Abulia – the psychopathological syndrome which is characterized by lack of will. Is followed by inability to make any actions which need can be realized. Patients do not feel desire to show activity, are incapable to satisfy basic requirements: cannot independently eat, drink water, perform hygienic procedures. Diagnostics includes observation, poll of close relatives, tool researches of a brain (KT, MPT), psychological testing. Treatment is defined by the main disease which symptom is abulia.
The word "abulia" in translation from Greek means "lack of will". The syndrome is actively investigated since 1838, comes to light at diagnosis of a depression, schizophrenia, deep intellectual backwardness, dementias, neuroinfections, organic diseases of a brain. Often develops as a part of an apato-abulichesky and abulicheski-akinetic syndrome. The epidemiology is not described as abulia is not allocated as an independent disease. The depression is the major etiologichesky factor therefore direct correlation with prevalence of a syndrome is probable – in the countries abulia meets the high standard of living for 30-40% more often than in the developing states.
Decrease in strong-willed activity is observed at neurosises, somatoformny frustration, as a result of excessive parental guardianship and suppression of activity of the child. Absolute lack of will develops on the basis of organic and metabolic violations in the central nervous system. Taking into account variety of the reasons of abulia it is possible to allocate several groups of violations at which this frustration can come to light:
- Neurologic pathologies. The syndrome is shown at injuries, tumors, toxic and infectious brain defeats, a disease of Gentington, a disease of Peak, Parkinson's disease, after a stroke. Lack of will is combined with motive braking and weakening of thought processes.
- Mental disorders. Abulia decides at patients on schizophrenia, a deep oligofreniya, an endogenous and neurotic depression, bipolar affective disorder, dementia. The motivation decreases because of "loss of energy potential" (E. Bleyer).
- Hereditary factors. Hereditary abulia is formed at children with predisposition to schizophrenia. Because of features of age it is diagnosed with delay.
Any regulation of activity is provided with functions of "the III block of a brain". The concept is entered by A. R. Luriya, unites the structures responsible for realization of processes of management of behavior – the prefrontal areas of bark of big hemispheres, some subcrustal and stem educations participating in programming, regulation and control of mental activity. According to modern researches, abulia develops on the basis of disorders of dofaminergichesky transfer in neurons at defeat of frontal departments of bark and/or subcrustal kernels. Primary stage of implementation of strong-willed acts – ability to initiate the movement, the speech, social interaction is broken. Progress and reversibility of strong-willed violations are defined by features of a course of the main disease – at degenerate pathologies of nervous system abulia gradually amplifies, at a depression against the background of successful treatment is reduced.
Abulia has accurately designated symptoms and degree of expressiveness – total absence of motivation, ability to initiate and support purposeful activity. Classification is based on syndrome duration, allows to make the forecast, to pick up the most effective treatment. Allocate the following types of clinical lack of will:
- Short-term. Is defined at an adynamic depression, borderlines (neurotic frustration, an asthenic syndrome). Critical abilities of the patient of a sokhranna, need of strong-willed efforts it is understood, but performance of activity is impossible.
- Periodic. Recurrent manifestation of a syndrome coincides with the periods of a depression of bipolar affective disorder, with stages of an exacerbation of schizophrenia. Lack of will quite often is replaced by a hyperactivity.
- Constant. The long lack of will which is not giving in to correction is characteristic of catatonic schizophrenia, heavy organic injuries of a brain. The abulia combination to apathy and an akineziya is widespread.
Abulia is characterized by inability to independently begin and support the purposeful movements, scarcity or lack of spontaneous movements, a speech obednennost, monotony and weak expressiveness of emotional reactions, passivity, narrowing of social contacts, decrease in interest in all types of active pastime. Without the aid of people around the patient spends at home all the time, lies or sits, occasionally changing situation. The blank look, does not answer questions or gives the answer after a pause. In the speech terse offers prevail. Emotional reaction is caused by bright, vitally significant events (for example, a fright at casual falling).
Interest in the occupations bringing earlier pleasure no. Lack of will is shown in daily rituals. The patient is not able to prepare and eat food independently. With the organizing and motivating help of other people can sit down at a dining table, but, having started a meal, long chews and does not swallow food, quickly loses appetite. Indifference to the appearance, failure to follow hygienic procedures is noted. At safe criticism to own state the patient understands need of actions therefore stimulation is from outside rather effective – it is possible to maintain neatness, to satisfy basic needs, to come into verbal contact.
Feature of abulia – need of the constant external stimulating and organizing help for satisfaction of basic physiological requirements and maintenance of the existing level of mental development. In the absence of due treatment and patient care the abulichesky syndrome leads to social and household disadaptation. Contacts with people stop, the cognitive interest vanishes. As a result communicative skills are lost, cognitive functions decrease. Defective food, non-compliance with rules of hygiene and the mode of physical activity promotes development of somatic pathologies: infections, diseases of digestive tract, musculoskeletal device, skin.
Detection of abulia is a part of complex diagnosis of mental and neurologic diseases. Examination is conducted by the neurologist, the psychiatrist, the psychologist. An important point is distinction of a pathological syndrome with laziness, consequences of the wrong education. Enter a complex of diagnostic procedures:
- Conversation, survey. Survey of relatives of the patient is conducted: the anamnesis, complaints becomes clear, duration and expressiveness of symptoms is specified. The conversation with the patient often is low-informative. The neurologist carries out survey: estimates safety of reflexes, movement skills, sensitivity. Proceeding from the obtained data, doctors make the assumption of the main disease and define the list of further procedures.
- Observation. Direct detection of symptoms of abulia happens during consultation and during finding of the patient in a hospital. Lack of interest in communication with the doctor, medical personnel, passivity, sluggishness, refusal of performance of daily rituals is noted.
- Tool inspection. It is appointed for the purpose of confirmation of the diagnosis and differentiation of neurologic pathologies. Widespread methods of inspection are the computer tomography and a magnetic and resonant tomography of a brain. At abulia existence of pathological signs in a prefrontal zone is characteristic.
- Psychodiagnostics. The clinical psychologist conducts a research of the cognitive and emotional and personal sphere. In most cases full diagnostics is impossible (the strong-willed component of activity is broken). Separate tests on the thinking, memory and an emotional state allowing to distinguish schizophrenia, a depression, maniac-depressive psychosis, dementia are carried out.
Treatment of abulia
Therapy of abulia is made within the general rehabilitation and knocking over of symptoms of the leading disease. Actions will be organized by the psychiatrist, the neurologist, the physiotherapist, reabilitology, the logopedist, the specialist in work therapy. The general scheme of treatment does not exist, methods are selected individually. At depressive frustration antidepressants are appointed, at schizophrenia – antipsychotic medicines, at organic damages of a brain – nootropa, means for blood circulation improvement. Rehabilitation programs are directed to restoration of speech and physical activity, based on creation of the various stimulating environment – patients attend individual classes with logopedists, instructors of LFK, then gradually join in group actions (work therapy, special courses of drawing, dances).
Methods of specific treatment of abulia continue to be investigated. Efficiency of the medicines increasing biological activity of dopamine is studied. Technicians of cognitive and behavioral psychotherapy and hypnosis at patients with a depression, maniac-depressive psychosis, schizophrenia are approved. Psychologists and psychotherapists manage to slow down progressing of a syndrome and to partially restore strong-willed functions, but the result is very unstable.
Forecast and prevention
The forecast of abulia completely depends on features of a course of the main pathology. The favorable outcome is most probable at pristupoobrazny schizophrenia, a depression, bipolar affective disorder with rare depressive episodes, and also at neurologic diseases with the return development. Special preventive measures are not developed, come down to the prevention of neurologic and mental diseases. At the first displays of abulia in some cases it is possible to slow down process of its progressing – it is necessary to organize the environment, various, interesting to the patient: to invite to friendly meetings, walks, sports activities, dances, creativity. The more socially and keen the patient will be active, the symptoms of lack of will will develop more slowly.