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Results for “Apathy”

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PubMed2001

Apathy, anhedonia, and psychomotor retardation in elderly psychiatric patients and healthy elderly individuals.

Normal aging of the brain affects the basal ganglia-thalamocortical circuits. These circuits are implicated in several neuropsychiatric disorders. Normal aging may therefore influence the symptomatology of psychiatric disorders in the elderly. We investigated motivational behavior that is associated with the function of these circuits, such as apathy, anhedonia, and psychomotor retardation in healthy elderly subjects and psychiatric inpatients (age > or = 60 yr). Apathy, anhedonia, and psychomotor retardation were assessed with the Apathy Evaluation Scale, the Snaith-Hamilton Pleasure Scale, and the Widlöcher Retardation Rating Scale. Other measurements included the Comprehensive Psychopathological Rating Scale, the Mini-Mental State Examination, and the assessment of vascular risk factors. We found some evidence for age-related changes in motivational behavior. In the healthy elderly group (n = 64), increasing age was associated with anhedonia, and in the patient group (n = 62), increasing age was associated with psychomotor retardation. Motivational disturbances could be the effect of an interaction between brain aging and the neuropathology of psychiatric disorders in the elderly.

Age Factors↗
PubMed2001

Relationship of numbing to alexithymia, apathy, and depression.

The present study assessed the relationship between numbing and three associated conditions of alexithymia, apathy, and depression, utilizing data collected on 353 Vietnam combat veterans diagnosed with Posttraumatic Stress Disorder from in- and out-patient settings and an outreach center at various Department of Veterans Affairs Medical centers. All subjects completed four self-report measures: the Glover Numbing Scale, the Beck Depression Inventory, the Apathy Evaluation Scale, and the Toronto Alexithymia Scale-20. The correlation matrix indicated that scores on the four measures were moderately to highly correlated. Principal components analysis with a varimax rotation indicated a five-factor solution that provided evidence for the factorial validity of each of the constructs assessed. Results of the factor analysis of items from the four measures were consistent with numbing being a separate and distinct construct from alexithymia, apathy, and depression. In general, results indicated that all constructs measured were separate and distinct from one another.

Affective Symptoms↗
PubMedDate not supplied

Executive dysfunction and apathy predict functional impairment in Alzheimer disease.

OBJECTIVE: The purpose of this study was to examine the extent to which executive cognitive dysfunction and frontally-mediated behavioral disturbances are associated with functional impairment in patients with mild-to-moderate Alzheimer disease (AD). METHODS: Patients with AD (N=45) completed the Mattis Dementia Rating Scale, and patients' caregivers completed the Frontal Systems Behavioral Inventory and a modified form of the Lawton and Brody Activities of Daily Living (ADLs) Questionnaire. RESULTS: Multiple-regression analyses revealed that executive cognitive dysfunction and apathy scores accounted for 44% of the variance in instrumental activities of daily living; executive cognitive dysfunction alone explained 17% of the variance in instrumental ADLs, and apathy scores explained an additional 27%. Executive dysfunction and frontal-behavioral impairment explained 28% of the variance in basic ADLs (BADLs), and, after accounting for executive dysfunction, apathy was the only symptom found to explain additional unique variance in BADLs. CONCLUSION: These findings suggest that specific cognitive and behavioral symptoms are associated with functional impairment in patients with AD.

Activities of Daily Living↗
PubMed2004

[Apathy in Alzheimer's disease: results from three French studies].

Apathy is defined as a lack of motivation in behaviour, cognition and affect. The aim of this article is to evaluate, in Alzheimer's disease (AD), the frequency of apathy and its relations with depressive symptoms and neuroanatomical correlates. We present the results of 3 French studies: the evaluation of behavioural symptoms in 499 AD subjects; the evaluation of depression and apathy in 128 AD subjects; a single photon computed tomography study (SPECT) performed in 31 AD subjects.

Affect↗
PubMedDate not supplied

Use of the Apathy Evaluation Scale as a measure of motivation in elderly people.

Motivation plays an important part in an elderly individual's ability to recover from a disabling event. On the other hand, apathy is a lack of motivation. The Apathy Evaluation Scale (AES) is an 18-item instrument that rates a person's thoughts, actions, and emotions over the previous 4 weeks. The purpose of this study was to use the AES with 102 patients in a geriatric rehabilitation program to determine if it predicted improved function after rehabilitation. In addition, a short 7-item version of the AES was tested. A strong correlation was demonstrated between the 18-item AES and the 7-item AES, the Mini-Mental State Examination, and the Geriatric Depression Scale. In separate regression analyses, we found that admission function and both the 18-item and 7-item AES were significant predictors of discharge function, and that functional level at admission to rehabilitation accounted for 31% of the variance in function after rehabilitation. The findings suggest that the AES might be an appropriate measure of motivation in older adults and might predict success in rehabilitation. Moreover, the ability to identify patients with low motivation can alert healthcare providers to develop interventions to improve older adults' motivation and help them attain and maintain their highest functional level.

Aged↗
PubMed2005

Effects of methylphenidate on cognition and apathy in normal pressure hydrocephalus: a case study and review.

The psychostimulant methylphenidate has been previously shown to improve cognitive performance in both normal control volunteers and patient populations. In the present case study, the effects of methylphenidate on cognitive and behavioural function were examined in a single patient with idiopathic normal pressure hydrocephalus (NPH) who had undergone ventriculoperitoneal shunting. A double-blind placebo-controlled ABBA drug design was employed, with the administration of two different doses of methylphenidate followed by neuropsychological assessment on a number of psychometric tests and cognitive tasks drawn from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Methylphenidate produced a dose-dependent positive improvement in behavioural measures in the patient associated with a reduction in apathy. It also had a dose-independent enhancing effect on performance of a Spatial Recognition task. These findings require replication in a large sample of patients to determine whether methylphenidate may prove to be generally useful in enhancing cognition and reducing apathy in normal pressure hydrocephalus.

Aged↗
PubMed2004

SSRI-induced apathy syndrome: a clinical review.

The authors review the literature pertaining to selective serotonin reuptake inhibitor (SSRI)-induced apathy syndrome. A literature search of Medline and International Pharmaceutical Abstracts from 1970 to the present was performed for relevant articles. Twelve relevant case reports and one open-label treatment trial were identified. An amotivational, or apathy, syndrome has been reported in a number of patients receiving SSRI treatment over the last decade. This adverse effect has been noted to be dose-dependent and reversible, but is often unrecognized. This phenomenon has caused significant negative consequences for adults as well as social and academic difficulties in adolescents.

Adolescent↗
PubMed1996

Apathy and loss of insight in Alzheimer's disease: a SPECT imaging study.

Apathy and loss of insight as correlates of behavior in Alzheimer's disease (AD) were studied in 40 patients by using clinical scales and cerebral blood flow measurements from SPECT imaging. Apathy was significantly correlated with decreased right temporoparietal perfusion and problem behaviors. Loss of insight was significantly correlated with decreased right temporo-occipital perfusion and impairment in daily functioning. Dementia severity as measured by the Mini-Mental State Examination (MMSE) was a poor predictor of behavioral problems or daily functioning. These data suggest that global measures of cognitive ability, which are weighted toward measuring left hemisphere function, are less important as indicators of management problems in AD than are measures of right hemisphere function such as motivation and insight.

Activities of Daily Living↗
PubMedDate not supplied

Apathy and executive dysfunction in mild cognitive impairment and Alzheimer disease.

OBJECTIVE: The authors assessed and contrasted frontally mediated behavior changes in patients diagnosed with Mild Cognitive Impairment (MCI) and Alzheimer disease (AD). Apathy, executive dysfunction, and disinhibition are common in AD, but these behaviors have not been studied in MCI. METHODS: Participants were patients diagnosed with AD (n=25) or MCI (n=20). Current behavior and behavior before the onset of cognitive impairment was rated by knowledgeable informants on the Frontal Systems Behavior Scale (FrSBe). RESULTS: Apathy and executive dysfunction exhibited the greatest increase in both MCI and AD, and both increased significantly over baseline scores. No significant differences in behavior change were found between the two groups. Behavior change was moderately correlated with a measure of dementia severity, indicating that greater disease severity was associated with more abnormal behavior. CONCLUSION: Changes in frontally-mediated behaviors are common in very early and mild stages of cognitive impairment, even before functional decline in daily living is evident. These behaviors deserve more study in MCI because they may have implications for prognosis, treatment adherence, family distress, and patient quality of life.

Aged↗
PubMed1997

Apathy, empathy, physicians, and Chekhov.

Healing depends on a caring, involved physician. In his story "Ward Number Six," Anton Chekhov illustrated how patients suffer when physicians become apathetic. Reading this story may inspire physicians to resist apathy and assume greater responsibility for the social conditions that impact on their patients' well-being. It may also stimulate physicians' imagination in such a way as to improve their ability to empathize with their patients. Finally, the act of reading itself--particularly reading great literature such as "Ward Number Six," can help rejuvenate those physicians who struggle with their own apathy.

Empathy↗
PubMed1989

SCH 23390 blocks drug-conditioned place-preference and place-aversion: anhedonia (lack of reward) or apathy (lack of motivation) after dopamine-receptor blockade?

The influence of the D1 antagonist SCH 23390 on the motivational properties of rewarding (morphine, nicotine and diazepam) and aversive (naloxone, phencyclidine and picrotoxin) drugs was studied in the rat in a two-compartment place-conditioning paradigm, which included a pre-conditioning test for spontaneous place-preference. The specific D1 dopamine-receptor antagonist SCH 23390 (0.05 mg/kg SC), paired with both compartments or, separately, with the preferred or with the non-preferred compartment, failed to affect the spontaneous unconditioned preference of the animal. Pairing of morphine (1.0 mg/kg SC), nicotine (0.6 mg/kg SC) or diazepam (1.0 mg/kg IP) with the less preferred compartment induced significant preference for that compartment. Pairing of SCH 23390 (0.05 mg/kg SC) with both compartments completely blocked the place-preference induced by morphine, nicotine and diazepam. Naloxone (0.8 mg/kg SC), phencyclidine (2.5 mg/kg SC) or picrotoxin (2.0 mg/kg IP) paired with the preferred compartment elicited place-aversion. Pairing of SCH 23390 (0.05 mg/kg SC) with both compartments abolished also the place-aversion induced by naloxone, phencyclidine and picrotoxin. The results indicate that blockade of dopamine transmission blocks the motivational properties of rewarding as well as aversive stimuli. It is suggested that neuroleptics rather than simply blocking the rewarding impact of positive reinforcers (anhedonia, lack of pleasure) exert a more general influence on conditioned behaviour by blocking the affective impact of negative as well as positive reinforcers (apathy, lack of motivation).

Animals↗
PubMed1995

Successful methylphenidate treatment of apathy after subcortical infarcts.

A patient with prominent apathy secondary to multiple subcortical infarcts was treated successfully with methylphenidate. SPECT and reaction time testing showed selective improvement of frontal system function, consistent with a recent model of frontal-subcortical circuits and behavior.

Activities of Daily Living↗
PubMed2004

Bupropion in the management of apathy.

We report on three males with prominent apathy as part of the symptom complex of depression or organic brain disease. Significant clinical responses were observed following treatment with bupropion, an antidepressant with dopamine (DA) reuptake activity. We present clinical evidence in support of the hypothesis that remission in these patients occurred as a consequence of bupropion-induced increases in central DA neurotransmission.

Adult↗
PubMed1988

Familial parkinsonism, apathy, weight loss, and central hypoventilation: successful long-term management.

We report a third family with six members with features of the syndrome of familial parkinsonism, depression, weight loss, and central hypoventilation. Patients with this syndrome typically die suddenly, presumably from central respiratory failure. Following multiple respiratory arrests, one affected member was successfully managed with aggressive pulmonary care, tracheostomy, and intermittent home mechanical ventilation, which, combined with carbidopa/levodopa, allowed for a functional lifestyle with improvement in apathy, mobility, and nutritional status.

Body Weight↗
PubMed1990

Dominantly inherited apathy, central hypoventilation, and Parkinson's syndrome: clinical, biochemical, and neuropathologic studies of 2 new cases.

We describe 2 new patients from a family in which 10 persons in 3 successive generations had a dominant neuropsychiatric disorder characterized by apathy, central hypoventilation, and parkinsonism. Neuropathologically, both patients showed severe neuronal loss and reactive gliosis in the substantia nigra. Neurochemical studies showed a marked depletion of dopamine in substantia nigra, putamen, and caudate nucleus, as well as reduction in serotonin content in the substantia nigra. Glutamate contents were low in frontal cortex and thalamus, and gamma-aminobutyric acid (GABA) contents were low in thalamus and substantia nigra of both patients. In addition, phosphoethanolamine contents were reduced in all brain regions of both patients, especially in the substantia nigra. One patient with severe symptoms had low levels of homovanillic acid, 5-hydroxyindoleacetic acid, and GABA in his CSF repeatedly for 3 years before death (aged 58), while the 2nd patient died (aged 51) of an unrelated cause before developing any symptoms of the familial disorder. Because brain deficiencies of multiple neurotransmitters appear to be involved, this disorder is unlikely to respond to treatment; however, neurochemical studies of CSF may make presymptomatic diagnosis feasible.

Adult↗
PubMed2004

[The treatment with methylphenidate of demoralisation, apathy and hypoactive delirium in patients with somatic illness].

In 3 patients, 2 women aged 21 and 65 and a man aged 60, admitted for the treatment of B-cell lymphoma, trauma caused by a traffic accident and Kahler's disease respectively, hypoactive delirium, apathy of unknown origin and depressive disorder or adjustment disorder with depressive mood ('demoralisation') were seen and caused somatic recovery to be compromised. The consulting psychiatrist prescribed methylphenidate with good results. They formed part of a group of 34 patients who were given methylphenidate on these indications over a period of 12 months. These indications are not among the accepted indications for this drug. In the literature, the beneficial use of psychostimulants in somatic illness has been described almost exclusively in palliative care and case reports of other somatically-ill patients with a poor prognosis. No reports were found on the effects of methylphenidate used for treatment of patients with hypoactive delirium nor were guidelines for its use in somatically-ill patients with a good prognosis. A randomised clinical trial to substantiate these reported findings is warranted.

Adult↗
PubMedDate not supplied

Tactics for counteracting staff apathy and hopelessness on a psychiatric unit.

In summary, then, the five following tactics are minimally demanding, and can provide high rewards in the battle against apathy and hopelessness on a psychiatric ward. 1. Identifying social system mechanisms. 2. Validating perceptions of ward happenings with a trusted other. 3. Giving (and hopefully receiving) "informational-support." 4. Using physical presence or being highly visible. 5. Chatting informally with other staff members.

Attitude of Health Personnel↗