Avolition

Avolition, as a symptom of various forms of psychopathology, is the decrease in the ability to initiate and persist in self-directed purposeful activities.[1] 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.

Not to be confused with abulia.

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 by the National Institute of Mental Health (NIMH),[2] and has been observed in patients with bipolar disorder as well as resulting from trauma.

Avolition is sometimes mistaken for other, similar symptoms also affecting motivation, such as abulia, anhedonia and asociality, 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.[3] 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, 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.[4]

Clinically, it may be difficult to engage an individual experiencing avolition in active participation of psychotherapy. 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 reported in 2013 that there currently are "no treatments with proven efficacy for primary negative symptoms"[5] (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.[6] 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 may be useful for treatment of apathy syndrome (avolition). However, its role and efficacy in treatment of apathy requires further investigation in clinical trials.[7]

Low dose amisulpride 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.[8]

Mitragynine contained in kratom may have the ability to reduce avolition.[9]

Cognitive behavioural therapy (CBT), is the kind of psychotherapy that shows most promise in treating avolition (and other negative symptoms of schizophrenia),[10] 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

References
  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (fifth ed.). Arlington, VA: American Psychiatric Association. p. 818. doi:10.1176/appi.books.9780890425596. hdl:2027.42/138395. ISBN 978-0-89042-554-1.
  2. Castonguay L, Oltmanns T (2013). "General Issues in Understanding and Treating Psychopathology". In Castonguay L, Oltmanns T (eds.). Psychopathology: From Science to Clinical Practice. New York: Guildford Publications. pp. 5–6. ISBN 978-1-4625-2881-3.
  3. Marin RS, Wilkosz PA (2005). "Disorders of diminished motivation" (PDF). The Journal of Head Trauma Rehabilitation. 20 (4): 377–88. doi:10.1097/00001199-200507000-00009. PMID 16030444. S2CID 11938168. Archived (PDF) from the original on 2015-08-11. Retrieved 2015-07-18.
  4. Morrison B (2012). "Suicide: Disease, Loneliness, Social Isolation, Suicide, Negative Thoughts ...". In LeCroy CW, Holschuh J (eds.). First Person Accounts of Mental Illness and Recovery. Hoboken, New Jersey: John Wiley & Sons, Inc. pp. 53–57. ISBN 978-0-470-44452-8.
  5. Kring A, Smith D (2013). "The Negative Symptoms of Schizophrenia". In Castonguay L, Oltmanns T (eds.). Psychopathology: From Science to Clinical Practice. New York, NY: Guildford Publications. pp. 370–388. ISBN 978-1-4625-2881-3.
  6. Carson VB (2000). Mental health nursing: the nurse-patient journey (2nd ed.). Philadelphia: W.B. Saunders. p. 638. ISBN 978-0-7216-8053-8. Archived from the original on 2016-11-25. Retrieved 2016-05-06.
  7. Monga, V.; Padala, P. R. (2015). "Aripiprazole for Treatment of Apathy". Innovations in Clinical Neuroscience. 12 (9–10): 33–36. PMC 4655898. PMID 26634180.
  8. Krause M, Zhu Y, Huhn M, Schneider-Thoma J, Bighelli I, Nikolakopoulou A, Leucht S (October 2018). "Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis" (PDF). European Archives of Psychiatry and Clinical Neuroscience. 268 (7): 625–639. doi:10.1007/s00406-018-0869-3. PMID 29368205. S2CID 24569827.
  9. Johnson, L. E.; Balyan, L.; Magdalany, A.; Saeed, F.; Salinas, R.; Wallace, S.; Veltri, C. A.; Swogger, M. T.; Walsh, Z.; Grundmann, O. (2020). "The Potential for Kratom as an Antidepressant and Antipsychotic". The Yale Journal of Biology and Medicine. 93 (2): 283–289. PMC 7309668. PMID 32607089.
  10. Elis O, Caponigro JM, Kring AM (December 2013). "Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions". Clinical Psychology Review. 33 (8): 914–28. doi:10.1016/j.cpr.2013.07.001. PMC 4092118. PMID 23988452.
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