Avolition: Lack of Motivation or Initiative

Definition, Importance, and Treatment of Avolition in Mental Health

Man relaxing on sofa holding remote controls
What is avolition and how it it treated. What is the problem with negative symptoms such as this with schizophrenia?. Getty Images/Adrian Nakic

Avolition - Definition

Avolition means a severe lack of initiative or motivation. A psychological term used to describe the lack of interest or will to become engaged in goal-oriented behavior, avolition is found in schizophrenia.

What is Avolition and What is it Not?

In schizophrenia or schizophreniform disorder, when avolition is so severe as to prevent a person from doing ordinary things such as work, hobbies, reading, or taking care of oneself, it is considered a so-called negative symptom of the condition.

It also helps to understand what avolition is not: It is not basic procrastination or avoidance of various tasks (possibly unpleasant tasks) in people without mental disorders.

What Is Avolition in Schizophrenia?

People with avolition may want to accomplish certain tasks, but they're simply unable to garner the mental and physical energy necessary to do them. They literally lack the ability to get things done, even if they want to do them.

Avolition Examples

Examples of situations involving avolition include someone who is:

  • Unable to start or complete paying bills (even when the bill-paying is urgent and necessary)
  • Staring at an assignment without getting to work on it
  • Just sitting for hours doing nothing

Someone who has avolition may want to participate in therapy for schizophrenia, but may literally be unable to do so. This obviously has major implications for the success of various schizophrenia treatments.

Avolition vs Anhedonia

Avolition is not the same as anhedonia. Anhedonia (another negative symptom of schizophrenia) is where activities bring no pleasure, even if they are activities that the person previously had enjoyed. Other negative symptoms of schizophrenia include asociality (a decrease in a person's motivation and interest to form relationships) and alogia (a decrease in speech).

Negative Symptoms in Schizophrenia

Negative symptoms of schizophrenia, such as avolition, are not "bad." They are distinguished from positive symptoms based on the how the symptom is experienced by the person living with schizophrenia. These symptoms may include a decrease in the expression of emotion (not a subjective sense of emotion, as someone with schizophrenia may feel the emotion but they do not express it objectively), a decrease in speech, and a decrease in apparent interest or sense of purpose as observed by others.

Negative symptoms are thought to occur in 20 to 40 percent of people with schizophrenia, and it is not known what causes it, other than people who have schizophrenia with negative symptoms are more likely to have been born during the summer months.

Research Into Avolition

Research indicates that people who suffer avolition as a result of schizophrenia are able to experience emotions, but they can't actually translate these feelings into behaviors that lead to results.

People with schizophrenia who have poor working memories are most affected by this problem, and it's felt that working memory is important in integrating emotions and behavior.

Impact and Prognosis of Avolition in People with Schizophrenia

Another study showed that people with schizophrenia who have a combination of avolition and apathy tend to have worse outcomes than people who have more symptoms of diminished expression and fewer symptoms of avolition and apathy. The authors of that study concluded that severe avolition and apathy in schizophrenia may indicate a more severe form of the condition

Treatments for Avolition and other Negative Symptoms of Schizophrenia

Negative symptoms of schizophrenia are considered extremely difficult to treat. In fact, they're much more difficult to treat than the so-called positive symptoms of schizophrenia, which include hallucinations, delusions, thought disorders and movement disorders.

Avolition and other negative symptoms, such as anhedonia, asociality and alogia, may respond to medication and/or to social skills training, Unfortunately, the negative symptoms which respond to treatment are often negative symptoms related to medications used to treat positive symptoms rather than primary negative symptoms, or negative symptoms related to the condition rather than the treatment of the condition.

Medications used to treat avolition in schizophrenia include atypical antipsychotics such as Zyprexa (generic name: olanzapine) and Risperdal (generic name: risperidone). Atypical antipsychotics do seem to reduce negative symptoms such as avolition by around 25 percent, but are otherwise not terribly effective. As noted, they are most effective in treating secondary negative symptoms, and have little effect in treating primary negative symptoms.

Currently there are no other approved treatments available in the U.S. for avolition and other negative symptoms which do not respond to atypical antipsychotics, and there is a tremendous need for other therapies which can address these symptoms for people with schizophrenia.

Sources:

Lui, S., Liu, A., Chui, W. et al. The Nature of Anhedonia and Avolition in Patients with First-Episode Schizophrenia. Psychological Medicine. 2016. 46(2):437-47.

Remington, G., Foussias, G., Fervaha, G. et al. Treating Negative Symptoms in Schizophrenia: An Update. Current Treatment Options in Psychiatry. 2016. 3(2):133-150.

Sarkar, S., Hillner, K., and D. Velligan. Conceptualization and Treatment of Negative Symptoms in Schizophrenia. World Journal of Psychiatry. 2015. 5(4):352-361.

Strauss, G., Horan, W., Kirkpatrick, B. et al. Deconstructing Negative Symptoms of Schizophrenia: Avolition-Apathy and Diminished Expression Clusters Predict Clinical Presentation and Functional Outcome. Journal of Psychiatric Research. 2013. 47(6):783-90.

Continue Reading