Amotivation syndrome is a psychopathological symptom complex characterized by flattening of affect, apathy, passivity. Occurs with alcoholism, cannabinoid addiction, schizophrenia. In patients, the level of motivation decreases, intellectual abilities weaken, fatigue increases rapidly. Diagnostics is carried out by methods of conversation, observation, experiment. Treatment is aimed at eliminating the underlying disease, restoring the motivational component of activity. It includes medical support, psychocorrection, special organization of the daily regime.
ICD 10
F54 Psychological and behavioral factors related to disorders or diseases classified elsewhere
General information
Amotivation syndrome is a pathological change in personality, emotional sphere and cognitive functions. Most clinical researchers consider it in the context of addiction to marijuana, drawing an analogy with the negative symptoms of schizophrenia. In a broader sense, this disorder is a sign of a long-term endogenous process, chronic intoxication with cannabinoids or ethyl alcohol. The prevalence is highest among young and middle-aged men.
Causes of amotivation syndrome
The disorder is based on chronic intoxication of the central nervous system and an excess of dopamine. It is assumed that the development of amotivation syndrome requires the presence of certain emotional patterns and character traits: passivity, isolation, infantilism. The immediate causes of development (triggers) are mental illnesses and chemical addictions:
- Cannabinoid addiction. Motivational and volitional disorders occur at the third stage of dependence, when there is a change in the patient’s personality. Symptoms are observed both in a state of intoxication and during periods of abstinence from drugs (hashish, marijuana, charas).
- Alcoholism. Signs of a pathological decrease in motivation are revealed at the late stages of alcoholism. They are formed during the period of social maladaptation and personal degradation of the patient.
- Schizophrenia. In the clinic of this mental disorder, the amotivation syndrome and the reduction of energy potential occupy a central place, determining the characteristic disorders of thinking. A decrease in motivation leads to the disintegration of personal meaning and a change in the selectivity of perception.
Pathogenesis
Presumably, the neurophysiological basis of amotivation syndrome is changes in the dopaminergic regulation system, organic damage to the frontal lobes of the cerebral cortex and reticular formation. Dopamine is a neurotransmitter, the main chemical factor of the “reward system”. It affects certain brain structures, causing a sense of pleasure and forming motivation to repeat actions that can bring satisfaction.
The level of dopamine increases with the use of drugs and alcohol, during sex, eating delicious food. With prolonged use of marijuana, hashish, alcohol, the function of receptors interacting with dopamine compensatorily decreases. Their desensitization occurs. Clinically, this is manifested by the development of anhedonia and loss of sensitivity to previously pleasant stimuli.
Prolonged intoxication provokes deterioration of the functions of the frontal cortex, as a result, programming and control of activity is weakened. The decrease in the energy reserve is due to a malfunction of the reticular formation. In schizophrenia, similar neurochemical changes occur, but they are caused not by external, but by internal causes. In the pathogenesis of the disease, there is an increase in dopamine activity and organic brain damage.
Symptoms of amotivation syndrome
There is a decrease in the functions of three spheres: motivational and personal, energy and cognitive. Alienation from the outside world occurs, the reaction to external stimuli is dulled, the ability to enjoy is lost. An indifferent attitude towards close people is formed, motives decrease. Interest in previously fascinating activities disappears. Patients are unable to start and continue routine tasks, perform duties.
The overall energy potential is reduced. Apathy and passivity increase. Patients feel weak, get tired quickly, become withdrawn and sullen. They feel depressed, isolated. Mood swings are not uncommon. A decrease in cognitive functions is manifested by memory impairment and absent-mindedness. Thinking becomes less productive, slower. A feeling of “confusion” and inhibition of thoughts is formed.
Complications
Amotivation syndrome leads to social degradation. Patients stop being interested in what is happening, do not keep in touch with friends, become detached when communicating with loved ones. Coordination of movements is disrupted. Patients cannot cope with the previous professional and educational load, in severe cases they stop performing household duties and hygiene procedures.
A decrease in intellectual functions and lack of motivation negatively affects careers and studies: patients lose their jobs, do not search for vacancies, students and schoolchildren do not attend classes. If intoxication with alcohol or cannabinoids continues, a pseudoparalytic syndrome develops, characterized by severe dementia, a decrease in criticism, delirium.
Diagnostics
If an amotivation syndrome is suspected, a psychiatrist and a clinical psychologist conduct an examination. An important diagnostic criterion is the presence of schizophrenia, cannabinoid or alcohol dependence in the late stage. Differential diagnosis of amotivation syndrome with depression, withdrawal syndrome of cannabis products is carried out. The standard examination procedure includes the following procedures:
- Clinical conversation. The doctor evaluates the patient’s ability to establish and maintain contact, his interest in treatment, the outcome of the disease. As a rule, the answers are monosyllabic or not at all, the speech is monotonous, with pauses. The patient is secretive, talks reluctantly.
- Observation. Slowness is noted in the movements, sometimes – insufficient coordination, stiffness. Emotional reactions are poorly expressed, indifference prevails, detachment from the diagnostic situation.
- Functional tests. Tests are conducted to determine the functions of attention and memory: a proof-reading test, Schulte tables, memorization of 10 words. According to the results, there is rapid fatigue, a slow pace of mental activity. In severe course of the syndrome, the patient does not begin to perform the task or stops working after a few seconds without finishing.
Treatment of amotivation syndrome
Specific therapy has not been developed. Helping patients is the treatment of the disease that caused the syndrome. Patients with alcohol and drug addiction are shown to give up psychoactive substances, detoxification measures and psychotherapy. If a motivation disorder has arisen on the basis of schizophrenia, regular medical monitoring, taking symptomatic medications, attending psychocorrection and psychotherapy sessions are necessary.
Provided adequate treatment of the underlying disease, it is possible to improve the condition of patients with amotivation syndrome with the help of proper organization of the daily routine and living conditions. It is necessary to devote time daily to things that bring pleasure and arouse interest (or were such before). It can be reading books, watching movies, computer games, sports.
At the first stages of recovery, a person needs constant organizing and motivating help from family members, but gradually begins to take the initiative on his own. The second step of the recovery program is the regular implementation of hygiene procedures and simple household chores – washing dishes for yourself, putting clothes in the closet.
It is important to focus the patient’s attention on the result of his actions, as this is a positive feedback that fixes the desired behavior. At the third stage, a person begins to feel energy, inner strength to perform actions. There is a craving for some activities. To maintain motivation, it is recommended to keep a diary of completed tasks or make a plan for the day.
Prognosis and prevention
The course of the amotivation syndrome and its outcome depend on the severity of the underlying pathology. The prognosis is most favorable in patients who have managed to get rid of alcohol or cannabinoid addiction. Active psychotherapeutic and rehabilitation measures allow them to quickly return to public life, restore relationships with family members, friends, colleagues. Prevention is reduced to early diagnosis and treatment of alcoholism, drug addiction, regular monitoring of schizophrenia.
