avolition
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Avolition, as a symptom of various forms of psychopathology, is the decrease in the ability to initiate and persist in self-directed purposeful activities. Such activities that appear to be neglected usually include routine activities, including hobbies, going to work and/or school, and most notably, engaging in social activities. A person experiencing avolition may stay at home for long periods of time, rather than seeking out work or peer relations.


Psychopathology

People with avolition often want to complete certain tasks but lack the ability to initiate behaviours necessary to complete them. Avolition is most commonly seen as a symptom of some other disorder, but might be considered a primary clinical disturbance of itself (or as a coexisting second disorder) related to disorders of diminished motivation. In 2006, avolition was identified as a negative symptom of
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
by the National Institute of Mental Health (NIMH), and has been observed in patients with
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
as well as resulting from trauma. Avolition is sometimes mistaken for other, similar symptoms also affecting motivation, such as
abulia In neurology, abulia, or aboulia (from grc, βουλή, meaning "will"),Bailly, A. (2000). Dictionnaire Grec Français, Éditions Hachette. refers to a lack of will or initiative and can be seen as a ''disorder of diminished motivation'' (''DDM'' ...
,
anhedonia Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers t ...
and
asociality Asociality refers to the lack of motivation to engage in social interaction, or a preference for solitary activities. Asociality may be associated with avolition, but it can, moreover, be a manifestation of limited opportunities for social relati ...
, or strong general disinterest. For example, abulia is also a restriction in motivation and initiation, but characterized by an inability to set goals or make decisions and considered a disorder of diminished motivation. In order to provide effective treatment, the underlying cause of avolition (if any) has to be identified and it is important to properly differentiate it from other symptoms, even though they might reflect similar aspects of mental illness.


Social and clinical implications

Implications from avolition often result in social deficits. Not being able to initiate and perform purposeful activities can have many implications for a person with avolition. By disrupting interactions with both familiar and unfamiliar people, it jeopardizes the patient's social relations. When part of a severe
mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
, avolition has been reported, in first person accounts, to lead to physical and mental inability to both initiate and maintain relationships, as well as work, eat, drink or even sleep. Clinically, it may be difficult to engage an individual experiencing avolition in active participation of
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
. Patients are also faced with the stresses of coping with and accepting a mental illness and the stigma that often accompanies such a diagnosis and its symptoms. Regarding schizophrenia, the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
reported in 2013 that there currently are "no treatments with proven efficacy for primary negative symptoms" (such as avolition). Together with schizophrenia's chronic nature, such facts added to the outlook of never getting well, might further implicate feelings of hopelessness and similar in patients as well as their friends and family.


Treatment

Antipsychotics are less effective in the treatment of negative symptoms of schizophrenia such as avolition than for positive symptoms. As a result, psychotherapy might be an alternative for the treatment of these symptoms, even if medication has a good effect on other manifestations of the disorder.
Aripiprazole Aripiprazole, sold under the brand names Abilify and Aristada among others, is an atypical antipsychotic. It is primarily used in the treatment of schizophrenia and bipolar disorder. Other uses include as an add-on treatment in major depressiv ...
may be useful for treatment of apathy syndrome (avolition). However, its role and efficacy in treatment of apathy requires further investigation in clinical trials. Low dose
amisulpride Amisulpride is an antiemetic and antipsychotic medication used at lower doses intravenously to prevent and treat postoperative nausea and vomiting; and at higher doses by mouth to treat schizophrenia and acute psychotic episodes. It is sold und ...
has shown to be more effective than placebo for treating the negative symptoms of schizophrenia, which includes avolition. It works by blocking pre-synaptic dopamine receptors, causing a release of dopamine into the synapse.
Mitragynine Mitragynine is an indole-based alkaloid and the most abundant active alkaloid in the Southeast Asian plant ''Mitragyna speciosa'', commonly known as '' kratom.'' The total alkaloid concentration in dried leaves ranges from 0.5 to 1.5%. In Thai va ...
contained in
kratom ''Mitragyna speciosa'' (commonly known as kratom, an herbal leaf from a tree of the Rubiaceae family, ) is a tropical evergreen tree in the coffee family native to Southeast Asia. It is indigenous to Thailand, Indonesia, Malaysia, Myanmar, and ...
may have the ability to reduce avolition.
Cognitive behavioural therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (su ...
(CBT), is the kind of psychotherapy that shows most promise in treating avolition (and other negative symptoms of schizophrenia), but more research is needed in the area. CBT focuses on understanding how thoughts and feelings influence behaviour, in order to help individuals develop methods and strategies to better handle the implications of their disorder. Some research suggests that CBT focusing on social skills and practice of interpersonal situations, like job interviews, seeing a doctor (to discuss medication, for example), or interacting with friends and family, as well as seemingly simple things like riding a bus, regular exercise, and a good diet might reduce negative symptoms of schizophrenia and be beneficial to patients with avolition. Other forms of psychotherapy might also complement the role of medication and help patients, their families, and friends to work through emotional and other challenges of living with a chronic psychological disorder, including avolition.


See also

*
Abulia In neurology, abulia, or aboulia (from grc, βουλή, meaning "will"),Bailly, A. (2000). Dictionnaire Grec Français, Éditions Hachette. refers to a lack of will or initiative and can be seen as a ''disorder of diminished motivation'' (''DDM'' ...
*
ADHD Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inapp ...
*
Akrasia Akrasia (; Greek , "lacking command" or "weakness", occasionally transliterated as acrasia or Anglicised as acrasy or acracy) is a lack of self-control, or acting against one's better judgment. The adjectival form is "akratic". Classical approa ...
*
Amotivational syndrome Amotivational syndrome is a chronic psychiatric disorder characterized by signs that are linked to cognitive and emotional states such as detachment, blunted emotion and drives, executive functions like memory and attention, disinterest, passiv ...
*
Anhedonia Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers t ...
*
Apathy Apathy is a lack of feeling, emotion, interest, or concern about something. It is a state of indifference, or the suppression of emotions such as concern, excitement, motivation, or passion. An apathetic individual has an absence of intere ...
*
Incontinence Incontinence or Incontinent may refer to: *Fecal incontinence, the involuntary excretion of bowel contents *Urinary incontinence, the involuntary excretion of urine * Lack of moderation or self-control, especially related to sexual desire - see I ...
*
Lethargy Lethargy is a state of tiredness, sleepiness, weariness, fatigue, sluggishness or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overwo ...
*
Volition (psychology) Volition or will is the cognitive process by which an individual decides on and commits to a particular course of action. It is defined as purposive striving and is one of the primary human psychological functions. Others include affect (feeling ...
*
Hikikomori , also known as acute social withdrawal, is total withdrawal from society and seeking extreme degrees of social isolation and confinement. ''Hikikomori'' refers to both the phenomenon in general and the recluses themselves. ''Hikikomori'' ha ...
*
Learned helplessness Learned helplessness is the behavior exhibited by a subject after enduring repeated aversive stimuli beyond their control. It was initially thought to be caused by the subject's acceptance of their powerlessness, by way of their discontinuing atte ...
*
Schizoid personality disorder Schizoid personality disorder (, often abbreviated as SzPD or ScPD) is a personality disorder characterized by a Asociality, lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotion ...


References

{{Authority control Symptoms and signs of mental disorders Schizophrenia Personality traits Motivation