What is polymorphism?
This is a wide variety of manifestations of the disease, which leads to some confusion in medicine, because if the disease is so diverse, then perhaps we are dealing not with one disease, but with a large number of diseases that for some reason, once upon a time, someone united in one? It’s probably not entirely correct to call such a wide variety of symptoms in one word – in this case, schizophrenia?
We still continue to adhere to the point of view that we are talking about one polymorphic disease, since the main and main clinical manifestation of this disease is where all these “rivers” ultimately flow. They all flow down to the same state, which, despite all this polymorphism, is called the same: “schisis” - splitting of the psyche, splitting of the mental organization, splitting of the personality, splitting of emotions, splitting of thoughts, desires, inclinations. Everything is falling apart! Hence the name of the disease, as I said earlier: “schiza” or “schizo” (Greek) is split, “phrenos” is the soul or mind, that is, a splitting of the soul.
Eugene Bleuler, the famous Swiss psychiatrist who first introduced this term, understood this splitting as a special form of life for these patients. It’s as if their life becomes a combination of incongruous things. The phenomena of “schisis” manifest themselves in almost the entire life of the patient; they can manifest themselves at work, when a person takes on two completely contradictory tasks, the goal of which is opposite things.
You look at this person and think: you choose one thing - either you go right or you go left, but this choice does not happen. A person, like a swan, a crab and a pike, torn apart by internal needs, these split opposites, remains in one place.
The same splitting can occur in the emotional sphere.
One of these striking manifestations of splitting was described by the famous German psychologist Ernst Kretschmer. He described this as a “phenomenon of wood and glass” - that is, the simultaneous coexistence of a special sensuality, a special vulnerability, a special sensitivity or sensitivity, as we say, to some manifestations occurring around this patient, and at the same time this same patient unexpectedly everyone suddenly turns out to be absolutely cold, callous and indifferent to the serious, sometimes catastrophic events taking place around them. Such a phenomenal discrepancy and inconsistency of internal emotional experiences.
Prognosis of the condition, possible complications
The prognosis is formed solely on the basis of the nosology of a mental or neurological disorder. In schizophrenia, for example, abulia can develop and remain a persistent and permanent symptom a year after the onset of the disease. Therefore, it is so important to begin treating schizophrenia in a timely manner with adequate dosages of antipsychotics in order to prevent the collapse and regression of the personality.
Abulia in depression can be complicated in severe cases by catatonia and akinetic disorders in the form of stiffness and mutism. A person may lie immobilized for a long time and refuse to eat or drink. This can disrupt the water-electrolyte balance of the body and lead to death due to thrombosis or cardiac arrest.
Violations of the intellect in the form of its underdevelopment in mental retardation or decay in dementia and Pick's disease are often accompanied by disorders of the volitional sphere. Such patients find it difficult to care for themselves, they feel helpless and worthless, and require control from relatives. Patients become a heavy burden on the shoulders of their relatives.
It is important to promptly seek medical help when the very first signs of memory impairment or difficulties in everyday life appear. Properly prescribed treatment will help prolong the years of active aging and slow down the processes of personality degradation.
In severe cases, abulia as part of a mental illness leads to disruption of work and social adaptation. A person loses his job, his previous social circle, stops taking care of himself, withdraws, and stops leaving the house. This state of affairs can lead to disability.
Signs of a thought disorder
The same schism can occur in the cognitive, mental sphere, when the patient shows clear signs of so-called thinking disorders. We see how his associative process loses logic and harmony, thoughts begin to scatter in all directions, he becomes more and more distracted. Psychologists call this phenomenon slippage from the main topic of a monologue or dialogue. The patient, as we say, becomes blurred along the tree of judgments.
Ultimately, we see how thinking loses its focus, which means it ceases to be productive. That is, the train of thought of a famous mathematician, for whom everything has always been very clear, clear, with cause-and-effect relationships, for whom everything is algorithmic and laid out on shelves, suddenly begins to diffusely disintegrate into many, many small streams, and, ultimately, nothing one of these thoughts is not completed. And we just hear thoughts about nothing, some kind of fruitless philosophizing. In our psychiatric lexicon, this phenomenon is called reasoning, thinking in vain.
Severe cases of illness
In extremely severe cases of the disease, when it has already reached its terminal stages, that is, in the distant stages of the disease, we already see gross disorders of thinking, which are manifested by the so-called fragmentation, incoherence. The patient’s speech in this situation becomes absolutely incomprehensible; we hear some set of awkward words, expressions, a jumble of fussy thoughts that are not connected with each other. The patient begins to pronounce words in consonance and it becomes clear that his mental activity is virtually de-energized; due to his illness, he is practically unable to produce ideational, mental products.
These phenomena in schizophrenia, the phenomena of such schizis, increase over the years, especially strongly if this disease is not treated.
A very important diagnostic criterion for this disease is its dynamics, that is, its development. In such a situation, we say that this development is progressive or, translated into ordinary language, progressive, aggravating.
Schizophrenia is like a river that can flow at different speeds, at different tempos. It can be wide, but lazy, like the Volga in the Saratov region, or it can be stormy, like the mountainous Kazbek. In many ways, the rate of flow of this river, which ultimately determines the prognosis of the disease, depends on how we treat this disease.
What I just talked about and listed until now - this group of symptoms is called in psychiatry negative symptoms, that is, symptoms of loss of one or another function.
For psychiatrists, until the end of the 20th century, these symptoms were from the category of irreversible, from the category of a defect caused by the disease - this is a word that in itself means a certain irreversibility of what happened, a piece of tissue that tears the disease out of one or another organ. It’s the same here, but it’s not tissue, but mental, mental processes.
Diagnosis of the condition
Only a competent certified specialist - a psychiatrist - can identify the presence of hypobulia and abulia. The doctor talks in detail with the patient and his relatives, gets acquainted with medical documentation and clinical studies. It is important to distinguish the pathology of the will from simple laziness, which is treated through occupational therapy and increased motivation.
For many people, the condition of abulia is extremely difficult to understand. How is it that a young and outwardly strong and healthy young man cannot do anything, leave the house? Unfortunately, this is a feature of many abulia conditions. The inability to engage in purposeful activities and weakness of will lead to real stigmatization and disability in the end.
Abulia is a mandatory symptom of schizophrenia, but abulia may not appear immediately, but as the personality defect increases (from a year to decades). The so-called negative symptoms of schizophrenia lead to disruption of the social and work adaptation of patients; they stop taking care of themselves, become isolated and have difficulty leaving the house.
Clinical examinations such as MRI and CT will help differentiate from other diseases. With their help, the doctor will be able to see the foci of brain damage in a particular pathological condition.
How to stop the flow?
With the advent of new drugs, new technologies in psychiatry, in psychotherapy, which have already found their application in the 21st century and continue to develop quite rapidly, psychiatrists around the world really saw that we are not talking about a defect, but about completely reversible phenomena that can be controlled. At least you can almost stop this flow. In some situations, doctors even detect a reversal of this flow in the opposite direction, that is, the restoration of certain important functions lost due to illness.
I talk a lot about the importance of treatment. It is the treatment process that can give a good result and prevent the serious consequences of the disease from developing. Unfortunately, very often patients with schizophrenia do not have this zeal, desire, motivation for treatment. People who are far from psychiatry often have a negative attitude towards this, since the usual human logic is that if you don’t want to be nice by force, if you don’t want to, don’t be treated, the main thing is that you have been warned, sign that you don’t want to be treated, and we will absolve ourselves all responsibility.
But psychiatrists understand the reason for this low motivation. And the reason is another symptom that I haven’t mentioned yet. This symptom is called "abulia". This is a very severe manifestation of schizophrenia, which gradually, unfortunately, also increases over the years the patient spends with the disease.
Approaches to the treatment of abulia
There is no treatment for abulia as a separate symptom of the disease. It is important to carry out treatment comprehensively and individually. The patient’s age, his physical condition, the duration of the mental disorder and its nature are always taken into account. Drug therapy is usually combined with psychotherapy. You need to understand that treatment should be carried out long-term and continuously, only under the supervision of the attending physician.
Medicinal effects
Abulia in schizophrenia is treated with antipsychotics. There is a group of atypical antipsychotics that appeared relatively recently. These drugs can prevent the development of negative symptoms in schizophrenia, maintain social and labor status, and increase the patient’s rehabilitation potential.
As a rule, antipsychotics in this group are highly effective and have minimal side effects. This group includes drugs such as Olanzapine, Quetiapine, Risperidone, Invega, Clopixol, Alimemazine. The dosage is selected by the doctor based on the clinical picture of the disease.
Depressive disorders can also be accompanied by the development of abulia, especially in severe cases. These conditions are difficult to treat; treatment with antidepressants should be carried out for a long time - from 6 months. Preference is given to the group of selective serotonin reuptake inhibitors (SSRIs): Sertraline, Paroxetine, Escitalopram, etc.
Psychotherapy
Any option and method of psychotherapy is used only after the necessary correction of the condition with medications. If we are talking about simple laziness, the question is only about increasing motivation to achieve desired goals, learning to plan work and your leisure time, and taking full responsibility for failure to complete tasks. Self-discipline and occupational therapy, primarily on oneself, bring positive results.
For abulia caused by a mental disorder, the method of work is selected individually by the psychotherapist. Cognitive behavioral, family and group therapies are well suited for this purpose. It is very important for depressed people to feel supported and understood by other people.
In the family, it is necessary to form the correct attitude of all its members towards this type of mental disorder, to create a favorable and calm environment for the patient. Psychotherapy is usually carried out throughout the year in courses of 10-15 sessions.
Abulia
The main manifestation of this symptom is a deficiency of will, a deficiency of mental energy, which determines the intensity of our impulses. Ultimately, this very abulia, which is also called reduction of energy potential, puts patients on the sofa, and it becomes the main abode of our patients.
Although physically they may be superbly built, athletic, without somatic ailments, but because of this abulia it can be very difficult to get them out of bed. The usual complaints of such patients: I’m lazy, I don’t feel like it, I’m not ready right now, I need to rest a little, and so on and so forth.
This extends, unfortunately, to the healing process, which ultimately turns out to be very modest, so the family environment plays a huge role. If we manage to explain to this environment that these are very severe symptoms, that we need to treat this not as laziness, that it is very important to find motivating forms of bringing the patient to the doctor, in this case the result turns out to be better.
It is also necessary to talk about those symptoms that arise not only in schizophrenia, although in schizophrenia they still occur more often than in other diseases. We are talking about those symptoms that bring our patients to psychiatric hospitals, to closed hospitals that have departments for seriously ill patients. They are engaged, first of all, in the treatment of this particular pathology in its various types.
Why does abulia occur?
Main reasons
The main causes of lack of will include such serious conditions as head injuries, cerebrovascular accidents, and neuroinfections (meningitis, encephalitis). Neurological diseases (Pick's disease, Huntington's chorea, Parkinson's disease) can also cause abulia, because The entire brain is diffusely affected.
In psychiatry, there are many etiological factors: schizophrenia, depression, dementia, profound mental retardation, neurotic disorders. For the most part, the heredity of mental disorders is also important.
Changes occurring in the body
Abulia can be caused by decreased blood supply to the brain, as well as morphological damage to structures such as the frontal lobes, corpus callosum, basal ganglia and anterior cingulate cortex. These structures are responsible for carrying out purposeful action.
Previously (before 1961), in the treatment of schizophrenia in psychiatric hospitals, a surgical method of treating this disease, namely lobotomy, was widely used. A sharp blade destroyed precisely these zones (the frontal lobes and the isthmus between them). At the moment, this method is not used due to its inhumanity. The science fiction film Sucker Punch talks about this very milestone in history. The main character's fantasies are closely intertwined with real events taking place in a psychiatric clinic.
Psychoses
The main manifestation of schizophrenia in its acute period, at the moment of exacerbation of this disease, is what we call the general word “psychosis”.
Psychoses are different, but the main manifestations of psychoses are described as symptoms of the first rank by the German psychiatrist Kurt Schneider. The main manifestations of these psychoses are deceptions of perception, these are pseudo-hallucinations, these are various kinds of voices or visions that arise inside the head and inside the psyche of a person, which in fact do not exist, and which are not the inner voice of this person, and various kinds of delusional disorders.
Delusional disorders
A lot can be said about delusional disorders. The main manifestation of delusion is behavior. We see how our patients with schizophrenia suddenly become agitated, unexpectedly for everyone, run away from someone, unexpectedly begin to enter into conflicting relationships with someone, behave completely awkwardly, inappropriately for the situation in which they find themselves. In general, they attract attention, including through awkward behavior, attracting the attention of the police. It often happens that a patient with this disease comes to the attention of psychiatrists, having first passed the field of view of internal affairs officers.
PsyAndNeuro.ru
The last decade has seen a resurgence of interest in abulia, driven in part by evidence that this symptom causes significant impairment in real-life functioning and is a predictor of poor functional outcome in people with schizophrenia.
Abulia is currently understood as a decrease in the initiation and maintenance of goal-directed activities. There is no agreement on the degree of overlap between terms such as abulia, decreased drive, amotivation, and apathy, and they are often considered interchangeable. There is also widespread debate about whether the definition and assessment of abulia should rely on the observations of an expert or the patient's caregivers, or on the patient's self-report of his or her participation in various activities or on the patient's expressed interest in participating in an activity. .
Like antisociality, abulia is not recommended to be assessed solely on the basis of observed behavior. Indeed, the inability to initiate and maintain goal-directed activities may be due to several factors that are not related to negative symptoms (eg, paranoid beliefs, depression, or lack of opportunity). The assessment should always include desire and interest in purposeful activities for the patient.
Clinical rating scales for abulia involve retrospective assessment that often combines more than one source of information whose consistency has almost never been tested. In the SANS, apathy/abulia is assessed using three behavior-based items: grooming and personal hygiene, instability at work/school, and physical anergy. In the PANSS, only one item actually refers to abulia, i.e. emotional withdrawal, assessed based on caregivers' report of the patient's interest and emotional involvement in daily life. The BNSS includes separate items to assess the internal experience of abulia and its behavioral manifestations; both items include motivation for work/study, leisure activities, self-care, and total time spent in inactivity. In the CAINS, abulia is assessed using two items on the Motivation and Enjoyment scale: motivation for work and school activities and motivation for leisure activities. Internal feelings and behavior are assessed within each individual item, except for self-care. The strength of correlations between BNSS and CAINS items ranges from moderate to high, but is inferior to the correlations for items assessing reduced affect and alogia.
According to the current concept, motivation is a multifaceted construct that includes positive experiences, reward prediction, and other elements such as reinforcement evaluation, effort evaluation, contingency encoding of action outcome, and decision making. This multifactorial construct closely resembles the Research Domains Criteria (RDoC) conceptualization of motivation in the positive valence framework and has been the subject of several experimental designs in recent decades, which will be briefly discussed next.
The hypothesis that disruptions in reinforcement negatively impact motivational aspects of the negative symptoms of schizophrenia has received much attention. It has been found that many people with schizophrenia experience pleasure in the same way as healthy people when engaging in pleasurable activities during daily life or when exposed to a pleasurable stimulus; however, they are less likely to engage in pleasure-seeking behavior due to their inability to anticipate future rewards. Research on reward anticipation in schizophrenia has focused primarily on the neurobiological underpinnings of this process and has systematically reported impairments in reward prediction mechanisms mediated by striatal nuclei.
The ability to predict reward requires a learning process. In this regard, several studies have focused on reward learning in schizophrenia and have reported difficulties in cases where rapid learning of reward cues is required and changes in outcome and feedback occur (e.g., a previously rewarded response is followed by punishment), in whereas no difference is observed when people learn through repeated repetition (routine/procedural learning).
The possibility was also considered that motivational deficits include the ability to “represent value information”, i.e. relate the hedonic properties of a stimulus to an individual's internal state (e.g., food is more valuable to a hungry person), the delay between stimulus and reward, and the need to change a response under contingency conditions (a previously rewarded stimulus that becomes associated with punishment). There is evidence that the ventromedial prefrontal cortex is involved in the representation of goal salience.
Another approach to understanding the relationship between reward anticipation and abulia assesses the amount of effort a person is willing to expend for a given reward. Recent attention has focused on experimental paradigms that measure cognitive, perceptual, and physical effort. Initial results from studies examining the psychometric properties of various measures appear promising. Tasks require gradually increasing effort, cognitive or physical, in order to obtain material rewards; the level of effort increases from attempt to attempt to find the person’s “control point”, i.e. the point at which the subject is no longer willing to exert effort to obtain the offered reward. People with schizophrenia tend to have cutpoint scores lower than or equal to those of the comparison group, and a low cutoff score is significantly associated with greater severity of motivational deficits. Brain regions that may be involved in calculating the expected cost of effort are the dorsomedial prefrontal cortex and the insular cortex.
The hypothesis that executive function deficits contribute to difficulties in engaging in goal-directed activities has also been supported by the results of some studies. However, conflicting results have been obtained, and more precise assessment of both areas will help identify the reasons for the discrepancies.
Despite the interest and progress generated by the experimental models described, it is clear that the interaction of neural systems involved in motivation is a complex process, and we are likely only beginning to comprehend this complexity. In addition to the neural level, also the level of psychopathology needs further clarification; in particular, the assessment process should include different tools and sources of information, and possible discrepancies should be highlighted. In addition, the possibility that personalized rewards (eg, making monetary rewards proportional to the subject's income) may have an impact on patient-control group differences should be considered, and sources of secondary abulia should also be carefully considered and, if possible, eliminated.
Translation into Russian was organized by the Council of Young Scientists of the Russian Society of Psychiatrists with the support of the World Psychiatric Association.
You can download the full issue in Russian, from which this article is taken, by following the link
Source: Stephen R. Marder, Silvana Galderisi. The current conceptualization of negative symptoms in schizophrenia. World Psychiatry. Feb 2022; 16(1): 14–24.
Translation: Pikirenya L.Yu., Pikirenya V.I., Shunenkov D.A.
Editing: Ph.D. Fedotov I.A.
Catatonic syndrome
This disease can also cause severe, even life-critical conditions, such as catatonic syndrome. This is a mental disorder in which, in addition to very difficult and difficult to bear internal experiences, there is also such a phenomenon as increased muscle tone. Patients can sometimes freeze in a so-called catatonic stupor, with waxy flexibility, with manifestations of the so-called plasticine man symptom, when you can approach this patient, change his position and see him frozen in the changed position that we gave him.
There are attacks of catatonic excitement. These conditions are very dangerous because they are always accompanied by a large number of unexpected and impulsive actions, which may include aggression. And most importantly – auto-aggression. If this catatonic symptomatology is associated with delusional states or with affective disorders, that is, with depressive experiences, for example, then the risk of suicidal behavior in such patients is very high. And they quite often commit some kind of auto-aggressive or suicidal actions throughout their illness.
Abulia and its manifestations
05.12.2019
Abulistic disorder (from the Greek negative particle and will) is a pathology in which it is impossible to perform any voluntary movements. Moreover, the patient may realize their necessity and importance at the moment.
Mechanism
III block of the brain , prefrontal areas of the cerebral cortex, stem and subcortical formations are responsible for the level of mental activity and behavior control. When the frontal regions or subcortical nuclei are damaged, significant disturbances in the functioning of dopamine D-2 receptors and dopaminergic transmission in nerve cells appear. Because of this, there are violations of the components of performing acts of will - speech , interaction with others, making voluntary movements.
Classification of abulia according to the duration of the disorder
Short term
The patient realizes that it is now necessary to act, he has retained his critical abilities, but he cannot do this.
A short-term lack of will is observed in asthenic disorders and depressive states.
Periodic
Occurs during exacerbation of schizophrenia, depression, bipolar affective disorder. Alternates with periods of hyperactivity .
Permanent
Combined with organic brain lesions , catatonic schizophrenia, apathy.
Cannot be corrected.
Causes
Hereditary predisposition
A significant proportion of patients are patients whose relatives suffered from schizophrenia.
CNS damage
Abulia can manifest itself as a result of a stroke, Huntington's disease, Parkinson's disease, or Pick's disease. And also be a side effect of neoplasms, previous injuries, infectious brain lesions .
At the same time, thought processes weaken, and motor activity noticeably decreases.
Various mental disorders
The development of the syndrome occurs with senile dementia, schizophrenia, major depression , mental retardation, idiocy, bipolar affective personality disorder.
Relative abulia can manifest itself in childhood with excessive care on the part of parents and their desire to do everything for the child.
This can be corrected by changing parenting methods or by contacting a psychologist .
Absolute abulia occurs due to metabolic and organic disruptions in the central nervous system.
Symptoms of abulia
- Lack of body movement or ability to perform only certain gestures
- Decreased vocabulary, monosyllabic answers to questions
- Extremely weak display of emotions
- Sharp limitation of social circle
- Decreased interest in everyday activities and all activities in general
- Indifferent, detached look, reluctance to make contact Inability to satisfy one’s vital needs - satisfy hunger, get dressed, wash, use the toilet
- Neglect of appearance and hygiene
Complications
In the absence of help in caring for oneself and monitoring the patient’s condition, maladaptation occurs in everyday life and in society. Contacts with others stop completely, and residual communication skills are lost. Due to skipping meals, physical inactivity, and severe body pollution, gastrointestinal diseases and skin infections develop.
In severe cases it can lead to death.
Diagnostics
Direct observation
The doctor notices a lack of interest in conversation, communication with other people, lethargy, and refusal of necessary daily procedures.
Survey and conversation with relatives
The doctor clarifies the complaints and all the points that bother them in the patient’s behavior, and asks how severe these symptoms are.
A neuropathologist or neurologist examines the patient himself and checks how well motor skills and reflexes are preserved.
Consultation with a psychologist
He will test memory, emotional state, explore the emotional, personal and cognitive sphere. This will help identify depression , schizophrenia, and dementia.
Treatment and prognosis
Therapy should be aimed at eliminating the disease, which resulted in lack of will, and adapting the patient to everyday life. This requires help and round-the-clock supervision from relatives or caregivers.
Therapy is carried out by a psychiatrist , neurologist , and rehabilitation specialist .
Medicines are selected depending on the underlying disease (schizophrenia, depression , dementia).
And additional and more important is the creation of a stimulating external environment - meetings with his friends, visiting new places, creative activities, new hobbies, occupational therapy .
If abulia occurs as a result of depression , a neurological disease, or schizophrenia with long stages of remission, then there is a chance of a favorable prognosis for later life.
Published in Psychiatry Premium Clinic
Disease under control
This disease is not simple, but we must always remember that in the vast majority of cases, especially today, we have the opportunity to use all the achievements of not only world psychiatry, but also physiology, pharmacology, biochemistry, and neurophysiology.
Today, when we have the opportunity to use all this, we can control the symptoms of this disease, we can minimize those very negative symptoms that I spoke about, minimize their development, slow down this flow, prevent severe, final, initial states of the disease. This is on the one hand, and on the other hand, we can reach the level of effect of our treatment, at which these severe, psychotic conditions, psychoses that bring patients to hospitals, can also be significantly reduced or disappear completely, and the intervals between them, so called remissions, cold periods of illness, when the patient returns to life and is able to work, these intervals become longer and longer.
Despite the fact that the disease is serious and cannot be ignored by doctors, the main thing in this situation is to never give up, no matter how severe the disease.
It is imperative to contact specialists, since today medicine has a sufficient number of possibilities to not only control the disease, but also treat it, and in some cases, cure it.
Violation of the emotional-volitional sphere
General information
For normal life activity and development in society, the emotional-volitional sphere of the individual is of great importance.
Emotions and feelings play an important role in human life. will is responsible for the ability that manifests itself during the regulation of its activities. From birth, a person does not possess it, since, basically, all his actions are based on intuition. As life experience accumulates, volitional actions begin to appear, which become more and more complex. The important thing is that a person not only gets to know the world, but also tries to somehow adapt it to himself. This is precisely what volitional actions are, which are very important indicators in life.
You may be interested in: Emotional volitional disorders in children Emotional disorders
The volitional sphere of personality most often manifests itself when various difficulties and trials are encountered along the path of life. The last stage in the formation of will is the actions that must be taken to overcome external and internal obstacles. If we talk about history, volitional decisions at different times were formed thanks to certain work activities.
What diseases cause a violation of the emotional-volitional sphere :
- Schizophrenia
- Manic syndrome
- Depressive syndrome
- Obsessive-phobic syndrome
- Psychopathy
- Alcoholism
- Addiction
External stimuli include certain social conditions, and internal stimuli include heredity. Development occurs from early childhood through adolescence.
Characteristics of the volitional sphere of personality
Volitional actions can be divided into two groups:
- Simple actions (do not require the expenditure of certain forces and additional organization).
- Complex actions (require a certain concentration, persistence and skill).
In order to understand the essence of such actions, it is necessary to understand the structure. An act of will consists of the following elements:
- pulse;
- motive;
- method and means of activity;
- decision-making;
- implementation of the decision.
Violations of the emotional-volitional sphere
Hyperbulia , a general increase in will and drives, affecting all the basic drives of a person. For example, an increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them. Hyperbulia is a characteristic manifestation of manic syndrome.
Hypobulia is characterized by a general decrease in will and drives. Patients do not feel the need to communicate, are burdened by the presence of strangers and the need to maintain a conversation, and ask to be left alone. Patients are immersed in a world of their own suffering and cannot take care of loved ones.
Abulia is a disorder limited to a sharp decrease in willpower. Abulia is a persistent negative disorder; together with apathy, it forms a single apathetic-abulia syndrome, characteristic of the final conditions of schizophrenia.
Obsessive (obsessive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Refusal to satisfy an instinct gives rise to strong feelings in the patient, and thoughts of an unsatisfied need constantly persist. Thus, a person with an obsessive fear of contamination will restrain the urge to wash his hands for a short time, but will definitely wash them thoroughly when no one is looking at him, because all the time he endures, he constantly thinks painfully about his need. Obsessive drives are included in the structure of obsessive-phobic syndrome.
Compulsive attraction is a very powerful feeling because it is comparable in strength to instincts. The pathological need occupies such a dominant position that a person quickly stops the internal struggle and satisfies his desire, even if this is associated with gross antisocial actions and the possibility of subsequent punishment.
