiprazole for Treatment of Apathy". Innovations in Clinical Neuroscience. 12 (9–10): 33–36. PMC   4655898 . PMID   26634180.
  11. ↑ Nielsen, Mette Ødegaard; Kristensen, Tina Dam; Borup Bojesen, Kirsten; Glenthøj, Birte Y.; Lemvigh, Cecilie K.; Ebdrup, Bjørn H. (2022-03-17). "Differential Effects of Aripiprazole and Amisulpride on Negative and Cognitive Symptoms in Patients With First-Episode Psychoses". Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.834333 . ISSN   1664-0640. PMC   8969108 . PMID   35370857.
  12. ↑ Johnson, L. E.; Balyan, L.; Magdalany, A.; Saeed, F.; Salinas, R.; Wallace, S.; Veltri, C. A.; Swogger, M. T.; Walsh, Z.; Grundmann, O. (2020). "The Potential for Kratom as an Antidepressant and Antipsychotic". The Yale Journal of Biology and Medicine. 93 (2): 283–289. PMC   7309668 . PMID   32607089.
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