Editing Avolition

{{Short description|Inability to initiate and persist in goal-directed activities}}
{{hatnote|Not to be confused with [[abulia]], a lack of will.}}
{{for|syndrome related to blunted emotion and drives and executive function|Amotivational syndrome}}
'''Avolition''' or '''amotivation''', as a symptom of various forms of [[psychopathology]], is the decrease in the ability to initiate and persist in self-directed purposeful activities.<ref>{{cite book|author=American Psychiatric Association|url=https://archive.org/details/diagnosticstatis0005unse/page/88|title=Diagnostic and statistical manual of mental disorders|publisher=American Psychiatric Association|year=2013|isbn=978-0-89042-554-1|edition=fifth|location=Arlington, VA|page=[https://archive.org/details/diagnosticstatis0005unse/page/818 818]|doi=10.1176/appi.books.9780890425596|hdl=2027.42/138395|author-link=American Psychiatric Association}}</ref><ref name="Lee">{{cite journal |vauthors=Lee JS, Jung S, Park IH, Kim JJ |title=Neural Basis of Anhedonia and Amotivation in Patients with Schizophrenia: The Role of Reward System |journal=Curr Neuropharmacol |volume=13 |issue=6 |pages=750–9 |date=2015 |pmid=26630955 |pmc=4759314 |doi=10.2174/1570159x13666150612230333 |url=}}</ref> Such activities that appear to be neglected usually include routine activities, including hobbies, going to work or school, and most notably, engaging in social activities. A person experiencing avolition may stay at home for long periods of time, rather than seeking out work or peer relations. It is a [[disorders of diminished motivation|disorder of diminished motivation]].

==Psychopathology==
People with avolition often want to complete certain tasks but lack the ability to initiate behaviors necessary to complete them. Avolition is most commonly seen as a symptom of some other disorder, but might be considered a primary clinical disturbance of itself (or as a coexisting second disorder) related to disorders of diminished motivation. In 2006, avolition was identified as a [[negative symptom of schizophrenia]] by the National Institute of Mental Health (NIMH),<ref name="Castonguay & Oltmann">{{cite book | vauthors = Castonguay L, Oltmanns T | veditors = Castonguay L, Oltmanns T | year = 2013 | chapter = General Issues in Understanding and Treating Psychopathology | title = Psychopathology: From Science to Clinical Practice | pages = 5–6 | location = New York | publisher = Guildford Publications | isbn = 978-1-4625-2881-3}}</ref> and has been observed in patients with [[bipolar disorder]] as well as resulting from trauma.

Avolition is sometimes mistaken for other, similar symptoms also affecting motivation, such as [[abulia]], [[anhedonia]] and [[asociality]], or strong general disinterest. For example, abulia is also a restriction in motivation and initiation, but characterized by an inability to set goals or make decisions and considered a disorder of diminished motivation.<ref name="pmid16030444">{{cite journal | vauthors = Marin RS, Wilkosz PA | title = Disorders of diminished motivation | journal = The Journal of Head Trauma Rehabilitation | volume = 20 | issue = 4 | pages = 377–88 | date = 2005 | doi = 10.1097/00001199-200507000-00009 | pmid = 16030444 | s2cid = 11938168 | url = http://www.yaroslavvb.com/papers/marin-disorders.pdf | access-date = 2015-07-18 | archive-date = 2015-08-11 | archive-url = https://web.archive.org/web/20150811041523/http://yaroslavvb.com/papers/marin-disorders.pdf | url-status = live}}</ref> In order to provide effective treatment, the underlying cause of avolition (if any) has to be identified and it is important to properly differentiate it from other symptoms, even though they might reflect similar aspects of mental illness.

==Social and clinical implications==
Implications from avolition often result in social deficits. Not being able to initiate and perform purposeful activities can have many implications for a person with avolition. By disrupting interactions with both familiar and unfamiliar people, it jeopardizes the patient's social relations. When part of a severe [[mental illness]], avolition has been reported, in first person accounts, to lead to physical and mental inability to both initiate and maintain relationships, as well as work, eat, drink or even sleep.<ref name= "First Person Accounts">{{cite book | vauthors = Morrison B | veditors = LeCroy CW, Holschuh J | year = 2012 | chapter = Suicide: Disease, Loneliness, Social Isolation, Suicide, Negative Thoughts ... | title = First Person Accounts of Mental Illness and Recovery | pages = 53–57 | location = Hoboken, New Jersey | publisher = John Wiley & Sons, Inc. | isbn = 978-0-470-44452-8}}</ref>

Clinically, it may be difficult to engage an individual experiencing avolition in active participation of [[psychotherapy]]. Patients are also faced with the stresses of coping with and accepting a mental illness and the stigma that often accompanies such a diagnosis and its symptoms. Regarding schizophrenia, the [[American Psychiatric Association]] reported in 2013 that there currently are "no treatments with proven efficacy for primary negative symptoms"<ref name="Negative Symptoms">{{cite book | vauthors = Kring A, Smith D | year = 2013 | chapter = The Negative Symptoms of Schizophrenia | title = Psychopathology: From Science to Clinical Practice | pages = 370–388 | veditors = Castonguay L, Oltmanns T | location = New York, NY | publisher = Guildford Publications | isbn = 978-1-4625-2881-3}}</ref> (such as avolition). Together with schizophrenia's chronic nature, such facts added to the outlook of never getting well, might further implicate feelings of hopelessness and similar in patients as well as their friends and family.

==Treatment==
Antipsychotics are less effective in the treatment of negative symptoms of schizophrenia such as avolition than for positive symptoms.<ref name=CarsonNursing>{{cite book | last1 = Carson | first1 = Verna Benner | name-list-style = vanc | title = Mental health nursing: the nurse-patient journey | date = 2000 | publisher = W.B. Saunders | location = Philadelphia | isbn = 978-0-7216-8053-8 | page = 638 | edition = 2nd | url = https://books.google.com/books?id=QM5rAAAAMAAJ | access-date = 2016-05-06 | archive-date = 2016-11-25 | archive-url = https://web.archive.org/web/20161125003432/https://books.google.com/books?id=QM5rAAAAMAAJ | url-status = live}}</ref> Low dose [[amisulpride]] has shown to be more effective than placebo for treating the negative symptoms of schizophrenia, which includes avolition. It works by blocking pre-synaptic dopamine receptors, causing a release of dopamine into the synapse.<ref name="pmid29368205">{{cite journal |vauthors=Krause M, Zhu Y, Huhn M, Schneider-Thoma J, Bighelli I, Nikolakopoulou A, Leucht S |date=October 2018 |title=Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis |url=https://boris.unibe.ch/110770/10/Krause%20EurArchPsychiatryClinNeurosci%202018_postprint.pdf |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=268 |issue=7 |pages=625–639 |doi=10.1007/s00406-018-0869-3 |pmid=29368205 |s2cid=24569827}}</ref>

Compared with [[social skills training]] (SST), [[Cognitive behavioral therapy|cognitive behavioural therapy]] (CBT) shows more promise in treating the negative symptoms of schizophrenia, including avolition.<ref>{{cite journal |vauthors=Elis O, Caponigro JM, Kring AM |date=December 2013 |title=Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions |journal=Clinical Psychology Review |volume=33 |issue=8 |pages=914–28 |doi=10.1016/j.cpr.2013.07.001 |pmc=4092118 |pmid=23988452}}</ref>

According to a 2015 article, [[aripiprazole]] may be useful for treatment of apathy syndrome (avolition). However, its role and efficacy in treatment of apathy requires further investigation in clinical trials.<ref>{{cite journal |title=Aripiprazole for Treatment of Apathy |journal=Innovations in Clinical Neuroscience |volume=12 |issue=9–10 |pages=33–36 |pmc=4655898 |year=2015 |last1=Monga |first1=V. |last2=Padala |first2=P. R. |pmid=26634180}}</ref> A comparison to amisulpride published in 2022, found that aripiprazole was effective in treating negative symptoms, while amisulpride was not.<ref>{{Cite journal |last1=Nielsen |first1=Mette Ødegaard |last2=Kristensen |first2=Tina Dam |last3=Borup Bojesen |first3=Kirsten |last4=Glenthøj |first4=Birte Y. |last5=Lemvigh |first5=Cecilie K. |last6=Ebdrup |first6=Bjørn H. |date=2022-03-17 |title=Differential Effects of Aripiprazole and Amisulpride on Negative and Cognitive Symptoms in Patients With First-Episode Psychoses |journal=Frontiers in Psychiatry |volume=13 |doi=10.3389/fpsyt.2022.834333 |issn=1664-0640 |pmc=8969108 |pmid=35370857 |doi-access=free }}</ref>{{Primary source inline|date=August 2023}}

According to a 2020 study, [[mitragynine]] contained in [[kratom]] may have the ability to reduce avolition.<ref>{{cite journal | title=The Potential for Kratom as an Antidepressant and Antipsychotic | year=2020| pmc=7309668| last1=Johnson| first1=L. E.| last2=Balyan| first2=L.| last3=Magdalany| first3=A.| last4=Saeed| first4=F.| last5=Salinas| first5=R.| last6=Wallace| first6=S.| last7=Veltri| first7=C. A.| last8=Swogger| first8=M. T.| last9=Walsh| first9=Z.| last10=Grundmann| first10=O.| journal=The Yale Journal of Biology and Medicine| volume=93| issue=2| pages=283–289| pmid=32607089}}</ref>

==See also==
*[[Athymhormia]]
*[[ADHD]]
*[[Akrasia]]
*[[Amotivational syndrome]]
*[[Apathy]]
*[[Autism spectrum disorder]]
*[[Hikikomori]]
*[[Incontinence (philosophy)]]
*[[Learned helplessness]]
*[[Lethargy]]
*[[Major depressive disorder]]
*[[Schizoid personality disorder]]
*[[Volition (psychology)]]

==References==
{{Reflist|32em}}

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[[Category:Symptoms and signs of mental disorders]]
[[Category:symptoms of schizophrenia]]
[[Category:Personality traits]]
[[Category:Motivation]]
[[Category:Disorders of diminished motivation]]
[[Category:Symptoms or signs involving motivation or energy]]