Abstract Objective Apathy is highly prevalent among neuropsychiatric populations and is associated with greater morbidity and worse functional outcomes. Despite this, it remains understudied and ...poorly understood, primarily due to lack of consensus definition and clear diagnostic criteria for apathy. Without a gold standard for defining and measuring apathy, the availability of empirically sound measures is imperative. This paper provides a psychometric review of the most commonly used apathy measures and provides recommendations for use and further research. Methods Pertinent literature databases were searched to identify all available assessment tools for apathy in adults aged 18 and older. Evidence of the reliability and validity of the scales were examined. Alternate variations of scales (e.g., non-English versions) were also evaluated if the validating articles were written in English. Results Fifteen apathy scales or subscales were examined. The most psychometrically robust measures for assessing apathy across any disease population appear to be the Apathy Evaluation Scale and the apathy subscale of the Neuropsychiatric Inventory based on the criteria set in this review. For assessment in specific populations, the Dementia Apathy Interview and Rating for patients with Alzheimer's dementia, the Positive and Negative Symptom Scale for schizophrenia populations, and the Frontal System Behavior Scale for patients with frontotemporal deficits are reliable and valid measures. Conclusion Clinicians and researchers have numerous apathy scales for use in broad and disease-specific neuropsychiatric populations. Our understanding of apathy would be advanced by research that helps build a consensus as to the definition and diagnosis of apathy and further refine the psychometric properties of all apathy assessment tools.
Disorders of diminished motivation Marin, Robert S; Wilkosz, Patricia A
The journal of head trauma rehabilitation,
07/2005, Letnik:
20, Številka:
4
Journal Article
Recenzirano
Disorders of diminished motivation occur frequently in individuals with traumatic brain injury. Motivation is an ever-present, essential determinant of behavior and adaptation. The major syndromes of ...diminished motivation are apathy, abulia, and akinetic mutism. Depending on their etiology, disorders of diminished motivation may be a primary clinical disturbance, a symptom of another disorder, or a coexisting second disorder. This article presents a biopsychosocial approach to the assessment and management of motivational impairments in patients with traumatic brain injury. The recognition and differential diagnosis of disorders of diminished motivation, as well as the mechanism and clinical pathogenesis, are discussed.
Brain-behavior relationships form the foundation for clinical assessment in neuropsychiatry and behavioral neurology. The complexity of the brain and its clinical disorders makes it important to have ...a systematic and useful way to apply them. This article introduces the three-dimensional approach to neuropsychiatric assessment (3DA), a process-based approach to integrating brain-behavior relationships into clinical activity. The 3DA is a simple, four-step process for teaching these relationships and their clinical use. The four steps are 1) Explain the principle of localization; first, as applied in general neurology; then, as applied to behavioral neurology and neuropsychiatry; 2) Review brain-behavior relationships in three dimensions: laterality (left-right), anteriority (anterior-posterior), and verticality (cortical-subcortical); 3) Introduce the "frontal-subcortical paradox" (subcortical dysfunction may cause what many know as "frontal lobe" signs) and its explanation (the neurobehavioral correlates of the frontal-subcortical circuits); 4) Present model disorders for the three dimensions. The presentation describes the rationale and approach for using the 3DA to teaching neuropsychiatry and behavioral neurology.
Echothymia is stimulus-bound affective behavior, an echophenomenon in the domain of affect. Like echolalia and echopraxia, it is a concomitant of the environmental dependency associated with ...dysfunction of the frontal-striatal systems that mediate so-called frontal lobe functions. The authors introduce the definition and phenomenology of echothymia, overview its differential diagnosis and clinical significance, and suggest ways in which understanding echothymia may contribute to clinical management.
Until recently, conventional antipsychotics were the standard pharmacotherapy for psychosis and behavioral disturbances associated with dementia. This double-blind, placebo-controlled study compared ...the acute efficacy of the selective serotonin reuptake inhibitor citalopram and the neuroleptic perphenazine with placebo for the treatment of psychosis and behavioral disturbances in nondepressed patients with dementia.
Eighty-five hospitalized patients with at least one moderate to severe target symptom (aggression, agitation, hostility, suspiciousness, hallucinations, or delusions) were randomly assigned to receive either citalopram, perphenazine, or placebo under double-blind conditions for up to 17 days.
Patients treated with citalopram or perphenazine showed statistically significant improvement on several Neurobehavioral Rating Scale factor scores. Compared to those receiving placebo, only patients treated with citalopram showed significantly greater improvement in their total Neurobehavioral Rating Scale score as well as in the scores for the agitation/aggression and lability/tension factors. Side effect scores were similar among the three treatment groups.
Citalopram was found to be more efficacious than placebo in the short-term hospital treatment of psychotic symptoms and behavioral disturbances in nondepressed, demented patients.
This paper discusses the definition of apathy, reviews its differential diagnosis, and proposes a classification for the conditions that may produce it. Apathy is defined as diminished motivation not ...attributable to diminished level of consciousness, cognitive impairment, or emotional distress. In its differential diagnosis, abulia, akinesia and akinetic mutism, depression, dementia, delirium, despair, and demoralization must be ruled out. Classification of apathy is organized in terms of its adaptive and functional consequences, its relationship to personality or to sociocultural or environmental events, and its association with psychiatric, neurological, and medical disorders. An approach to assessment and treatment is proposed.
The authors examined apathy symptoms, their improvement, and their association with functional recovery after a hip fracture. Of 126 participants, 37% had clinically significant apathy symptoms, ...which predicted functional outcome (i.e., poorer recovery from the fracture among those with higher baseline apathy). Of participants with high baseline apathy, approximately one-third improved; these participants had a better functional outcome than those with persistently high apathy scores. It is concluded that apathy symptoms are common after a hip fracture, but improve in one-third of individuals, with a concomitant functional recovery after hip surgery. Interventions to prevent or improve apathy in elderly persons deserve further attention.
Transforming the mental health system into a recovery oriented, integrated system of care requires a psychiatric work force that understands the relationship between recovery processes and community ...living. Fellowship programs in public and community psychiatry contribute to this transformation by educating psychiatrists about recovery, system dynamics, leadership, effective administration and community involvement. This paper describes a novel approach to fellowship programming that accomplishes these aims through an organizational strategy that emphasizes community engagement. After describing the administrative background for the program, we describe how the content curriculum and teaching process focus on the engagement of community members—both service users and service providers—as participating faculty. The faculty includes over 100 consumers, family members, advocacy group representatives, clinicians, and administrators. We present evaluation data obtained from 45 of the 100 community and university faculty who participated in the first 2 years’ of the fellowship and conclude with a critique and recommendations for further progress in community engaged fellowship training.
The purpose of this study was to evaluate the discriminability of apathy and depression by determining whether the relationship of these two dimensions of behavior varies in different diagnostic ...groups. Using the authors' Apathy Evaluation Scale and the Hamilton Rating Scale for Depression, we rated 123 subjects, mean age 72 years, who met research criteria for healthy elderly controls, left or right hemisphere stroke, probable Alzheimer's disease, and major depression. Elevated apathy scores unassociated with elevated depression were most frequent in Alzheimer's disease and right hemisphere stroke, and also occurred in a small number of left hemisphere stroke and normal subjects. In major depression, apathy was associated with high depression scores, although a substantial number of major depressives showed elevated depression without elevated apathy. In left hemisphere stroke, probable Alzheimer's disease, and major depression, there were significant positive correlations between apathy and depression. The slope of the regression of apathy on depression was greatest in probable Alzheimer's disease and major depression. These results indicate that the relationship between apathy and depression differs across diagnostic groups and, thus, support the discriminability of apathy and depression.
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