Hypobulia

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

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Epidemiology

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

Causes of the hypobuloses

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

Risk factors

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

• depression was observed in childhood or adolescence;
• in the history there are stories of anxiety disorders, PTSD, a person has a borderline personality type;
• drug abuse, as well as alcoholic beverages;
• presence of such character traits as increased self-criticism, dependence on others, pessimism and low self-esteem;
• presence of severe chronic pathologies - diabetes, cancer, heart failure;
• the admission of certain categories of drugs - for example, hypotensive drugs or sleeping pills;
• stresses or traumatic events - for example, sexual or physical violence, loss of a loved one or an expensive person, problems with finances or in a relationship;
• the patient has close relatives suffering from bipolar disorder, depression or alcoholism, and also attempted suicide.

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Pathogenesis

PET results obtained after examination of patients with severe depression showed that they have abnormalities in the functioning of the visceral brain, the anterior parts of the cerebral cortex, and in addition to the striatum, thalamus and pale ball.

With endogenous depression, hereditary factors are distinguished as leading factors (manifested in bipolar psychoses, periodic attacks of monopolar depression, and also late depression). Disorder of the processes of metabolism of biological amines is a factor of predisposition to the development of mood disorders. The occurrence of a depressive syndrome is associated with a relative lack of biological amines in the synaptic cleft (such substances as norepinephrine, serotonin or dopamine). When the development of depression is very important is also a weakening of the activity of the DA-ergic system, and in addition a low index of neurotransmitters in the synaptic cleft along with a change in the sensitivity and the number of nerve endings in the CNS corresponding to the neurotransmitter.

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

Symptoms of the hypobuloses

With hypobulosis, the patient is suppressed all the main types of craving, among which are also physiological. The patient's appetite is reduced and, although the doctor is able to convince him of the need for food, he will eat with reluctance and only small portions.

As a result of the decline in sexual desire, not only interest in sex disappears, but at the same time, interest in their own appearance disappears. Patients also lack the need to communicate with other people, they are burdened by the presence of someone nearby and the need to talk, so they often ask to be left alone.

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

Due to the fact that the instinct of self-preservation weakens, the patient can make attempts at suicide. A characteristic sign is a shame for their own helplessness and total inaction.

As for the movements of the patient, they become inhibited, irregularities in the gait are observed, the handwriting changes - the letters lose their outline. The man's posture acquires a sorrowful look, a suffering expression on his face with a dull look and drooping corners of his mouth. There is sluggishness with gestures, gestures express despair and hopelessness.

Stages

In the first stage of hypobulosis, there are such manifestations as lack of initiative and purposefulness, and in extreme form - Apato-Abulic syndrome.

In case of transition of the disease to the 2 nd stage, the patient manifests the inability to correctly calculate his own actions, because of what they look inconsistent and chaotic.

At the third stage 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 (an extreme form becomes conformism, for example, ZRL, which at the extreme turns into ambition). In addition, the reverse form of the disorder can also be manifested - nonconformism, which is characterized by negativism and strong obstinacy, and beyond that, excessive dreaminess.

At the 4th stage of the disease a person becomes completely non-executive.

Complications and consequences

Among the complications that can cause a hypobulosis that has developed into depression:

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

Diagnostics of the hypobuloses

Diagnosis of hypogamy can be based on anamnesis and the results of a patient's survey, as well as his relatives and loved ones. After this, an assessment of his mental state is carried out, and then a somatic examination is performed. 

Differential diagnosis

Hypopulia should be differentiated from diencephalic adynamy, which is often accompanied by hypopathy, and in addition to depressive form of adynamia, in which the patient manifests criticality, as well as an unproductive (rationally) desire to get rid of adynamia. In addition, the disease must be distinguished from simple adynamia.

Treatment of the hypobuloses

With hypobulosis, you need to increase the demand for the person - in relation to adherence to the treatment regimen. It is necessary to activate them for performing elementary actions - in time to drink medicines, undergo medical procedures and so on. A positive effect is the performance of simple instructions, which can be carried out at a hospital under the supervision of doctors. If the patient is on ambulatory treatment, relatives should be treated with care and attention.

With hypobulosis and depressed condition, the patient is prescribed medications that can have an activating effect (antidepressants) - these are MAO inhibitors, as well as tachytymoleptics (such as desipramine or nortriptyline, etc.).

Prevention

To prevent the development of a depressive state, one must learn to cope with stress and problems. This helps to maintain a healthy lifestyle, regular exercise, as well as the correct regime of the day.

The medication method for the prevention of depressive conditions is the administration of such drugs as lithium preparations, carbamazepine and valproate.

Forecast

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