Abulia: definition, causes and treatment

Abulia is a condition characterized by a marked reduction in motivation and initiative ability and manifests itself in different psychiatric, neurological and medical conditions.

More specifically, the term “abulia” derives from the Greek to- (deprivation) e boulé (will), and describes a condition in which the subject cannot undertake or complete voluntary actions, despite having physical and cognitive abilities.

Manifestation of abbulia

Abulia occurs through different processes, which involve behavioral and cognitive-emotional aspects:

• Reduction of motor activity: slowed movements or absence of spontaneous actions.
• Decision -making inability: Difficulty making choices, even banal.
• Absence of initiative: inability to start personal or social activities.
• Emotional flattening: decrease in emotional responses to stimuli.

The symptomatological compromise framework can vary in intensity, from mild forms that limit some daily activities to serious forms that completely prevent autonomous functioning.

Abulia and other similar conditions

Distinguishing abulia from other similar conditions, with which it can manifest itself in comorbidity, is essential both from a diagnostic point of view and, above all, to formulate effective therapeutic interventions.

• Apathy: While abulia is characterized by a difficulty in the initiative and execution of the actions often described by patients as a feeling of “internal paralysis”, apathy refers to a loss of general interest, not specifically aimed at executing motor acts.
• Anedonia: Abulia and Anedonia, especially in depressive paintings, often manifest themselves in comorbilities. However, unlike abbulia, aedonia is characterized by a specific inability to feel pleasure, rather than in a block in the action.
• Acinesia: Common in movement disorders, such as Parkinson’s, refers to the reduction of spontaneous movements, without necessarily implying a loss of motivation.

The causes of abbulia

As mentioned, Abulia is not a disturbance in its own right but represents a symptom of more complex pathological conditions.

More specifically, abulia can be caused by neurochemical imbalancescan manifest itself in some neurological and neurodegenerative paintings and in some psychiatric and psychopathological conditions.

Neurological causes of abbulia

Among the most common neurological causes we find brain lesions and strokes.

Abulia presents itself with a certain frequency in cases where there is one damage to the front lobesin particular to be paid by the front-round circuit.

This area is in fact directly involved in the regulation of motivation and behavior.

Neurochimic and neurodegenerative causes of abbulia

One of the most involved neurotransmitters in the genesis and maintenance of abbul is the dopamine.

This neurotransmitter, in fact, plays a fundamental role in regulating motivation and pleasure.

Imbalances against the dopaminergic system, and in particular a reduction in dopaminergic transmission, are therefore frequently associated with abulic paintings.

The role of dopamine In regulating motivation and pleasure he explains why neurodegenerative diseases such as Parkinson’s, Alzheimer’s and Huntington disease, which affect the dopaminergic system, are often accompanied by abulic symptoms.

Also other neurotransmitters, such as serotonin and norepinephrine They can help aggravate the picture, as happens for example in depressive paintings.

Psychiatric causes of abbulia

In addition to the neurological paintings, Abulia also manifests itself in a series of psychopathological and psychiatric conditions among which we find in particular:

• The greatest depression: especially in depressive cases characterized by an important gravity, Abulia represents a central symptom, combining frequently with anedonia. In this context, the loss of motivation, in addition to deriving from neurochemical alterations, is often linked to the presence of negative thoughts, the sense of helplessness and a pessimistic vision of the future, typical elements of the depressive paintings. Unlike neurological paintings, in the greater depression, moreover, Abulia is also associated with very important experiences of guilt by the patient, often consequent precisely to the reduction of activities.
• Schizophrenia: Abulia is part of the negative symptoms of schizophrenia, together with apathy, of allogia (poverty of language) and social isolation.
• Anxiety disorders: although less common, abulia can also appear in anxious paintings, where excessive fear can help block the patient’s motivation to action.

The care of abbulia

The treatment of abbul is strictly dependent on the case underlying this condition and can include rehabilitation approaches, as in the case of neurological, pharmacological and psychotherapeutic lesions.

Pharmacological approaches

• Dopaminergic stimulants: Drugs such as levodopa (used in Parkinson’s) or dopamine agonists can improve abulic symptoms in patients with dopaminergic system dysfunctions.
• Antidepressants: The inhibitors of the Ricapation of serotonin (SSRI) or dopamine (such as bupropion) are effective in cases where abulia is associated with depression.
• Atypical antipsychotics: Used in schizophrenic patients, some antipsychotics (such as aripiprazole) have shown to alleviate negative symptoms, including abulia.

Psychotherapy

Psychotherapy is of fundamental importance where the cause of abbulia is to be identified in a psychopathological framework as it helps patients develop strategies to overcome the motivational blocks directly responsible for the reduced action capacity.

In particular, cognitive behavioral psychotherapy represents the Gold Standard for the treatment of depression and anxiety disorders.

This acts using two approaches, cognitive and behavioral one. In depression, for example, cognitive intervention focuses on the renovation and modification of the thoughts that generate the emotions typically present in this picture and associated with abbul as sadness, the sense of impotence and the sense of guilt. On the other hand, behavioral therapy aims to stimulate the patient in the gradual resumption of pleasant and significant activities.

These two interventions reinforce each other: the cognitive intervention, in fact, motivates the patient at the resumption of activities and, in parallel, the resumption of pleasant activities promotes more positive thoughts.

Cognitive behavioral therapy, therefore, stimulates the genesis of a virtuous circle opposite to the vicious circle typically associated with depressive paintings.

Abulia and quality of life

Abulia has a significant impact on the quality of life of patients and their family members.

There lack of initiative and social retreat Often they lead to isolation, unemployment and relational difficulties.

Furthermore, the sense of guilt and failure that accompany abulia can aggravate underlying psychiatric conditions, such as depression.

In this perspective, the early and personalized interventions They can make a difference, improving the patient’s daily functioning and reducing the load for families and caregivers.

Bibliography

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4. Stahl, sm (2013). Stahl’s Essential Psychopharmacology.4th ed. Cambridge: Cambridge University Press.