Abulia: causes, symptoms and treatment

Depression, anxiety, lack of motivation and lack of energy disorders are a serious social problem. According to the World Health Organization (WHO), in the world 300 million people suffer from depression and 260 million, anxiety problems, a figure comparable to many pandemic events to which more attention. Neurological emotional imbalances can manifest in many ways, and lack of motivation is one of the most common.

However, distinguishing between a trait, a transitory emotion, and a pathology can be a problem. A person who feels constantly tired and unmotivated, at least once, is going to wonder once if her situation falls within “what is expected” or if she incurs a pathological picture. The same is true in the opposite case: someone may believe that they are sick, when in reality they are just going through a difficult time and their physical responses are within expectations.

Based on all these premises, this time we dive into the world of apathy, a lack of initiative that falls between psychological disorder and the trait. Do not miss it.

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What is abulia?

The medical dictionary of the Navarra University Clinic (CUN) defines abulia as the lack of will, inability to perform a voluntary act or make a decision on the part of a person. In other words, the individual feels the desire to perform an act, but lacks the necessary strength to carry it out. According to some professionals, it is one of the basic pillars of schizophrenia, but it can also be caused by organic damage to the brain.

Talking about abulia is a slippery field, as there is still no consensus about its status as a syndrome, disorder or, failing that, a symptom of a prior condition. Apathy is in between apathy (mild extreme) and akinetic mutism (MA), a behavioral disorder, characterized by the inability to move or speak in patients awake. Due to the disagreements cited, the literature in clinical psychology (such as DMS-5) does not classify apathy as its own disorder.

However, other entities include apathy, apathy and akinetic mutism within the group of Disorders of Diminished Motivation (DDM). Depending on where the boundary is set (from a lack of motivation to a reduction in action, emotion, and cognition), abulia can be considered a separate disorder or a symptom of another. Even so, it is clear that it is a clinical entity of its own, regardless of its status.

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Symptoms of abulia

Like any clinical entity, abulia has a series of associated symptoms, almost all of them subjective and based on the person's own perceptions of the condition. Among them, we can highlight the following:

• Difficulty initiating and maintaining meaningful movements.
• Lack of spontaneous movements.
• Spontaneous dialect reduction.
• Increased response time to spontaneous actions.
• Passivity.
• Reduction in social interaction, emotional response, spontaneity and interest in activities that were previously stimulating.

Interestingly, professional sources (such as the portal Statpearls) categorize abulia to a lesser and greater degree, depending on the associated clinical signs. Let's see its characteristics.

1. Minor abulia

Minor abulia is synonymous with apathy. In this clinical picture, the individual can carry out activities that are proposed to him (initiated by others), but not propose plans or carry out activities that have been planned by himself. In a picture of apathy, the person is not very spontaneous and can contrive about planning in front of the public, but not carry it out. This term refers to a psychological state of clear indifference towards the environment.

2. Major abulia

Major abulia is synonymous with akinetic mutism (MA). Typically, it has been described as a transient complication of brain tumor surgery, extracted from the posterior fossa. In this most extreme part of the entity, the patient does not move (akinesia) or speak (mutism). People with this condition are not paralyzed as such, but they do not have sufficient motivation to perform movements and speak in a manner consistent with expected social norms.

Causes of abulia

If we conceive apathy as apathy, the causes are psychological in most cases. In any case, if we value it at the most serious limit of the spectrum (greater abulia), we find that the reason for the atypical behavior is neurological in nature.

For example, it is established that a lesion in the cerebral anterior cingulate cortex could cause abulia of a minor type, generally caused by a cerebral infarction of an arterial nature. Injuries to the cerebral arteries could also be the cause of transient abulias, associated with contralateral motor negligence, due to damage to the medial premotor area. Focal subcortical lesions, pressure on brain tissues, direct blows, and many other conditions can also cause apathy.

In addition, there is increasing evidence that the dysfunction causing abulia can occur in a site other than the injured one, something that further complicates the clinical picture and diagnosis. However, it has been shown that lesions in key areas of the dopaminergic circuit are translated in experimental models into a greater or lesser degree of apathy or apathy. Although much remains to be clarified, the path is more or less directed.

Diagnosis

Again, we place special emphasis on the duality of this condition. Some conceive abulia as a disorder, but others as a symptom derived from an underlying neurological problem. In general, doctors rely on the following 3 pillars to confirm an abulia condition:

• Spontaneity and reduced speech ability.
• Prolonged latency when responding to commands, stimuli, and directions.
• Reduced ability to persevere in an act.

In any case, abulia can be considered as a picture of apathy or akinetic mutism depending on severity, so the diagnosis does not have to be fixed based on symptoms at all cases.

Treatment

Treatment of abulia is just as difficult to address as the etiology, definition, and causality of the condition. As it is not clear if it is a disorder by itself, the method of action may vary, depending on the opinion of the healthcare professional or the person in charge of the patient's well-being at that time.

Anyway, the treatment is almost always pharmacological, mainly based on the prescription of long-term antidepressants (SSRIs). These drugs are selective serotonin reuptake inhibitors, and their job is to allow the amount of this neurotransmitter to increase in a person's neuronal circuitry. If this is achieved, chronic apathy and fatigue may disappear, or at least be controlled.

In addition to helping the patient regain motivation, it is also necessary to treat headaches, pain muscles, seizures and symptoms associated with the neurological damage that may have caused in the first instance the abulia. Lastly, specialized therapies will also be helpful in treating loss of cognition and sensorimotor skills. Most abulias are relatively transitory complications, so a possible return to normality is envisioned.

Resume

As you can see, apathy is not simply a loss of will. It is a clinical entity of greater or lesser severity, ranging from established apathy to a pathological inability to respond to external stimuli. Depending on where the limits are established, it can be considered a psychological or physical pathology, due to the neurological damage that it causes.

If we want you to get an idea of ​​all this terminological conglomerate, it is better not to self-diagnose when you feel something out of the ordinary in your mind or physical organism. You may believe that you suffer from a list of apathy for a long time, but really you are facing a nutritional deficiency, demotivation or depression. As you may have seen, for an abulia to be considered such, certain requirements that go beyond the trait and personality must be met.