Abulia

Specialty: Psychiatry.

• Loss of will
• lack of initiative
• hypobulia
• volitional paralysis

Why it occurs

• Melancholic or severe depression
• Residual or predominantly negative schizophrenia
• Frontotemporal dementia (behavioral variant)
• Crebrovascular accident affecting the anterior cerebral artery or the territory of the caudate
• Brain trauma with involvement of the prefrontal lobe
• Schizoid or schizotypal personality disorder

Initial workup

Comprehensive neurological examination; magnetic resonance imaging (MRI) of the brain to evaluate prefrontal or subcortical structural lesions; Negative Symptom Rating Scale (SANS); general analysis with electrolytes, kidney and liver function to rule out metabolic encephalopathies.

Standard management

• Aripiprazole — second-generation antipsychotic with partial dopaminergic agonism, useful in negative symptoms of schizophrenia
• Cariprazine — partial D2/D3 agonist, specific for volitional deficit and apathy in psychosis
• Modafinil — promoter of alertness, used as an adjuvant in conditions of apathy and organic abulia
• Levodopa or dopamine agonists — if the condition is associated with parkinsonism or damage to the basal ganglia