Abulia is a psychopathological syndrome characterized by a lack of will. Accompanied by the inability to perform arbitrary actions, the need for which may be realized. Patients do not feel the desire to be active, are unable to meet basic needs: they cannot eat, drink water, perform hygiene procedures on their own. Diagnostics includes observation, questioning of close relatives, instrumental brain examinations (CT, MRI), psychological testing. Treatment is determined by the underlying disease, the symptom of which is abulia.
F63 Disorders of habits and drives
The word “abulia” in Greek means “lack of will”. The syndrome has been actively investigated since 1838, it is detected in the diagnosis of depression, schizophrenia, profound mental retardation, dementia, neuroinfections, organic brain diseases. It often develops as part of apato-abulic and abulic-akinetic syndrome. Epidemiology is not described, since abulia is not isolated as an independent disease. Depression is the main etiological factor, therefore, a direct correlation with the prevalence of the syndrome is likely – in countries with a high standard of living, abulia occurs 30-40% more often than in developing countries.
Causes of abulia
A decrease in volitional activity is observed in neurosis, somatoform disorders, as a result of excessive parental care and suppression of the child’s activity. Absolute lack of will develops on the basis of organic and metabolic disorders in the central nervous system. Taking into account the variety of causes of abulia, several groups of disorders can be distinguished in which this disorder can be detected:
Neurological pathologies. The syndrome manifests itself in injuries, tumors, toxic and infectious brain lesions, Huntington’s disease, Pick’s disease, Parkinson’s disease, after a stroke. Lack of will is combined with motor inhibition and weakening of thought processes.
Mental disorders. Abulia is determined in patients with schizophrenia, deep oligophrenia, endogenous and neurotic depression, bipolar affective disorder, dementia. Motivation decreases due to the “loss of energy potential” (E. Bleyer).
Hereditary factors. Hereditary abulia is formed in children with a predisposition to schizophrenia. Due to the peculiarities of age, it is diagnosed late.
Arbitrary regulation of activity is provided by the functions of the “III block of the brain”. The concept was introduced by A. R. Luria, unites the structures responsible for the implementation of behavior management processes – prefrontal areas of the cerebral cortex, some subcortical and stem formations involved in programming, regulation and control of mental activity.
According to modern research, abulia develops on the basis of disorders of dopaminergic transmission in neurons with damage to the frontal cortex and/ or subcortical nuclei. The primary stage of the implementation of volitional acts is violated – the ability to initiate movement, speech, social interaction. The progress and reversibility of volitional disorders are determined by the peculiarities of the course of the underlying disease – with degenerative pathologies of the nervous system, abulia gradually increases, with depression, it is reduced against the background of successful treatment.
Abulia has clearly marked symptoms and severity – a complete lack of motivation, the ability to initiate and maintain purposeful activities. The classification is based on the duration of the syndrome, allows you to make a prognosis, choose the most effective treatment. There are the following types of clinical lack of will:
- Short-term. It is determined in adynamic depression, borderline states (neurotic disorders, asthenic syndrome). The critical abilities of the patient are preserved, the need for volitional efforts is understood, but the performance of activities is impossible.
- Periodic. The recurrent manifestation of the syndrome coincides with periods of depression of bipolar affective disorder, with the stages of exacerbation of schizophrenia. Lack of will often gives way to hyperactivity.
- Permanent. Prolonged inactivity that cannot be corrected is characteristic of catatonic schizophrenia, severe organic brain damage. A combination of abulia with apathy and akinesia is common.
Symptoms of abulia
Abulia is characterized by
- inability to independently start and maintain purposeful movements
- scarcity or lack of spontaneous movements
- impoverishment of speech
- monotony and low intensity of emotional reactions
- narrowing of social contacts
- decreasing interest in all types of active pastime.
Without the help of others, the patient spends all the time at home, lying or sitting, occasionally changing his position. The look is indifferent, does not answer questions or gives an answer after a pause. Monosyllabic sentences predominate in speech. Emotional reaction is caused by vivid, vital events (for example, fright at an accidental fall).
There is no interest in activities that bring pleasure earlier. Lack of will manifests itself in daily rituals. The patient is not able to cook and take food on his own. With the organizing and motivating help of other people, he can sit down at the dining table, but after starting a meal, he chews for a long time and does not swallow the food, quickly loses his appetite. There is indifference to their appearance, non-compliance with hygiene procedures. With continued criticism of his own condition, the patient understands the need for action, so stimulation from the outside is relatively effective – it is possible to maintain cleanliness, meet basic needs, establish verbal contact.
The peculiarity of abulia is the need for constant external stimulating and organizing assistance to meet basic physiological needs and maintain the existing level of mental development. In the absence of proper treatment and care for patients, the abusive syndrome leads to social and household maladaptation.
Contacts with people stop, cognitive interest disappears. As a result, communication skills are lost, cognitive functions are reduced. Poor nutrition, non-compliance with hygiene rules and physical activity regime contributes to the development of somatic pathologies: infections, diseases of the gastrointestinal tract, musculoskeletal system, skin.
Diagnostics of abulia
The detection of abulia is part of a comprehensive diagnosis of mental and neurological diseases. The examination is carried out by a neurologist, psychiatrist, psychologist. An important point is to distinguish the pathological syndrome with laziness, the consequences of improper upbringing. The complex of diagnostic procedures includes:
- Conversation, inspection. A survey of the patient’s relatives is conducted: anamnesis, complaints are found out, the duration and severity of symptoms are specified. The conversation with the patient often turns out to be uninformative. A neurologist performs an examination: assesses the safety of reflexes, motor skills, sensitivity. Based on the data obtained, doctors make an assumption about the underlying disease and determine a list of further procedures.
- Observation. The direct detection of the symptoms of abulia occurs during the consultation and during the patient’s stay in the hospital. There is a lack of interest in communicating with a doctor, medical staff, passivity, slowness, refusal to perform daily rituals.
- Instrumental examination. It is prescribed for the purpose of confirming the diagnosis and differentiation of neurological pathologies. Common methods of examination are computed tomography and magnetic resonance imaging of the brain. With abulia, the presence of pathological signs in the prefrontal zone is characteristic.
- Psychodiagnostics. A clinical psychologist conducts research on the cognitive and emotional-personal sphere. In most cases, a full-fledged diagnosis is impossible (the volitional component of activity is violated). Separate tests are performed on thinking, memory and emotional state, allowing to distinguish schizophrenia, depression, manic-depressive psychosis, dementia.
Treatment of abulia
Abulia therapy is performed as part of general rehabilitation and relief of symptoms of the leading disease. The events are organized by a psychiatrist, neurologist, physiotherapist, rehabilitologist, speech therapist, occupational therapist. There is no general treatment regimen, the methods are selected individually. In depressive disorders, antidepressants are prescribed, in schizophrenia – antipsychotic drugs, in organic brain lesions – nootropics, means to improve blood circulation.
Rehabilitation programs are aimed at restoring speech and motor activity, based on the creation of a diverse stimulating environment – patients attend individual classes with speech therapists, physical therapy instructors, then gradually get involved in group activities (occupational therapy, special drawing courses, dancing).
Methods of specific treatment of abulia continue to be investigated. The effectiveness of drugs that increase the biological activity of dopamine is being studied. Techniques of cognitive-behavioral psychotherapy and hypnosis are tested in patients with depression, manic-depressive psychosis, schizophrenia. Psychologists and psychotherapists manage to slow down the progression of the syndrome and partially restore volitional functions, but the result is very unstable.
Prognosis and prevention
The prognosis of abulia depends entirely on the features of the course of the underlying pathology. A favorable outcome is most likely in paroxysmal schizophrenia, depression, bipolar affective disorder with rare depressive episodes, as well as in neurological diseases with reverse development. Special preventive measures have not been developed, they are reduced to the prevention of neurological and mental diseases.
At the first manifestations of abulia, in some cases, it is possible to slow down the process of its progression – it is necessary to organize a diverse, interesting environment for the patient: invite to friendly meetings, walks, sports, dancing, creativity. The more socially active and enthusiastic the patient is, the slower the symptoms of lack of will develop.