Apathy

, characterized by a decrease or absence of motivation, an evident lack of interest in life and a "generalized indifference towards the surrounding world.

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An apathetic person is a person devoid of his emotionality, who lacks motivation in the workplace and who is not interested in establishing new social relationships and maintaining existing ones.
Apathy recognizes numerous causes; in fact, it can depend on: a psychological disease, such as dysthymia; on a neurological disease, such as Alzheimer's disease or Parkinson's; on the excessive use of psychoactive substances, such as alcohol or cocaine; etc.
The treatment of apathy depends on the triggering causes and generally involves the use of drugs and the use of psychotherapy.

and the abuse of various psychoactive substances.
In addition, it sometimes appears in association with: head trauma, nutritional deficiencies, yellow fever, syphilis, hyperthyroidism, porphyria and tuberculous meningitis.

Finally, it should be noted that some people become apathetic for no clear and identifiable reason.

Psychiatric Causes of Apathy

Among psychiatric diseases, possible causes of apathy are:

• Schizophrenia;
• The dysthymia;
• The forms of minor depression.

Neurological Causes of Apathy

Neurological diseases that can cause apathy are:

• Alzheimer's disease;
• Frontotemporal dementia;
• Huntington's disease;
• Parkinson's disease;
• Progressive supranuclear palsy;
• The stroke;
• Vascular dementia;
• Intracranial tumors;
• Hepatic encephalopathy.

Did you know that ...

From a scientific study of 2011 a fairly important correlation emerged between the lesion / degeneration of the frontal lobe of the brain and the manifestations of apathy; this has led scholars to believe that, in the human brain, the control center of apathy resides precisely on the anterior portion of the organ, ie on the frontal lobe.

Psychoactive Substances That Cause Apathy

The psychoactive substances that most commonly cause apathy are:

• Cocaine;
• Amphetamines;
• The alcohol.

;

Disinterest in all those activities which, before the onset of apathy, aroused curiosity and interest;

Disinterest in establishing new social relationships and maintaining existing ones;

Lack of interest in wanting to learn new things and / or have new experiences;

Tendency to isolate themselves;

Problems in the workplace.

Are Apathy and Depression the Same Thing?

Although symptomatically similar, apathy and depression are two different conditions. While it is true that both cause disinterest in life and lack of motivation, it is equally true that only depression leads to feelings such as despair, guilt and suicidal manias.

) and an assessment of the psychiatric profile.
The possible use of laboratory analyzes (blood tests, etc.) and diagnostic imaging tests (X-rays, CT, nuclear magnetic resonance, etc.) serves to definitively clarify the causes.
A precise knowledge of the triggers of apathy allows the doctor to plan the most appropriate treatment for the circumstances.

Criteria for the Diagnosis of Apathy

Experts in the field of psychic and mental illnesses and disorders have established that 4 conditions must be met for the diagnosis of apathy; these 4 conditions - which can be defined with the name of diagnostic criteria - are:

1. The patient shows a significant decrease or complete absence of motivation, regardless of his age, his background and other similar aspects.
2. The patient experiences behavioral changes, emotional fluctuations and changes in thinking skills.
   Behavioral alterations hinder interpersonal relationships and the accomplishment of daily activities.
   Emotional fluctuations and changes in thinking skills, on the other hand, are responsible for the lack of interest in new things and getting to know new people.
3. The disorders that the patient suffers from significantly affect the quality of life, in every area (work, social, etc.).
4. Behavioral changes do not depend on problems such as physical disabilities or altered levels of consciousness.

or drugs, a change in lifestyle is also essential (in this case, stop taking alcohol).
Finally, more and more clinical trials are recently demonstrating the therapeutic importance of attending support groups for patients or former patients with apathy (or similar disorders).

Pharmacological treatment: some examples

In this section, the article reports the pharmacological treatments envisaged in some specific situations:

• In case of Alzheimer's disease: drug therapy involves the administration of anti-dementia medicines, such as donepezil, galantamine and rivastigmine.
• In case of dysthymia and minor forms of depression: drug therapy consists in the administration of different classes of antidepressants, including selective serotonin reuptake inhibitors (fluoxetine, fluvoxamine and paroxetine), serotonin and norepinephrine reuptake inhibitors (duloxetine and venlafaxine) and tricyclic antidepressants (clomipramine and imipramine).
• In the case of Parkinson's disease: drug therapy involves the administration of drugs belonging to the category of dopaminergic agonists. A classic example of a dopaminergic agonist used in the treatment of Parkinson's apathy is ropinirole.
• In case of schizophrenia: drug therapy involves the administration of antipsychotic medicines. By acting on dopamine (a brain neurotransmitter), antipsychotics have a calming, anti-hallucinatory and mood-stabilizing effect.

Psychotherapy for the Apathetic patient

Psychotherapy is a broad term that encompasses various psychological treatment techniques.
Among the different psychotherapy techniques that exist, the most practiced in case of apathy are cognitive-behavioral therapy and family therapy.
Entering more details:

• Cognitive-behavioral therapy is a form of psychotherapy, which aims to teach the patient how to recognize and master problematic behaviors (or, in specialist jargon, inactive behaviors).
• Family therapy is a form of psychotherapy that affects the patient's entire family.
  Briefly, it is based on the concept that parents, siblings and other close relatives play a decisive role in supporting their loved one during the therapeutic path foreseen for him.
  For family therapy to be effective and for the patient to receive the support they need, the family should learn the characteristics of apathy and the disease that causes it.

Importance of combining drug treatment with psychotherapy

The combination of psychotherapy and drug treatment is far more effective than psychotherapy alone or drug treatment alone. For this reason, it is a good idea to never separate (not even temporally) the two treatments.

Family support: how to help an Apathetic person?

The family can greatly help the apathetic subject; here's how:

• Persuading the patient to go out and spend some time with friends / acquaintances;
• By proposing activities that the patient once loved doing;
• Encouraging the patient to physical activity (clearly, this activity must be appropriate to the abilities of the sick subject);
• Making the patient have new experiences and new activities.

Possible Therapies of the Future

In recent years, scientific investigations have shown the efficacy of a treatment known as cranial electrotherapy stimulation.
Patients with apathy who seem to derive the greatest benefits from cranial electrotherapy stimulation are those who have suffered traumatic injuries to the brain, precisely to the frontal lobe of the brain.

Antonio Griguolo

Graduated in Biomolecular and Cellular Sciences, he obtained a Specialized Master in Journalism and Institutional Communication of Science