Abulia

Painful lack of will, inability and unwillingness to move, act, make decisions, and interact with others is called Abulia in psychiatry and neurology.

To date, there is no consensus on whether Abulia is a manifestation of various mental disorders or is an independent nosological unit, since its manifestations are very diverse.

The inability to force oneself to perform any actions when one is aware of their necessity, the lack of motivation and initiative are often signs of mental pathology, and not laziness and weak will, which, if desired, can be overcome with the help of self-discipline and training.

Abulia in combination with a decrease or disappearance of emotions is an apathetic-abulic syndrome (apatic-abulic), with loss of motor activity is abulic-akinetic.

Epidemiology

Abulia is not considered an independent disease, so its epidemiology has not been described. However, since depression is named as one of the main risk factors for its occurrence, this condition is quite common: in countries with a higher standard of living, almost a third of their citizens are familiar with depression firsthand, and in countries with a low standard of living, a fifth.

The prevalence of schizophrenia in the world is about 1%, and strokes - 460-560 cases per 100 thousand people per year, adding head injuries, tumors, infections and stress, we can conclude that many people are likely to encounter abulia.

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Causes abulia

Minor symptoms of abulia (hypobulia) often accompany people with a vulnerable psyche and those prone to somatoform disorders.

Abulia occurs as a result of circulatory disorders in the right hemisphere of the frontal zone of the brain due to disease or injury. Its pathogenesis is assumed to be associated with a decrease in dopaminergic neurotransmission for some reason in the frontal lobes of the cerebral cortex, responsible for purposeful motor activity, the ability to show initiative, planned actions aimed at solving certain problems and overcoming obstacles. Patients with lesions of the frontal part of the brain are characterized by inertia and inactivity.

Most experts cite stress as the main factor that triggers the development of abulia.

Abulia deprives a person of the main human quality - he ceases to be a person.

This is a serious disease that manifests itself in the disappearance of a person’s motives that prompt him to act to achieve a certain goal.

Abulia is especially dangerous in childhood, since parents may simply not pay attention to the child's painful condition, mistaking it for banal laziness or weak will. The most difficult is hereditary abulia, which manifests itself already in infancy. A sedentary, very calm child, not loud, to the envy of parents of other children, should cause parents not joy, but anxiety, since late diagnosis will lead to complications of the disease.

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Risk factors

Many psychoneurological pathologies are accompanied by abulia. The main risk factors are post-stroke and post-traumatic conditions, consequences of intoxication, hypoxia, infectious diseases, brain tumors, Parkinson's disease, Hattington's disease, Pick's disease, congenital dementia, depression, alcohol and drug abuse.

Abulia is an invariable companion of schizophrenics, who over time experience worsening mental changes, weakening volitional impulses, increasing passivity, and an unwillingness to perform even the simplest and most necessary actions (for example, those related to self-care).

A simple form of schizophrenia is characterized by apathetic-abulic syndrome, not accompanied by delusions and hallucinations. Schizophrenics often have parabulia - very diverse behavioral disorders, an irresistible passion for committing unnatural acts (exhibitionism, pedophilia).

Temporary manifestations of abulia may appear as a reaction to mental trauma (psychogenic stupor), usually do not last long and pass when the traumatic situation is resolved; with depressive and apathetic stupor; with catatonic stupor (hyperbulia) - this condition can last from several months to several years. Symptoms of abulia often appear as a side effect of prolonged use of large doses of antipsychotic drugs.

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Symptoms abulia

Psychoneurologists call abulia a pathological unwillingness to make efforts to any, even necessary actions or previously favorite activities, or a significant decrease in the energy of volitional manifestations. This is noticeable already at the very beginning of any process, since the individual is tense at the very thought of doing something. Abulia is characterized by the lack of desire, and not the ability to make even minimal efforts to achieve any result.

Psychiatrists described the symptoms of abulia as early as the beginning of the 19th century as behavioral changes characterized by loss of initiative, will, aspirations, inhibition of speech and thought processes. Individuals with abulia suffer from sleep disorders, appetite, memory, chronic fatigue, they are accompanied by a pessimistic mood, unwillingness to act causes dependence on other people.

Clinical manifestations of this condition:

• sloppy, untidy appearance;
• difficult, uncoordinated movements;
• inhibited emotional and speech reactions;
• unwillingness to interact with others, social isolation;
• impoverishment of speech, gestures, facial expressions;
• absence of any manifestations of activity;
• inability to make independent decisions;
• lack of interest in previously favorite activities (hobbies);
• a long silence before answering a question.

Patients cannot bear even minimal loads, any obstacle immediately causes a refusal of the plan, they are impatient, demanding, lazy and inert. Attempts to stir them up, to make them act cause resistance. At the same time, most patients eat with pleasure, allow themselves to be entertained (they can listen to music or watch TV all day long). In cases of a more severe degree of abulia, they stop leaving the house, getting out of bed, almost do not eat, do not follow basic hygiene rules.

With apathetic-abulic syndrome, in addition to volitional manifestations, a person’s emotions fade away – conscientiousness, modesty, the ability to love, and compassion disappear.

The often repeated, painfully familiar phrase: “I don’t want to”, which develops into: “I can’t”, often becomes the first warning.

Lack of interest in one's own person, which is the first thing that catches the eye - in appearance (dirty hair, nails, uncleaned teeth, dirty clothes) - the first signs of abulia.

Other characteristic manifestations are also noteworthy: spontaneous incomprehensible movements, difficulties with coordination, long thoughts before answering a question, the desire to eat, sleep, and communicate with friends may disappear. The child loses interest in favorite toys and games. Passivity and lack of volitional impulse are characteristic features of abulia.

Abulia causes an inability to move from the desired to the actual, a feeling that there is not enough strength to implement the plan - it is not worth starting. There is an opinion that abulia is a sign of schizophrenic spectrum disorders, at the same time, similar symptoms are inherent in other brain pathologies that have nothing to do with schizophrenia.

Nevertheless, psychoneurology quite clearly differentiates this mental disorder from laziness and weak will as a consequence of deficiencies in upbringing.

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Forms

The stages of abulia severity can be either mild (with minor deviations from the norm, decreased motivation, when the patient can still be involved in some activity) or severe, up to the complete suppression of volitional impulses, unwillingness to perform the simplest actions (get out of bed, tidy yourself up, eat).

Volitional dysfunction is associated with a decrease in an individual’s initiative, his inability to overcome obstacles and systematically achieve results, a lack of motivation to perform actions and deviations from social norms of behavior.

The following types of volitional disorders are classified:

• hyperbulia - its main symptom: hyperactivity;
• hypobulia - a noticeable decrease in the motivation to act;
• parabulia – behavioral deviations from generally accepted norms;
• Abulia is a pathological absence of volitional urges to act.

The duration of abulia can be short-term, periodic and constant.

Depressive and asthenic syndrome with elements of adynamia, neuroses, psychopathic disorders are often accompanied by a short-term absence of volitional drives and a decline in activity.

Periodic abulia is a companion of drug addicts, alcoholics, people with advanced somatoform disorders, schizophrenics (coincides with periods of exacerbation of the disease). Repetition of periods of lack of will is characteristic of the clinic of manic-depressive psychosis.

A constant deficit of motivation and volitional impulses is a symptom of the possibility of catatonic stupor, often occurring in schizophrenic disorders and severe organic brain damage (progressive tumors, traumatic brain injury).

Abulia is often combined with mutism - unwillingness to speak. Verbal contact with patients is disrupted, and it is impossible to get answers from them to questions.

Apathy and abulia often combine to form apathetic-abulic syndrome, the symptoms of which are manifested by emotional insufficiency and automatism of movements. Patients withdraw into themselves, try to avoid communication, demonstrating with their whole appearance indifference to the interlocutor, to close people, lose interest in favorite activities, entertainment.

Abulichesko-akinetic syndrome is a combination of lack of will with partial or complete immobility, often accompanied by a slowdown in the thought process.

Having noticed signs of abulia, it is necessary to seek professional help from specialists. The consequences and complications of the process of volitional inactivation not stopped in time do not bode well not only for the patient, but also for his immediate environment. Depriving a person of aspirations and goals leads to personality degradation, since it is in rational actions that volitional, mental and emotional human functions are realized.

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Diagnostics abulia

Today, the status of abulia (a disease or a symptom of other diseases) is still being debated, although it is not yet recognized as a separate nosological entity. Pathological weakness of will is often found among a set of symptoms inherent in a number of mental illnesses. The diagnosis is determined by the symptoms of the underlying mental illness, for the diagnosis of which, as a rule, surveys and tests are used to compile a psychoneurological anamnesis of the patient; instrumental methods: magnetic resonance and computed tomography, ultrasound examination, electroencephalography of the brain; laboratory blood tests.

The main goal of a neuropsychiatrist is to differentiate abulia (psychopathology) from laziness, apathy (phenomena that are generally within normal limits), as well as apatho-abulic syndrome from conditions with similar symptoms (asthenoanergic syndrome, asthenoapathetic depression).

In these cases, differential diagnostics is used, the symptoms of similar conditions are compared according to many criteria, comparative characteristics of symptoms are presented in the form of tables for ease of use. Comparison criteria: from complaints of patients (whether they express voluntarily and what kind), emotions, motor skills, thinking to social relations and behavior with friends, relatives, loved ones.

The greatest difficulty is in children's diagnostics. It is more difficult to understand here. Of course, the reluctance to collect toys cannot be considered a sign of abulia, but if the child sits for hours, imitating reading or drawing, then you need to seek psychiatric help, because the parents themselves will not cope with the development of pathology.

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Differential diagnosis

Differential diagnostics and instrumental methods allow us to make an accurate diagnosis and prescribe the correct treatment.

Treatment abulia

First of all, treatment is prescribed that corresponds to the underlying disease, which is complicated by the lack of volitional aspirations.

When schizophrenia manifests itself in this way, drug treatment is carried out with atypical neuroleptics. In case of abulia against the background of depression, antidepressants are used.

Therapy is carried out only according to strict prescriptions and under the supervision of a psychiatrist based on the patient’s medical history and diagnostic results.

In schizophrenic disorders with apathetic-abulic syndrome, with symptoms of slow mental and physical activity, Frenolon is prescribed. This drug has a psychostimulating effect, in recommended dosages it does not cause drowsiness. It is prescribed individually, the dosage is determined by the severity: minimum - 5 mg twice a day, maximum - 10 mg three times a day. It is not prescribed for arrhythmia, endomyocarditis, renal and / or hepatic insufficiency of moderate or more severity. As a result of use, vegetative disorders, facial edema, tremor of the limbs, coordination motor disorders may occur.

Triftazin is also recommended for apathetic-abulic states in schizophrenics and in old age, starting with 5 mg two to three times a day in combination with piracetam (one capsule twice a day), increasing the dosage of triftazin by about 5 mg daily, bringing to a daily dosage of 30-80 mg. Recommended dosages of triftazin do not cause drowsiness. Contraindicated in acute cardiac disorders (in particular, conduction), moderate and severe renal failure, acute hepatitis, pregnant women. As a result of use, tremors of the extremities, movement coordination disorder, allergies, insomnia, dizziness, nausea, and occasionally toxic hepatitis and neutropenia may occur.

Solian has a selective effect on dopamine receptors, without affecting other types of receptors, which contributes to the absence of many side effects of other antipsychotics. The effect of the drug depends on its dosage - in small doses (50-300 mg / day) the drug removes the symptoms of apathy and abulia. According to the instructions, it does not cause drowsiness, but, judging by the reviews, it promotes sleep, simultaneous use with sleeping pills, narcotic drugs, local anesthetics enhances their effect. Solian is contraindicated in case of hypersensitivity to it, pituitary prolactinoma, malignant tumors of the mammary glands, pheochromocytoma, pregnant and lactating women, aged 0-17 years, kidney diseases. The treatment regimen is prescribed and changed, if necessary, only by the attending neuropsychiatrist.

Sulpiride is intended for use in cases of suppression of volitional impulses caused by depressive syndrome, with manifestations of apathy, slowness, decreased motor and verbal activity, in senile and acute psychoses with alternation of excited and depressed states caused by schizophrenic spectrum disorders and other mental pathologies. The average dosage is 0.2–0.4 g per day, the maximum is 0.8 g. It is not prescribed to hypertensive patients, in cases of pheochromocytoma and excited states. In addition to tremor of the limbs, movement coordination disorder, insomnia, dizziness, nausea, it has a stimulating effect, increases blood pressure, causes menstrual cycle failures, galactorrhea outside the lactation period, enlargement of the mammary glands in male patients.

Physiotherapy is used to treat abulia and prevent its relapses: phototherapy, therapeutic swimming, taking therapeutic baths, oxygen barotherapy. Physiotherapy today has many methods that stimulate the central nervous system. As a rule, their combination with spa treatment is more effective. The effect of mineralized waters of thermal springs and the application of therapeutic mud to the vegetative plexuses have a beneficial effect on stabilizing the condition of patients. Patients suffering from depressive disorders are recommended to rest south of their permanent place of residence, and schizophrenics benefit from highlands.

Additionally, individual and group sessions with a psychotherapist are held. The main goal of individual communication with the patient is to establish trusting relationships. Group sessions, starting with minimal joint actions, gradually move on to involving the patient in discussions, restoring the ability to communicate in everyday life and communication skills.

In supportive therapy, the role of the family and each of its members, their relationships are very important. The psychotherapist conducts explanatory work with the patient's loved ones, helps resolve intra-family problems, conflict situations and strives to help establish a harmonious microclimate.

Alternative treatment

Mental illnesses are generally difficult to treat, however, there are folk remedies for depressive states and even schizophrenia.

Tibetan medicine, the most authoritative among alternative methods, recommends rubbing a schizophrenic with olive oil. This can be done at home, even simultaneously with drug therapy.

Take a liter of olive oil (sunflower oil is also possible), pour it into a clay container, seal it and bury it in the ground to a depth of about 0.5 m. The oil should lie in the ground for a year. After a year, dig it up and use it for rubbing.

Massage the entire body with gentle movements, head - with special care. Do not spare oil on the shoulders, neck, upper back. Rubbing lasts about half an hour, every other day for two months. Then - a break for a month, and the course of treatment is repeated. The patient can wash on those days when there is no rubbing.

Physical exercise, particularly yoga, and cold showers also have a positive effect on the well-being of schizophrenics.

Instead of a cold shower, you can wipe yourself in the morning with salt water at room temperature: dissolve one teaspoon of sea salt in half a liter of water.

At the same time, you also need to eat right. The antidepressant diet is vegetarian, it also involves excluding tea and coffee, alcoholic beverages and chocolate bars, products made from white wheat flour and sweets, chemical additives and hot spices. You need to eat three times a day. Breakfast - fruits, nuts, a glass of milk. Lunch - steamed vegetable dishes, whole grain bread and milk. Dinner - green vegetable salads, legumes, cheese, kefir or yogurt.

Traditional medicine is full of herbal recipes used for depression and nervous exhaustion to raise vitality. Herbal treatment alone will certainly not help get rid of abulia, but herbal therapy can be used in a complex of treatment measures. In the treatment of depressive disorders, ginseng roots and leaves, chamomile aster flowers, roots with rhizomes of zamaniha and angelica, knotweed grass and even ordinary straw are used. However, before using any medicinal plant, it is necessary to consult with your doctor, since interaction with prescribed drugs can negatively affect the treatment process.

For over two hundred years, there has been a special direction in clinical medicine – homeopathy, based on the law of similarity. The selection of homeopathic drugs is very individual, the patient's symptom complex is carefully studied and a drug is prescribed that can cause similar symptoms in a healthy person. In homeopathic medicine, there are no drugs for cough, hypertension or fever. Homeopathy treats not the disease, but the person, that is, the entire complex of symptoms inherent in a given patient, with one drug. In this case, the drug is prescribed in ultra-small doses.

A properly selected homeopathic preparation helps to significantly improve health and get rid of chronic diseases. The therapeutic effect of homeopathic treatment usually occurs within three months to two years.

In homeopathy there are remedies for conditions whose description is similar to abulia and apatho-abulic syndrome.

For example:

• Carbo vegetabilis – deep weakening, decline of vital force;
• Gelsemium – a feeling of exhaustion and mental sluggishness, constant desire to sleep, pseudo-dementia, tremors, muscle weakness;
• Glonoinum - great exhaustion, profound reluctance to work, great irritability; intolerance of bickering, periodically blood rushes to the head;
• Kali phosphoricum (Kali phosphoricum) – severe exhaustion, loss of strength, especially indicated at a young age with overexcitement, anxiety, unwillingness to contact with others, a state of severe fatigue and depressive disorder, any action seems very difficult, impossible to perform, absolute disbelief in the success of any undertaking.

As already mentioned, dosages and treatment regimens are prescribed only individually; there are no recommended doses of the drug, as in traditional medicine, in classical homeopathy.

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Prevention

How to prevent the development of abulia? This question can arise at any age.

In old age, a person needs confidence that he is needed, useful to his loved ones, and not indifferent to them. A person has an incentive to act, a desire to justify the expectations of others.

In the prevention of abulia in adolescents and middle-aged people, the presence of hobbies, favorite activities, and interests plays an important role.

The most common mistake of relatives is pity for the patient, the desire to protect him from difficulties, indulgence of his whims. This only aggravates the painful condition. Help from the close environment should be contained in attempts to stir up the patient. Organizing trips to a picnic, for mushrooms, to another city on an excursion, noisy parties. It is necessary to involve the patient with abulia in work, emphasizing that without his help it is impossible to cope. He should feel himself necessary to younger or older family members, animals, to take care of someone or something. If the process of abulia is just beginning, then by acting in this way, you can successfully bring the person out of it.

If the process is prolonged, then the intervention of specialists and drug therapy will be required.

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Forecast

The prognosis for the treatment of apatho-abulic syndrome in schizophrenic disorders is most often unfavorable. In practical psychiatry, with prolonged treatment of the pathology, only incomplete disappearance of the symptoms of the disease was noted, cases of the development of schizophrenia with an increase in symptoms were observed. The best results were progress in socialization, restoration of contacts with others.

In the treatment of abulia, psychotherapeutic methods are widely used, especially in the case of short-term, mild forms of the disease. Psychotherapy in the treatment of the absence of volitional impulses in schizophrenic spectrum disorders is a matter for discussion.

However, hypnotic sessions and cognitive-behavioral psychotherapy are practiced to reduce the manifestations of abulic syndrome. Psychotherapeutic measures are aimed at restoring socialization, communication skills and creating a volitional and motivational base.

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