Editing Abulia (section)

==Symptoms and signs==
The clinical condition denoted ''abulia'' was first described in 1838; however, since that time, a number of different, some contradictory, definitions have emerged.<ref name="DELPHI">Vijayaraghavan, L., Krishnamoorthy, E. S., Brown, R. G., & Trimble, M. R. (2002). Abulia: A Delphi survey of British neurologists and psychiatrists. [Article]. Movement Disorders, 17(5), 1052-1057.</ref> Abulia has been described as a loss of drive, expression, behavior and speech output, with slowing and prolonged speech latency, and reduction of spontaneous thought content and initiative,<ref name="WILL">Jahanshahi, M., & Frith, C. D. (1998). Willed action and its impairments. [Review]. Cognitive Neuropsychology, 15(6-8), 483-533.</ref> being considered more recently as 'a reduction in action emotion and cognition'.<ref name="DELPHI"/> The clinical features most commonly associated with abulia are:<ref name="DELPHI"/>

* Difficulty in initiating and sustaining purposeful movements
* Lack of spontaneous movement
* Reduced spontaneous speech
* Increased response-time to queries
* Passivity
* Reduced emotional responsiveness and spontaneity
* Reduced social interactions
* Reduced interest in usual pastimes

Especially in patients with progressive dementia, it may affect feeding.<ref name="STARK">Starkstein, S. E., & Leentjens, A. F. G. (2008). The nosological position of apathy in clinical practice. [Review]. Journal of Neurology, Neurosurgery, and Psychiatry, 79(10), 1088-1092.</ref> Patients may continue to chew or hold food in their mouths for hours without swallowing it.<ref name="STARK"/> The behavior may be most evident after these patients have eaten part of their meals and no longer have strong appetites.{{cn|date=June 2022}}

===Differentiation from other disorders===
Both [[neurologists]] and [[psychiatrists]] recognize abulia to be a distinct clinical entity, but its status as a syndrome is unclear. Although abulia has been known to clinicians since 1838, it has been subjected to different interpretations – from 'a pure lack of will', in the absence of motor paralysis to, more recently, being considered 'a reduction in action emotion and cognition'.<ref name="DELPHI"/> As a result of the changing definition of abulia, there is currently a debate on whether or not abulia is a sign or a symptom of another disease, or its own disease that seems to appear in the presence of other more well-researched diseases, such as Alzheimer's disease.<ref name="DELPHI"/>

A 2002 survey of two movement disorder experts, two neuropsychiatrists, and two rehabilitation experts, did not seem to shed any light on the matter of differentiating abulia from other DDMs. The experts used the terms "[[apathy]]" and "abulia" interchangeably and debated whether or not abulia was a discrete entity, or just a hazy gray area on a spectrum of more defined disorders.<ref name="DELPHI"/> Four of the experts said abulia was a sign and a symptom, and the group was split on whether or not it was a syndrome.<ref name="DELPHI"/> Another survey, which consisted of true and false questions about what abulia is distinct from, whether it is a sign, symptom, or syndrome, where lesions are present in cases of abulia, what diseases are commonly associated with abulia, and what current treatments are used for abulia, was sent to 15 [[neurologists]] and 10 [[psychiatrists]]. Most experts agreed that abulia is clinically distinct from depression, akinetic mutism, and [[alexithymia]].<ref name="DELPHI"/> However, only 32% believed abulia was different from apathy, while 44% said they were not different, and 24% were unsure. Yet again, there was disagreement about whether or not abulia is a sign, symptom, or syndrome.<ref name="DELPHI"/>{{citation needed|date=October 2013}}<!-- I don't have access to the source. Sentence was originally "only 32% believed aboulia was different from apathy, while 44% said they were different, and 24% were unsure." My reasoning is that editor forgot the word not. But I cannot check this. Please check if you have access to the source!-->

The study of motivation has been mostly about how stimuli come to acquire significance for animals. Only recently has the study of motivational processes been extended to integrate biological drives and emotional states in the explanation of purposeful behavior in human beings. Considering the number of disorders attributed to a lack of will and motivation, it is essential that abulia and apathy be defined more precisely to avoid confusion.<ref name="DELPHI"/>