Abulia
Painful lack of will, inability and unwillingness to move, act, make decisions, contact with others in psychiatry and neurology is called Abulia.
Until now, there is no common opinion whether Abulia is a manifestation of various disorders of the psyche or an independent nosological unit, since its manifestations are very diverse.
Impossibility to force oneself to perform any actions in the awareness of their necessity, the lack of motivation and initiative are often signs of mental pathology, not laziness and weakness, over which, if desired, you can win by self-discipline and training.
Abulia in combination with the decrease or disappearance of emotions - apato-abulic syndrome (apatiko-abulic), with loss of motor activity - is abulic-akinetic.
Epidemiology
Abulia is not considered an independent disease, so her epidemiology is not described. However, since depression is one of the main risk factors for its occurrence, this condition is very common: in states with a higher standard of living, almost one-third of their citizens are familiar with the state of depression, with a low one-fifth.
The prevalence of schizophrenia in the world is about 1%, and the number of strokes - 460-560 cases per 100 thousand people per year, adding head injuries, tumors, infections and stresses, one can conclude that many people are likely to meet with abulia.
Causes of the abulia
Minor symptoms of abulia (hypobulia) are often accompanied by people with a vulnerable psyche and prone to somatoform disorders.
Abulia arises as a result of a circulatory disturbance in the right hemisphere of the frontal zone of the brain due to illness or trauma. Its pathogenesis is supposed to be associated with a decrease for any reasons of dopaminergic neurotransmission in the frontal lobes of the cerebral cortex, responsible for targeted motor activity, the ability to manifest initiative, planned actions aimed at solving certain problems and overcoming obstacles. Patients with lesions of the frontal part of the brain are distinguished by inertia and inactivity.
As the main factor that triggers the development of the abulia, most experts call stress.
Abulia deprives a person of the main human quality - he ceases to be a person.
This is a serious disease, manifested by the disappearance of a person's motives, urging him to action to achieve a certain goal.
Especially dangerous is the abulia in childhood, because parents can simply not pay attention to the child's morbid state, taking him for trivial laziness or weak-willedness. The most difficult is the hereditary abulia, which manifests itself in infancy. A sedentary, very calm child, not loud-spoken, to envy parents of other kids, should cause parents not joy, but anxiety, because belated diagnosis will lead to complication of the disease.
Risk factors
Many psychoneurological pathologies are accompanied by an abulia. The main risk factors are post-stroke and post-traumatic states, the consequences of intoxication, hypoxia, infectious diseases, brain tumors, Parkinson's disease, Hattington, Pick syndrome, congenital dementia, depression, alcohol and drug abuse.
Abulia is an indispensable companion of schizophrenics, which in time are aggravated by changes in the psyche, impulses are weakened, passivity grows, unwillingness to perform even the simplest and necessary actions (for example, associated with self-service).
For a simple form of schizophrenia characterized by apato-abulic syndrome, not accompanied by delirious phenomena and hallucinations. In schizophrenics, parabulism is often found - very diverse behavioral disorders, an irresistible passion for performing unnatural deeds (exhibitionism, pedophilia).
Temporary manifestations of abulia may appear as a reaction to a psychic trauma (psychogenic stupor), usually lasts for a short time and passes when solving the traumatic situation; with a depressive and apathetic stupor; with catatonic stupor (hyperbulia) - this condition can last from several months to several years. Symptoms of abulia are often manifested as a side effect of prolonged intake of large doses of antipsychotic drugs.
Symptoms of the abulia
Psychoneurologists call abulia pathological reluctance to exert efforts to any, even necessary actions or previously favorite activities, or a significant decrease in the energy of strong-willed manifestations. This is noticeable already at the very beginning of any process, as the individual is exaggerated by the very thought of doing something. Abulia is characterized by a lack of desire, and not the possibility of making 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 activity. Individuals with abulia suffer from disorders of sleep, appetite, memory, chronic fatigue, they are accompanied by a pessimistic mood, unwillingness to act causes dependence on other people.
Clinical manifestations of this condition:
- untidy, sloppy appearance;
- hindered uncoordinated movements;
- inhibited emotional and speech reactions;
- unwillingness to contact others, social isolation;
- impoverishment of speech, gestures, facial expressions;
- absence of any manifestations of activity;
- impossibility of making independent decisions;
- lack of interest in previously favorite pursuits (hobbies);
- long silence before answering the question.
Patients do not tolerate even minimal loads, any obstacle immediately causes a rejection of the intended, impatient, demanding, lazy and inert. Attempts to stir them up, get them to work cause resistance. At the same time, most patients eat with pleasure, allow themselves to entertain (they can listen to music or watch TV all day). In cases of a more severe degree of abulia, they stop leaving the house, get out of bed, almost do not eat, do not follow basic rules of hygiene.
In the apatiko-abulic syndrome, in addition to volitional manifestations, emotions fade away - conscience, shyness, ability to love, compassion disappear.
Often repeated, familiar to the pain phrase: "I do not want", growing into: "I can not", often becomes the first warning.
Lack of interest in his own person, which is first of all striking - to the appearance (dirty hair, nails, unclean teeth, stale clothes) - the first signs of an abul.
Noteworthy are other characteristic manifestations: spontaneous incomprehensible movements, coordination difficulties, long meditations before answering the question, there may be a desire to eat, sleep, communicate with friends. The child has lost interest in his favorite toys and games. Passivity and lack of volitional impulse - a characteristic feature of the abulia.
Abulia generates an inability to move from the desired to the real, the feeling that there is not enough energy to implement the plan - it is not worth starting. There is an opinion that abulia is a sign of disorders of the schizophrenic spectrum, at the same time, similar symptoms are inherent in other brain pathologies that have nothing to do with schizophrenia.
Still, psychoneurology quite clearly differentiates this disorder of the psyche from laziness and weak-willedness as a consequence of deficiencies in upbringing.
Forms
Stages of severity of abulia can be as light (with slight deviations from the norm, reduced motivation, when the patient can still be involved in any activity), and severe up to complete suppression of strong-willed impulses, unwillingness to produce the simplest actions (get out of bed, lead myself in order, eat).
Volitional dysfunction is associated with a decrease in the initiative of the individual, his inability to overcome obstacles and the systematic achievement of the result, the lack of motivation to commit acts and deviations from social norms of behavior.
Classify the following types of strong-willed disorders:
- Hyperbulia is its main symptom: hyperactivity;
- Hypobulia - a noticeable decrease in motivations for action;
- parabulium - behavioral deviations from the generally accepted norms;
- Abulia - the pathological absence of willful motives for actions.
The duration of the abulia can be short-term, periodic and permanent.
Depressive and asthenic syndrome with elements of adynamia, neuroses, psychopathic disorders are often accompanied by a brief absence of willful motives and a decline in activity.
Periodic abulia - a companion of drug addicts, alcoholics, people with somatoform disorders, schizophrenics (coincides with periods of exacerbation of the disease). Repetition of periods of lack of will characterize the clinic of manic-depressive psychosis.
The constant deficit of motivation and volitional impulses - a symptom of the probability of catatonic stupor, often occurs with schizophrenic disorders and severe organic brain lesions (progressive tumors, craniocerebral trauma).
Abulia is often combined with a mutism - an unwillingness to talk. Verbal contact with patients is broken, they can not be answered.
Apathy and abulia often combine to form Apato-Abulian syndrome, the symptomatology of which is manifested by emotional insufficiency and automatic movements. Patients are locked in themselves, trying to evade communication, demonstrating all their appearance of indifference to the interlocutor, to close people, lose interest in their favorite activities, entertainment.
Abulian-akinetic syndrome - a combination of lack of will with partial or complete immobility, often accompanied by a slowing down of the thought process.
Having noticed signs of an abulia, it is necessary to address to experts for professional help. The consequences and complications in the time of the uninhibited process of willful inactivation do not promise anything good not only to the patient, but also to his closest associates. Depriving a person of aspirations and goals leads to the degradation of the personality, because it is in the rational actions that volitional, mental and emotional human functions are realized.
Diagnostics of the abulia
To date, the status of abulia (a disease or a symptom of other diseases) is still debated, although so far it has not been recognized as a separate nosological unit. Pathological lack of will often occurs among a combination 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, polls and tests are used to compile a psychoneurological history of the patient; instrumental methods: magnetic resonance and computer tomography, ultrasound, brain electroencephalography; laboratory blood tests.
The main goal of the psychoneurologist is the differentiation of abulia (psychopathology) from laziness, apathy (phenomena in general, within the norm), and also Apato-Abulian syndrome from symptoms similar in symptomatology (asthenoanergic syndrome, asthenoapatic depression).
In these cases, differential diagnosis is used, the symptoms of similar conditions are compared by a set of criteria, the comparative characteristics of the symptoms are presented in tabular form for ease of use. Comparison criteria: from complaints of patients (whether voluntarily and what they say), emotions, motor skills, thinking to social relations and behavior with friends, relatives, loved ones.
The greatest difficulty is caused by child diagnosis. It's harder to understand. Of course, the reluctance to collect toys can not be considered a sign of an abulia, but if a child sits for hours, imitating reading or drawing, then you need to seek psychiatric help, because parents themselves can not cope with the development of pathology.
Treatment of the abulia
First of all, a treatment corresponding to the underlying disease is prescribed, which is complicated by the lack of willful aspirations.
When schizophrenia manifests in this way, medication is performed by atypical antipsychotics. At an abulia on a background of depression antidepressants are applied.
Therapy is carried out only for strict appointments and under the supervision of a psychiatrist based on anamnesis of the patient and the results of diagnosis.
In disorders of the schizophrenic type with apato-abulic syndrome, with symptoms of retardation of mental and physical activity, Phrenolone is prescribed . This drug has a psychostimulating effect, at recommended dosages does not cause drowsiness. Assigned individually, dosing, is due to the degree of severity: a minimum of 5 mg twice a day, a maximum of 10 mg three times a day. It is not prescribed for arrhythmia, endomyocarditis, renal and / or hepatic insufficiency of medium and more severity. As a result of application, vegetative disturbances, edemas on the face, tremor of the extremities, coordination motor disorders can occur.
Triftazine is also recommended for apatho-abulic conditions in schizophrenics and in old age, they start taking from 5 mg two to three times a day in combination with pyracitam (twice a day, one capsule), increasing the dosage of triftazine by about 5 mg daily, adjusted to a daily dosage 30-80mg. The recommended dosages of trifazine do not cause drowsiness. Contraindicated in acute violations of cardiac activity (in particular, conduction), renal insufficiency of moderate and more severe, acute hepatitis, pregnant women. As a result of the application, tremor of the extremities, movement coordination disorder, allergies, insomnia, dizziness, nausea, and occasionally toxic hepatitis, 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 clears the symptoms of apathy and abulia. According to the instructions, it does not cause drowsiness, but, judging by the reviews, it contributes to falling asleep, simultaneous use with sleeping pills, narcotic drugs, means for local anesthesia enhances their effect. Solian is contraindicated in hypersensitivity to it, prolactinoma of the pituitary gland, malignant tumors of the mammary glands, pheochromocytoma, pregnant and lactating women, aged 0-17 years, kidney diseases. The treatment regimen is appointed and amended only by the attending physician-psychoneurologist, if necessary.
Sulpirid supposes the use in cases of suppression of volitional impulses caused by a depressive syndrome, with manifestations of apathy, sluggishness, a decrease in motor and verbal activity, with senile and acute psychoses with a change in the excited and oppressed state caused by disorders of the schizophrenic spectrum and other psychiatric pathologies. The average dosage is 0.2-0.4 g per day, the maximum dosage is 0.8 g. It is not prescribed to hypertensive patients, in cases of pheochromocytoma and excited states. In addition to limb tremor, movement coordination disorder, insomnia, dizziness, nausea, it acts excitantly, raises blood pressure, causes malfunctions of the menstrual cycle, galactorrhea outside the lactation period, increases mammary glands in male patients.
For the treatment of abulia and the prevention of its relapses, physiotherapy is used: phototherapy, therapeutic swimming, taking medicinal baths, oxigenobarotherapy. Physiotherapy today has many techniques that stimulate the central nervous system. As a rule, their combination with sanatorium treatment is more effective. The stabilization of the patients is favorably affected by the action of mineralized waters of thermal springs, the application of therapeutic mud to the vegetative plexus. Patients suffering from depressive disorders are shown to rest south of their permanent residence, and schizophrenics are favored by high mountains.
In addition, classes with a therapist, individual and group, are conducted. The main goal of individual communication with the patient is to establish a trusting relationship. Lessons in the group, beginning with minimal joint actions, gradually move to involving the patient in the discussion, restoring the ability to communicate with each other and communication skills.
In supporting therapy, the role of the family and each of its members, their relationship is very important. The psychotherapist conducts explanatory work with close people of the patient, helps to resolve intrafamily problems, conflict situations and strive to help establish a harmonious microclimate.
Alternative treatment
Mental diseases in general are difficult to treat, nevertheless, there is a folk treatment of depressive conditions and even schizophrenia.
Tibetan medicine, the most authoritative among non-traditional methods, recommends rubbing the schizophrenic with olive oil. This can be done at home, even at the same time as drug therapy.
Take a liter of olive oil (you can also sunflower), pour in clay ware, cork and bury in the ground to a depth of about 0.5 m. The oil should lie in the ground for a year. In a year it is dug out and used for grinding.
Massaging with soft movements the entire body, the head - with particular care. On the shoulders, neck, the upper back of the oil do not regret. Duration of rubbing - about half an hour, every other day for two months. Then - a break for a month, and the course of treatment is repeated. You can wash yourself sick in those days when there is no rubbing.
Physical exercises, in particular - yoga, and a cold shower also have a positive effect on the health of schizophrenics.
Instead of a cold shower, you can wipe yourself with salt water at room temperature in the morning: dissolve one teaspoon of sea salt for half a liter of water.
At the same time, you need to eat right. The antidepressant diet is vegetarian, it also involves the exclusion of tea and coffee, alcoholic beverages and chocolates, white wheat flour and sweets, chemical additives and spicy seasonings. You need three times a day. Lunch - with fruits, nuts, a glass of milk. Dine - dishes from vegetables, steamed, bread from wholemeal flour and milk. Dinner - salads from green vegetables, legumes, cheese, kefir or yogurt.
Alternative medicine is replete with phytotherapeutic prescriptions used for depression and nervous exhaustion to raise vitality. Only herbal treatment, of course, will not help to get rid of the abulia, nevertheless, phytotherapy can also be used in the complex of therapeutic measures. In the treatment of depressive disorders apply roots and leaves of ginseng, flowers aster chamomile, roots with rhizomes zamanichi and angelica, grass mountaineer bird and even ordinary straw. However, before using any medicinal plant, it is necessary to consult the attending physician, since interaction with the prescribed medications can adversely affect the treatment process.
For more than two hundred years, there has been a special direction in clinical medicine - homeopathy, based on the law of similarity. The selection of homeopathic remedies is very individual, the patient's complex of symptoms is carefully studied and a drug is prescribed that can trigger similar symptoms in a healthy person. In homeopathic medicine there is no cough medicine, hypertension or fever. Homeopathy treats not a disease, but a person, that is, the whole complex of symptoms inherent in a given patient, with one drug. In this case, the drug is prescribed in ultra low doses.
Properly selected homeopathic drug helps to significantly improve health and get rid of chronic diseases. The therapeutic effect of homeopathic treatment comes, as a rule, in the interval from three months to two years.
In homeopathy there are preparations for conditions, the description of which is similar to abulia and apato-abulic syndrome.
For example:
- Carbo vegetabilis (Carbo vegetabilis) - a deep weakening, a decline in vitality;
- Gelsemium - a feeling of exhaustion and slowness of the psyche, all the time you want to sleep, pseudodementia, tremor, weakness in the muscles;
- Glonoinum (Glonoinum) - a strong exhaustion, a deep reluctance to work, a strong irritability; intolerance of wrangling, periodically blood flows to the head;
- Cali phosphoricum is a strong exhaustion, a decline in strength, especially shown at a young age with overexcitation, anxiety, unwillingness to contact others, a state of severe fatigue and a depressive disorder, any actions seem very complicated that can not be performed, absolute disbelief in success every enterprise.
As already mentioned, dosages and treatment regimens are prescribed only individually, the recommended doses of the drug, as in traditional medicine, are not found in classical homeopathy.
Prevention
How to prevent the development of an abulia? This question can arise at any age.
In old age for a person need confidence in the fact that he is needed, useful to his relatives, not indifferent to them. A person has a motivation for action, a desire to justify the expectations of others.
In the prevention of abulia in adolescents and middle-aged people, an important role is played by the presence of hobbies, favorite pursuits, hobbies.
The most common mistake of relatives is pity for the patient, the desire to protect him from difficulties, indulgence to his whims. This only aggravates the painful condition. The help of a close environment should be contained in attempts to stir up the patient. Organization of trips to a picnic, for mushrooms, to another city for an excursion, noisy parties. It is necessary to involve the patient with an abulia to work, emphasizing his attention to the fact that he can not cope without his help. He must feel necessary for younger or older members of the family, animals, for someone or for something to take care of. If the process of abulia only begins, then acting in this way, you can successfully withdraw a person from it.
If the process is delayed, then specialist intervention and medication will be required.
Forecast
The prognosis of treatment of Apato-Abulic syndrome in schizophrenic disorders is most often unfavorable. In practical psychiatry with prolonged treatment of pathology, only the incomplete disappearance of symptoms of the disease was noted, there were cases of the development of schizophrenia with the increase of symptoms. The best results were the progress of socialization, the restoration of contacts with others.
In the treatment of abulia, psychotherapeutic techniques are widely used, especially in the case of short-term, mild forms of the disease. Psychotherapy in the treatment of the absence of strong-willed impulses in disorders of the schizophrenic spectrum is a matter for discussion.
Nevertheless, hypnotic sessions and cognitive-behavioral psychotherapy are practiced with a view to reducing the manifestations of Abulian syndrome. Psychotherapeutic measures are aimed at restoring socialization, communication skills and creating a strong-willed and motivational base.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"