Prevalence Of Clinically Significant Apathy At 10 Years And Associations To Global Functioning
In line with previous long-term studies in FEP , the prevalence of clinically significant apathy was substantial. Apathy also had an independent negative association with global functioning at 10 years. While the cross-sectional design for this particular research question precludes causal inference, our findings corroborate previous cross-sectional findings at BL and 1YFU in overlapping samples to the current sample and the TIPS study , and thus add to the suggested burden of apathy in psychosis .
Why Are They Called Positive
They are called positive symptoms because they refer to changes in behaviors or thoughts that came about after the individual developed schizophrenia, rather than before.
Negative symptoms are named as such because they refer to thoughts and behaviors that the individual had before developing schizophrenia but has since lost. In other words, negative symptoms are key aspects or characteristics of the person that have disappeared.
Although the symptoms of schizophrenia vary in terms of severity, people with this condition have an increased risk of negative outcomes. For instance:
- Schizophrenia is linked with a
- inattentiveness or lack of concentration
Despite receiving less media attention, these negative symptoms also greatly affect the individuals quality of life and their ability to live normally. Without treatment, many people have difficulty coping with these symptoms.
Most people with schizophrenia receive a diagnosis between their teenage years and early 30s. It can sometimes be difficult to diagnose the condition early on because some of the early symptoms such as lethargy, apathy, and lack of motivation can also be common features of adolescence.
Once a person starts experiencing delusions, fully realized hallucinations, thought disorder, and hyperactive behavior, the condition becomes easier to diagnose.
Diagnosis usually includes some or all the following:
What Is Schizophrenia Or Paranoid Schizophrenia
Schizophrenia is a challenging brain disorder that often makes it difficult to distinguish between what is real and unreal, to think clearly, manage emotions, relate to others, and function normally. It affects the way a person behaves, thinks, and sees the world.
The most common form is paranoid schizophrenia, or schizophrenia with paranoia as its often called. People with paranoid schizophrenia have an altered perception of reality. They may see or hear things that dont exist, speak in confusing ways, believe that others are trying to harm them, or feel like theyre being constantly watched. This can cause relationship problems, disrupt normal daily activities like bathing, eating, or running errands, and lead to alcohol and drug abuse in an attempt to self-medicate.
Many people with schizophrenia withdraw from the outside world, act out in confusion and fear, and are at an increased risk of attempting suicide, especially during psychotic episodes, periods of depression, and in the first six months after starting treatment.
Take any suicidal thoughts or talk very seriously
If you or someone you care about is suicidal, call the National Suicide Prevention Lifeline in the U.S. at 1-800-273-TALK, visit IASP or Suicide.org to find a helpline in your country, or read Suicide Prevention.
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What Is Deficit Schizophrenia
Deficit schizophrenia, which is not synonymous with deficit symptoms or negative symptoms, is diagnosed when patients have:
- At least two out of the six negative symptoms
- The symptoms are persistent, or present for at least one year, and the patient experiences them even during times of clinical stability
- The symptoms are primary, or not due to other causes like medication or other conditions
People with deficit schizophrenia have a poorer response to treatment, social and occupational functioning, and overall quality of life than people with non-deficit schizophrenia.
What Should I Look For
You may feel a lack of passion or motivation if you experience apathy. It can affect your behavior and ability to complete daily activities.
The main symptom of apathy is a lack of motivation to do, complete, or accomplish anything. You may also experience low energy levels.
You may have diminished emotions, motivation, and willingness to act. Activities or events that normally interest you may create little to no response.
Apathy may cause disinterest in many aspects of life. You may be indifferent when you meet new people or try new things. You may show no interest in activities or addressing personal issues.
Your facial expressions may not appear to change. You may exhibit a lack of effort, planning, and emotional response. You may also spend more time by yourself.
Continued apathy can affect your ability to maintain personal relationships and perform well at school or work.
Apathy is not the same as depression, although apathy can be a symptom of depression. Depression may also cause feelings of hopelessness and guilt. Serious risks associated with depression include substance use and suicide.
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The Connection Between Apathy & Schizophrenia
Schizophrenia may be known for creating intense and distressing hallucinations, delusional thoughts, and disorganization, but the condition will also bring a host of effects marked by the absence of thoughts, perceptions, and behaviors. Called negative symptoms of schizophrenia, apathy is one of the best examples.
Other negative symptoms connected to schizophrenia include:2
- Inattention and being easily distracted
- Limited speech
- Anhedonia where the person experiences little pleasure
- Blunted affect where the person is less expressive in their facial reactions
Clinical Presentation Diagnosis And Identification Of Negative Symptoms
It is generally accepted that negative symptoms include 5 key constructs, which can be further categorized into 2 independent factors .,,
Key negative symptom constructs. Blunted affect=decreased expression of emotion alogia=reduction in quantity of words spoken avolition=reduced initiation and persistence of goal-directed activity due to decreased motivation asociality=reduced social interactions and initiative due to decreased interest in relationships with others anhedonia=reduced experience of pleasure during an activity or in anticipation of an activity.
Although the presence of negative symptoms is not mandatory for a diagnosis of schizophrenia, negative symptoms , are 1 of the 5 symptom criteria taken into consideration in the Diagnostic and Statistical Manual of Mental Disorders . Diminished expression, which includes reduction in the expression of facial emotions, eye contact, and speech intonation, and reduction in head, hands, and face movement that gives emotional emphasis to speech, is generally observable during a clinical interview. Avolition, indicating decrease in self-motivated and self-initiated purposeful activities, requires inquiry into patients behaviors outside the interview setting. A level of functioning in work, school, relationships, or self-care that is markedly below the level that has previously been achieved is also diagnostic and suggests the presence of avolition and the reduced drive to pursue goal-directed behavior.
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What Is Apathy All About
We all experience apathy from time to time and do not wish to show interest in anything. It could be due to lack of motivation or because of no interest in day to day activities. However, the degree can vary amongst people and sometimes can be a symptom of depression, stress or mental health disorder.
Interestingly, the term apathy or feeling pathetic can also be described as lack of concern for the loved ones or losing interest in what was always loved before. A number of types could be seen to understand the depth of apathy.
- Emotional apathy- Where the person doesnt feel any kind of emotions, positive or negative.
- Behavioral apathy- It shows lack of self initiated behavior
- General apathy- No motivation or no interest in social behavior
Apart from the above ones, other forms of apathy include and Compassion fatigue .
Why Do I Have 0 Motivation
Here are some common reasons for a lack of motivation: Avoidance of discomfort. Whether you don’t want to feel bored when doing a mundane task, or you are trying to avoid feelings of frustration by dodging a tough challenge, sometimes a lack of motivation stems from a desire to avoid uncomfortable feelings. Self-doubt.
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Development Of Apathy In Participants With Fep
The finding of an overall decrease in apathy levels in the long-term is in line with results from two previous follow-up studies from FEP and first-admission schizophrenia participants . In the FEP TIPS study, a group characterized by enduring high apathy levels was discernible in the second year of treatment. Another group with lower and decreasing apathy levels over time explained most of the overall reduction in apathy levels in the total sample . The primary reduction in apathy levels both in the TIPS study and the current study took place within the first years of treatment. This finding supports that the notion of a critical period for symptom development in FEP, i.e. a time interval where symptoms may be more amenable to interventions, also comprises the development of apathy .
We also found that the individual variations in apathy levels already at BL were carried forward through the follow-up period, corresponding to the persistently high apathy group in the TIPS study . Since the TIPS was an early intervention study, it recruited FEP with a short DUP during their first week of treatment , which may explain why symptom trajectories were less stable over the first years of treatment. Taken together this indicates that factors influencing apathy trajectories are in place well before the first adequate treatment of the psychotic illness. This notion is supported by findings of stable negative symptoms in ultra-high-risk populations .
Deliberate Cultivation Of Positive Experience
Probably the best approach to overcoming negative symptoms is the deliberate cultivation of positive experience. Responses can be dramatic. Here are some examples.
A young man with schizophrenia was spending most of his time in the basement of his parents house. He did very little down there. He had more of an existence than a life at that point. When he expressed a tiny bit of curiosity about guitars, his parents bought one for him. He played with it, started watching YouTube videos and played a bit more. It started to become a regular thing. Eventually, he decided to get some in-person lessons from a teacher in his city. This required riding the bus to and from the lessons. After several bus rides, he decided to clip his nails and wash and trim his hair realizing that his previous inattention to grooming made him look different from the other passengers. Thus began a pathway to sustained improvements and a solid passion for music.
A psychiatrist had struggled for many years to help a woman with longstanding schizoaffective disorder. Multiple antipsychotic medications had failed to improve the patients symptoms. Long-acting injectable medications were hardly effective. Even clozapine had minimal benefit.
Knowing of an interest in music, an astute case manager encouraged her to sign up for a local song contest. The feedback and support she received made a profound improvement. The patients psychiatrist wrote:
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Avolition And Drug Development
After two decades of psychotropic drug development with moderately superior tolerability profile over the previous drugs, the 2000s have been characterized by stagnation of productivity in psychiatric drug development,. The stagnation has been attributed to a lack of pathophysiological understanding of the mental disorders, difficulties in defining targets, poor translation from animal models to human, and the absence of biological markers. Adherence to diagnostic systems that were not specifically designed for drug development, such as the DSM, and the use of overinclusive outcome measures and scales has also been suggested as a major reason for the failure to develop novel psychotropics,,.
Indeed, it is accepted by academicians, clinicians, and regulators that the behavioral syndromes defined by DSM classifications and the assessment scales attempting to define the severity of these impairments do not correspond to specific, putative biological processes and brain abnormalities. Nevertheless, meeting criteria for the DSM classifications and manifesting a threshold level of severity still constitute the criteria for patients inclusion in trials and the basis for independent investigator-initiated studies and new drug applications.
What Causes The Negative Symptoms Of Schizophrenia
As a whole, researchers are still trying to figure out what causes schizophrenia, but they have been able to come up with some theories regarding the causes of negative symptoms. It is hypothesized that degeneration of the brain, circuitry dysfunction, and imbalances in neurotransmitter levels all play a role in leading to the negative symptoms. Many believe that too much dopamine can lead to the positive symptoms, and too little dopamine can lead to the negative symptoms.
Most of the primary negative symptoms are related to the core pathophysiology of this mental illness. However, there are secondary negative symptoms that can be caused by other mental illnesses, medications , as well as the environment. Antipsychotic medications have been shown to cause blunted affect or akinesia. Having something as simple as comorbid major depression can cause people to experience anhedonia, lack of motivation, unemotional speech, and social withdrawal.
It also has been established that poor environmental conditions can also lead to motivational deficits and social isolation. Therefore the environment that the person with schizophrenia is in could also influence symptoms. People that experience persistent negative symptoms for an extended period of time are said to have the deficit syndrome. People with deficit syndrome are said to have poorer overall cognition and outcomes compared to individuals who do not have this syndrome.
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What Are The Two Types Of Motivation
Motivation comes from two places:
- Intrinsic motivation: This is when motivation comes from “internal” factors to meet personal needs. We do things we do because we enjoy them, not because we have to. …
- Extrinsic motivation: This is when motivation comes from “external” factors that are given or controlled by others.
Apathy And The Eldery
A review from 2009 looked at apathy and its impact on the elderly and concluded that this common feeling is easy to overlook, especially since its often mistaken for, or related to, depression. Apathy is often associated with a number of brain disorders that involve the frontal lobes and their associated subcortical structures. It is often related to a number of adverse outcomes, including apparent cognitive impairment, decreased daily function, poor insight into ones own functional and cognitive impairment, and poor outcome from rehabilitation treatment. It also has the potential to significantly add to a caregivers burden.
However, treatment of apathy depends on understanding it from a biomedical, psychological, and socio-environmental perspective.
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How Does Apathy Affect Someones Mental Health
When apathy presents, it may be a fleeting experience of disinterest and low motivation, or it could become a lasting problem. The sum of apathy plus time can result in negative impacts to a personâs mental health and well-being.
Apathy has the power to affect energy, motivation, interest, pleasure, and optimism. These symptoms are all related to depression and major depressive episodes.
In the case of schizophrenia and neurocognitive disorders, apathy is an effect, not a cause, but in the case of depression, it can be either cause or effect. People must work to identify and resolve this type of apathy before it can build towards depression.
The Concept Of Avolition And Its Central Role In Negative Symptoms Of Schizophrenia
Avolition reflects the decrease in the motivation to initiate and perform purposeful activities,. In the larger picture, the individual seems to experience a lack of interest in improving themselves intellectually, physically, socially, and financially. The activities that are not performed range from elementary ones, such as grooming, personal hygiene, or preparing food, and extending to more complex acts, such as going to work and/or school and engaging in social activities. A person experiencing avolition may stay at home, staring at the TV for hours and days, hardly following the content, rather than seek work or peer interaction. In fact, EMA surveys of participants with schizophrenia who are rated as having avolition often find that they are home and alone for the majority of the day and that they are more likely than healthy people to have only engaged in one, typically inactive, activity in the past hour. Differently from a person experiencing a major depression associated with unipolar or bipolar disorder, a person experiencing avolition would not necessarily complain of depressed mood, insomnia, guilt, or suicidal thoughts. Even anxious mood seems absent in people experiencing avolition, suggesting a general experiential emptiness.
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Apathy: Symptoms Causes And Treatments
The apathy symptoms can be defined as a neuro-behavioral syndrome characterized by a lack of will or interest in daily activities and entertainment, and a loss of motivation, which is also reflected in the decline in emotional response .
Apathy refers to cognitive and affective aspects as well as to certain behaviors, aspects that together cause a significant reduction of self-generated behaviors with a certain purpose.
In other words and for you to understand it well, the apathetic person has little initiative of his own to carry out activities and also shows a decrease in his feelings and emotions.
Apathy can be considered as a syndrome with its own clinical criteria, but it usually means that there are other diseases present in the patient.
Often patients with Alzheimers disease, Parkinsons disease , schizophrenia , major depression, brain trauma or cerebrovascular accidents may experience apathy.
What Are Positive And Negative Symptoms
Positive and negative symptoms are medical terms for two groups of symptoms in schizophrenia.
Positive symptoms add. Positive symptoms include hallucinations , delusions , and repetitive movements that are hard to control.
Negative symptoms take away. Negative symptoms include the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships.
There is also a third group of symptoms, usually called cognitive symptoms. This includes anything related to thinking, such as disorganized thoughts, memory problems, and difficulties with focus and attention.
Where can I learn more?
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.
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