Hypobulia

Hypobulia is a decrease in intensity and a reduction in the number of human motivations for any activity. In this case, there is a regression of motives and hypokinesia (sedentary lifestyle), and in addition, the patient develops a subjective feeling of helplessness and constant fatigue.

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Epidemiology

Since hypobulia is a manifestation of depression, we should turn to epidemiological results regarding this pathology. Depression is considered one of the most common mental disorders. Statistics show that it is observed in approximately 350 million people of any age category in the world. However, depression is more common in women than in men.

Causes hypobulia

The cause of hypobulia is the development of depressive syndrome in a person.

Risk factors

Since hypobulia is one of the manifestations of depression, it is necessary to highlight the main risk factors for the development of this syndrome or its relapse:

• depression was observed in childhood or adolescence;
• there is a history of anxiety disorders, PTSD, the person has a borderline personality type;
• drug abuse, as well as alcohol abuse;
• the presence of such character traits as increased self-criticism, dependence on others, pessimism and low self-esteem;
• the presence of severe chronic pathologies – diabetes, cancer, heart failure;
• taking certain categories of medications, such as antihypertensive drugs or sleeping pills;
• stress or traumatic events – for example, sexual or physical abuse, loss of a loved one, financial or relationship problems;
• the patient has close relatives who suffer from bipolar disorder, depression or alcoholism, and who have also attempted suicide.

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Pathogenesis

PET scans of patients with severe depression showed abnormalities in the functioning of the visceral brain, the anterior cortex, and in addition the striatum, thalamus and globus pallidus.

In endogenous depressions, hereditary factors are identified as leading factors (they manifest themselves in bipolar psychoses, periodic attacks of unipolar depression, and late depression). Disorders of the exchange processes of biological amines are a predisposition factor to the development of mood disorders. The development of depressive syndrome is associated with a relative deficiency of biological amines in the synaptic cleft (substances such as norepinephrine, serotonin, or dopamine). In the development of depression, a weakening of the activity of the DA-ergic system is also very important, as well as a low level of neurotransmitters in the synaptic cleft along with a change in sensitivity and the number of nerve endings in the central nervous system corresponding to the neurotransmitter.

Depressive states appear due to various somatic pathologies – for example, hypothyroidism of the thyroid gland, endocrinopathy, hypercorticism syndrome, and in addition to this, hypocorticism, carcinomas of various localizations, neurological disorders, infectious diseases or collagen diseases (such as rheumatoid arthritis or Libman-Sachs disease).

Symptoms hypobulia

In hypobulia, the patient experiences suppression of all basic types of desire, including physiological ones. The patient's appetite decreases and, although the doctor can convince him of the need for food, he will eat reluctantly and only in small portions.

As a result of decreased sexual desire, not only does interest in sex disappear, but also interest in one's own appearance. Patients also lose the need to communicate with other people, they are burdened by the presence of someone nearby and the need to conduct conversations, so they often ask to be left alone.

Patients spend a lot of time on their own suffering and worries, and therefore do not want to take care of their loved ones (this phenomenon is often found in mothers during the period of postpartum depression, when the mother is unable to force herself to take care of the baby).

Because the instinct of self-preservation weakens, the patient may attempt suicide. A characteristic sign is also shame for one's own helplessness and complete inaction.

As for the patient's movements, they become inhibited, gait disturbances are observed, handwriting changes - letters lose their outline. The person's posture acquires a mournful look, the face has a suffering expression with a dull look and drooping corners of the mouth. Lethargy is observed in gesticulation, gestures express despair and hopelessness.

Stages

At the first stage of hypobulia, manifestations such as lack of initiative and determination are observed, and in its extreme form – apathetic-abulic syndrome.

If the disease progresses to stage 2, the patient shows an inability to correctly calculate his own actions, which makes them appear inconsistent and chaotic.

At stage 3 of the disorder, obsessive experiences and a feeling of indecision are observed.

In the second and third stages, manifestations of impulsiveness and increased suggestibility are possible (the extreme form of this is conformism - for example, ZRP, which in the extreme degree turns into ambitendent). In addition, the opposite form of the disorder can also manifest itself - nonconformism, which is characterized by negativism and strong stubbornness, and in addition, excessive dreaminess.

At stage 4 of the disease, a person becomes completely incompetent.

Complications and consequences

Among the complications that hypobulia that develops into depression can cause:

• a sharp increase in weight up to obesity, which can lead to the development of diabetes and heart failure;
• use of drugs and alcohol in large quantities;
• the emergence of a feeling of anxiety and panic attacks or the development of social phobia;
• various problems and conflicts at work, school, and family;
• self-isolation from society;
• the emergence of thoughts of suicide, attempts to commit it;
• self-inflicted injuries and mutilations;
• premature death due to other diseases.

Diagnostics hypobulia

Hypobulia can be diagnosed based on the patient's medical history and the results of questioning his relatives and friends. After that, his mental state is assessed, and then a somatic examination is performed.

Differential diagnosis

Hypobulia must be differentiated from diencephalic adynamia, which is often accompanied by hypopathy, and in addition to this, from the depressive form of adynamia, in which the patient exhibits criticality, as well as an unproductive (in the rational sense) desire to get rid of adynamia. In addition, the disease must be distinguished from simple adynamia.

Treatment hypobulia

In case of hypobulia, it is necessary to increase the demands on the person – in relation to compliance with the treatment regimen. They should be activated to perform basic actions – take medications on time, undergo treatment procedures, etc. A positive effect is provided by the performance of simple instructions, which can be carried out in a hospital under the supervision of doctors. If the patient is on outpatient treatment, relatives should treat him with care and attention.

In case of hypobulia and depression, the patient is prescribed medications that can have an activating effect (antidepressants) - these are MAO inhibitors, as well as tachythymoleptics (such as desipramine or nortriptyline, etc.).

Prevention

To prevent the development of a depressive state, you should learn to cope with stress and problems. This is helped by maintaining a healthy lifestyle, regular exercise, and a proper daily routine.

The drug method of preventing depressive states is taking medications such as lithium, carbamazepine and valproates.

Forecast

Hypobulia can have both a favorable and an unfavorable prognosis - it depends on whether treatment was started and how timely it was done. If the disease is neglected, it can develop into severe depression and even schizophrenia. In this case, the risk of suicide increases.