What Is Apathy?
Apathy is one of the most confusing and ambiguous concepts that we can find in relation to moods. For some, it’s a syndrome that’s distinguished from other conditions; for others, it’s a symptom of a mental disorder. In popular culture, people often use the term to describe a temporary state of listlessness, although today, we know that it’s much more complex than this.
Indeed, apathy is one of the most puzzling states for doctors and psychologists. It has qualities that can allow it to be considered an autonomous syndrome, although it often accompanies certain mental disorders such as depression. Its particularity is that it often lasts for a long time and usually manifests resistance to conventional treatments.
The most common characteristics of apathy
The first thing you need to know is that there’s currently no consensus on what exactly apathy is. Experts generally refer to it as a primary motivational loss syndrome. This motivational loss is not related to emotional distress, intellectual impairment, or decreased level of consciousness.
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Therefore, the syndrome affects the patient’s life in different ways: emotionally, behaviorally, cognitively, and socially. Contrary to popular belief, this is not a temporary state of hours or days, but is usually postponed for weeks. In fact, and according to researchers, the following criteria must converge for a patient to be diagnosed with apthy:
- Symptoms must persist for at least four weeks.
- They must affect at least two of three basic dimensions of the syndrome (behavior/cognition, emotion, and social interaction).
- Identifiable functional disturbances must be evident.
- The sequelae cannot be explained entirely on the basis of the effects of a substance or changes in the patient’s environment.
When these criteria are met, the patient can be diagnosed with this syndrome. Apathy is a condition that’s set apart from other disorders in the face of the manifestation of these variables, one that demands the involvement of specialists to monitor and treat it. Evidence indicates that it’s more common in men and that its prevalence increases as people age.
A study published in 2016 in the Journal of Affective Disorders found that in a population of 2751 healthy adults aged 19-40 years, apathy as an isolated syndrome has a prevalence of 1.45%. This is irrespective of an underlying mental disorder or other explanations. It is thus a real phenomenon that affects a significant part of the population.
The most common causes of apathy
While it’s true that the condition can develop in isolation, it can also develop in conjunction with an underlying disease. Experts indicate that apathy is very common in Alzheimer’s disease (55%), mixed dementia (70%), mild cognitive impairment (43%), Parkinson’s disease (27%), schizophrenia (56%), and major depression (94%).
When a patient develops symptoms of apathy conditioned by these mental disorders, we can’t speak of a syndrome, but of a symptom of these disorders. The distinction is not minor, since in order to treat it, the underlying condition must be directly addressed.
As for its manifestation as an isolated symptom, scientists have found that people who have apathy present an alteration of the dorsal anterior cingulate cortex (dACC), the ventral striatum (VS), and other connected brain regions.
This results in an alteration of normative behavior related to motivation. The latter is an indispensable component for the willingness to work and do things, both to start, continue, finish, and find the objective or subjective reasons to do so.
We’d like to reiterate again that experts distinguish between depression and apathy. The evidence still suggests that many patients are diagnosed as depressive when in fact they’re actually apathetic. This is not a subtle difference, so individuals and specialists involved in the treatment of these conditions should be aware of the distinguishing criteria.
How apathy is treated
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Once the specialist determines the diagnosis of the syndrome (based on the criteria we have given and the search for a differential diagnosis), treatment will be initiated. Apathy is a very difficult condition to treat, as it often resists conventional options and must be approached from different perspectives.
This doesn’t imply that it can’t be controlled, only that the patient and the specialists must try several alternatives before finding those with the greatest benefits. The least invasive treatment may revolve around the following:
- Including exercise as part of the patient’s weekly routine.
- Striving to do activities with friends and family.
- Attend concerts, plays, operas, museums, and so on (whatever the person tends to enjoy doing).
- Trying a new hobby (if this is in a group, so much the better).
- Managing big tasks into many small ones (this way you ensure completion).
- Adding rewards after completing an activity.
- Joining support groups for apathetic patients.
- Attending therapy with a psychological professional.
- Avoiding scheduling their day-to-day lives based on a monotonous or inflexible routine.
- Identifying triggers that often predict an increase or onset of symptoms.
The specialist may also opt for the intake of medications such as antidepressants, antipsychotics, or stimulants. These should be prescribed with caution, as there’s evidence that, in some cases, they can worsen the condition.
Apathy is a real syndrome, one that’s more common in men and usually worsens as a person ages. It’s difficult to treat, although with personal commitment and that of experts, effective medium- and long-term options can be found. Since it can affect a person’s life in many different ways, it’s advisable to seek professional help as soon as symptoms of demotivation are detected.It might interest you...
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- Brodaty H, Altendorf A, Withall A, Sachdev P. Do people become more apathetic as they grow older? A longitudinal study in healthy individuals. Int Psychogeriatr. 2010 May;22(3):426-36.
- Fahed, M., & Steffens, D. C. Apathy: Neurobiology, Assessment and Treatment. Clinical Psychopharmacology and Neuroscience. 20121; 19(2): 181.
- Levy, M. L., Cummings, J. L., Fairbanks, L. A., Masterman, D., Miller, B. L., Craig, A. H., … & Litvan, I. Apathy is not depression. The Journal of neuropsychiatry and clinical neurosciences. 1998; 10(3): 314-319.
- Le Heron, C., Apps, M. A. J., & Husain, M. The anatomy of apathy: a neurocognitive framework for amotivated behaviour. Neuropsychologia. 2018; 118: 54-67.
- Marin RS. Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci. 1991 Summer;3(3):243-54.
- McCusker M. Apathy: who cares? A concept analysis. Issues Ment Health Nurs. 2015;36(9):693-7.
- Mulin, E., Leone, E., Dujardin, K., Delliaux, M., Leentjens, A., Nobili, F., … & Robert, P. H. Diagnostic criteria for apathy in clinical practice. International journal of geriatric psychiatry. 2011; 26(2): 158-165.
- Pardini M, Cordano C, Guida S, Grafman J, Krueger F, Sassos D, Massucco D, Abate L, Yaldizli Ö, Serrati C, Amore M, Mattei C, Cocito L, Emberti Gialloreti L. Prevalence and cognitive underpinnings of isolated apathy in young healthy subjects. J Affect Disord. 2016 Jan 1;189:272-5.
- Robert P, Lanctôt KL, Agüera-Ortiz L, Aalten P, Bremond F, Defrancesco M, Hanon C, David R, Dubois B, Dujardin K, Husain M, König A, Levy R, Mantua V, Meulien D, Miller D, Moebius HJ, Rasmussen J, Robert G, Ruthirakuhan M, Stella F, Yesavage J, Zeghari R, Manera V. Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group. Eur Psychiatry. 2018 Oct;54:71-76.