What is apathy in simple words - 10 signs of manifestation in humans and ways to get rid of it without drugs

Hello everybody!

Few people can boast that they have never experienced a feeling of apathy. This state is like in a song from a cartoon: I don’t want anything! I propose to talk about what apathy is in simple words.

In the morning you can smile, but by lunchtime, as they say, it’s over. The picture of life becomes gray. I don’t want to do anything, sometimes I don’t even want to move. And in the evening everything seemed to get better. Sometimes it doesn’t let go at all. It would seem that there is nothing wrong. Life is life, and whatever happens, it will pass.

That’s right, but the risk of a more serious situation developing is not small. There is a danger of mental illness. And spending part of your life in despondency and coma is a so-so prospect. This is if everything is left to chance. But we won’t allow this. And how to resist this scourge, you will learn from the article.

• How apathy differs from depression - you need to know
• And then came Her Highness Apathy
• What is apathy in simple words - 10 signs
• Reasons for Her Highness's coming
• Who needs to fear apathy?
• How can we overcome it?
• More proven methods of dealing with Her Highness

In the dictionary Dictionary of foreign words

and, pl. no, w.

A state of complete indifference, indifference, indifference. Apathetic - characterized by apathy.||Cf. ABULIA" title='ABULIA, ABULIA this, what is ABULIA, ABULIA interpretation'>ABULIA, DEPRESSION" title='DEPRESSION, DEPRESSION this, what is DEPRESSION, DEPRESSION interpretation'>DEPRESSION I (1), DYSTHYMIA" title='DISTHYMIA , DISTHYMIA is, what is DISTHYMIA, DISTHYMIA interpretation'>DISTHYMIA, PROSTATION" title='PROSTRATION, PROSTATION is, what is PROSTATION, PROSTATION interpretation'>PROSTRATION, SOPOR" title='SOPOR, SOPOR this, what is SOPOR, SOPOR interpretation '>STOPOR, STUPOR" title='STUPOR, STUPOR is what is STUPOR, STUPOR interpretation'>STUPOR.

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The meaning of the word apathy

Examples of the use of the word apathy in literature.

Seized by a strange apathy, he studied the picture for a long time with the caption: Privileged, stinkless powder closet of the system of mechanical engineer S.
In Mikael one can discern some kind of mental numbness, a touch of apathy, reeking of chlorpromazine and hospital procedures.

So, as stated, the student Anselm fell, after the evening when he saw the archivist Lindhorst, into a dreamy apathy, which made him insensitive to all external touches of ordinary life.

Duque readings under the pressure of a representative from the Federation - weak participation in them, a meager number of demonstrators marching under the vital slogans of anti-militarism and anti-colonialism, are primarily a consequence of the apathy of the leaders, causing growing discontent among ordinary members of the Communist Party and the Communist Youth of France.

As Jack believed, true autism lay in apathy towards social aspirations, as if the human personality were not a product of inherited social values.

I wanted to preserve these poems not only because of the author’s natural misconception regarding their quality, but also because of a fierce desire to prove that no one will ever be able to bring a person to a given state of dejection, lack of will, apathy and submissive vegetation within the permitted framework.

But Irish da Gama, exhausted by excesses, was in such apathy that Carmen could not dispel with any reproaches.

Surrendering to this apathy, Mr. Hardy reached such a state that he began to consider such slumber of the mind the highest good.

James rose from his apathy and translated: “On behalf of your eldest son, President George Romagnos, the highly respected Grand Duke, his personal envoy Mr. Domestico Dolmetcher asks you to accept a gift of ten thousand of the best Latin American eggs!”

Goncharov, again, with daguerreotypical fidelity, reproduces the external expressions of despair, and then apathy of his hero.

But before leaving this magical land in which I resided between the sea and the mountains, sheltered from all winds except those that blow from the south and which have imbued this damned land with stuffiness and apathy, I would not like to keep silent about the terrible cries of the twitchers who they made incessant noises throughout the short summer night, rushing across the fields and meadows with an annoying loud crash.

When the contents of the syringe were pumped out and the nurse removed the needle, the commandant experienced a surge of noticeable excitement, while Verkramp, on the contrary, sank into a strange dull apathy.

And the masses, who are trying to inflame themselves with terrorist hype, are plunging even deeper into hungry apathy.

He was sitting three steps from the cage, smoking, and the acrid tobacco smoke, the terrible smoke that Lobik had long known and hated, with which the memory of gunshots and burning pain in the body was associated - this smoke flowed quietly, reaching his nose, but the deep apathy that gripped the beast , did not allow him to find the strength to show the full depth of hatred towards man, and he did not react in any way to either the vile smoke or the actions of this vile creature.

During the years of the Napoleonic Empire and the Restoration that followed, Megul experienced an increasing sense of creative apathy and lost interest in social activities.

Source: Maxim Moshkov library

And then came Her Highness Apathy

Apathy can also be confused with laziness. But only at first glance. Laziness is simply a bad character trait or habit. A lazy person sleepily performs only duties that are not interesting to him. He will go with joy to have fun or do something exciting for him.

With apathy, the desire to do anything at all disappears. That's the difference between them. So what is apathy? In a way, it's kind of like falling in love. Until you've experienced this feeling, you can only imagine what it's like. What makes the feeling of apathy unique is the feeling of having no feelings at all.

Whenever you feel that something you need is missing in your life, but you don’t have the slightest desire to get it, it means that Her Highness Apathy is visiting you. That is, you understand that you need it and you know how to do it. But you have neither the strength nor the desire to do this. You don't care.

It is important that in a state of apathy, indifference is manifested in all areas of our lives. Both good and bad news will be neutral for us. Apathy is often a symptom of nervous disorders and diseases. Experts divide apathy into 3 types.

1. Passive . People around you can easily notice the signs: a complete lack of interest in others, in life; lethargy; detachment.
2. Active . Changes in the psyche are not visible to others. Leads to serious mental illness or suicide.
3. Traumatic . Occurs with brain injuries, tumors, and impaired blood supply to the brain. When these diseases are cured, the symptoms of apathy also disappear.

Apathy is the etymology (origin) of the term.

The term “apathy”, in its modern sense, came into use during the First World War. It was used to describe the condition of soldiers returning from the war, who experienced all the horrors of trench warfare, constant shelling and the death of their friends. Upon their return, such people experienced absolutely no emotions in relation to real peaceful life. In their understanding, the most important emotional events took place during the war, and everything else seems gray and unimportant.

Reasons for Her Highness's coming

To eliminate this condition, we need to identify the main causes of its occurrence. This will be the first step towards getting rid of apathy.

• Emotional burnout . This may be fatigue from the profession, when a person works for a long time at the same, albeit favorite job. He suddenly realizes that this activity has not only ceased to bring joy, but is also unpleasant. But there is no opportunity to change the field of activity, and the person continues to suffer. Or suddenly he was interested in something for many years. I devoted all my free time to this hobby. And suddenly bam, it was cut off - not interesting. There is emptiness in my soul.
• Stress . Any strong negative event: death of a loved one, major quarrel, separation from a loved one, moving to a new uncomfortable place, betrayal of a loved one, loss of a job. This also includes minor but constant conflicts in the family or a nervous environment at work.
• Overwork. In this case, the nervous system signals to us that it is time to quit everything and rest. Even if a person does not feel tired.
• Serious illness. For many of us, even the diagnosis of some terrible disease causes stupor and shock. This is not surprising. And the very course of the disease depletes all strength. And if this is a disease of the nervous system, then the person will be exhausted both physically and mentally.
• “Side effects” from medications are not a rare occurrence and can also cause signs of apathy. These are sleeping pills, blood pressure lowering agents, and contraceptives.

Development in pregnant women

For women carrying a child, there is an interesting moment when complete indifference sets in. Emotional and physical overload during this process is the main root cause of disease.

When a pregnant woman has all the endocrine glands of the body begin to work differently, in accordance with the increase in the amount of hormones, the emotional state changes significantly.

It is even possible to have an exaggerated assessment of the manifestations of the external world, which gives rise to illness. The psychological state of the expectant mother is also a very important aspect that contributes to the full bearing of the child. Often, women who were previously engaged in very active activities, but are now in a kind of depressed state, are more predisposed to the occurrence of such an illness, because there is no way to 100% realize their vital energy. After a woman finds out about her pregnancy, she realizes that she will not be able to engage in her usual activities.

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Philosophical reflections about the meaning of life, bearing a child, prospects, can turn into the root cause of the disorder. This disease cannot be ignored in case of pregnancy - apathetic symptoms as they progress put the woman in a dangerous state.

Attention, apathy! Symptoms

In addition to complete passivity and indifference, apathy is characterized by the following:

• refusal to work and maintain hygiene; • decreased mood; • cessation of active communication with friends and acquaintances; • absent-mindedness; • giving up favorite activities and hobbies; • physical weakness; • inability to concentrate; • slowing down reactions; • general weakness; • feeling of loneliness, abandonment, fear; • memory lapses; • dizziness.

These are the signs of apathy. If you notice these in yourself or your loved ones, and they last for more than two weeks, then this is a reason for concern. It is necessary to consult a doctor to find out how to get out of this situation.

At the same time, one must not confuse depression with apathy: in the first case, a person does not have moral and physical strength against the background of a depressed mood, and in the second, his physical condition is good, he simply does not want to communicate with anyone or do anything.

More proven methods of dealing with Her Highness

Let's look at what else can improve our lives.

• Rest. Sometimes all a person needs is a thorough rest. Not 2-3 days, but three or four weeks. As far away from work and home as possible. So that no thoughts about the office or unpleasant events. Someone will need to be alone and do something exciting so that bad thoughts don’t come to mind. As they say, change the stop, shake yourself up. Fishing, hunting, hiking in the mountains. Anything that helps relax the nervous system.

• Daily regime . Chronic lack of sleep, nightly vigils at the computer, insomnia are not our friends. Sleep should be 7-8 hours. Lights out preferably at 22-23 hours. We often underestimate the restorative powers of good sleep. At first, following a regimen may seem like an unnecessary strain. In fact, by leading a measured lifestyle, a person gets more done and has fewer reasons to worry about time pressure. Another minus factor is the appearance of apathy.

• Strong physical activity. Physical activity in moderation magically brings us back to life. Just in moderation. Exercising every day or running until you drop will only do harm. You can start simply with walking and morning exercises. Yoga, ping-pong, swimming pool, cycling are good options.

• Auto-training and meditative practices. Of course, all these events are without any mystical nonsense. It would be nice, of course, to take a few lessons from a good master. But you can also learn a couple of relaxing and calming simple techniques on your own. There are no problems with information on the Internet now.
• Reasonable nutrition. I mean full-fledged, with all sorts of salads, vegetables and fruits. Balanced in proteins, fats and carbohydrates. The energy of our body, and therefore its resistance to stress, depends on the composition of the food we eat.
• If possible, remove all small annoying moments . We are not always clearly aware of how many little things can infuriate us. We're used to it. But these factors accumulate and, as they say, quantity can develop into quality. Hello, apathy, or something like that.

An annoying colleague - avoid communication or, if not possible, reduce it to a minimum. Do not communicate with a friend if such contact no longer brings pleasure, but only infuriates. If something irritates a loved one, then discuss it with him, do not tolerate it in silence. Yes, we can correct something. But if you have tried these life improvements, but vile apathy does not want to give up, then do not delay. You need to see a neuropsychiatrist.

How apathy differs from depression - you need to know

Very often we call any of our blues or bad mood depression. Which, of course, is not the case. What we mistakenly call depression most often turns out to be apathy. Let's separate one from the other. Flies separately - cutlets separately.

The difference between these phenomena can be illustrated by the example of two diseases: a mild cold and pneumonia. If the first one can go away even without visiting a clinic, then inflammation without urgent medical intervention can lead to very tragic consequences.

Of course, you shouldn’t let a cold take its course; it can develop into a more serious illness. That's what apathy is. If no action is taken in time, it can develop into a serious mental illness. And sometimes it goes away on its own, just like it never happened. Only a specialist should work with depression. And urgently.

We will look at the signs of apathy later. Some of them are similar to depression. And to distinguish one misfortune from another, I will give the main manifestations of depression:

• sleep disturbances (can be either drowsiness or insomnia);
• irritability, anger, anxiety;
• thoughts of suicide;
• Negative thoughts about yourself are constantly present;
• a person can constantly expose himself to danger (extreme sports, drug and alcohol abuse);
• pessimism, hopelessness (a person may believe that everything is bad and nothing can be fixed);
• increased excitability (even with slight excitement, he begins to walk from corner to corner, cannot find a place for himself).

In general, apathy is indifference, and depression is deep depression. I think that now we will be able to distinguish one enemy from another.

How to get out of apathy: 10 proven methods

As Ostap Bender said: “The salvation of drowning people is the work of the drowning people themselves.” No one will pull you out of the swamp called “apathy”. You can only rely on yourself.

The first step is to determine the cause and try to eliminate it. If you have health problems, consult a doctor. If the causes of apathy lie in psychology, let’s try to cope with it at home. Let's look at effective self-help and prevention methods.

Realize that you are at the bottom

Without exaggeration, apathy is rock bottom. The bottom of an energy hole, from which it is very difficult to get out. You should not have any illusions that you will be able to pull yourself together at any moment and live a normal life. You can't.

The main trap of apathy is that subjectively this bottom feels like a completely comfortable place. A person may even be satisfied that he has no desires, goals or ambitions. But now you don’t need to worry about anything and experience stress from failures.

But getting out of apathy is always associated with severe discomfort. This process is long and unpleasant. You must be mentally prepared for this. Every day you will have to do something that you absolutely do not want to do and that you have absolutely no strength for. But, unfortunately, there is no other way.

Use negative motivation

In a state of apathy, motivation sleeps soundly. You don’t want to do anything; any of your own actions feel like hellish work, because you don’t receive the proper reward. And all because the biochemical processes of the brain are disrupted. This means that the production of so-called happiness hormones and goal achievement hormones - dopamine, serotonin, endorphin - decreases.

No matter how hard you try to force yourself to want and become interested, you will not succeed. Only negative motivation can help you. Now I’ll explain what it is.

Normal healthy motivation for a mature person is based on the desire to achieve a goal. Negative motivation is associated with the fear of bad consequences from one’s inaction. For example, you are too lazy to change summer tires to winter ones, but the fear of getting into an accident forces you to do it.

To begin to slowly crawl out of apathy, you need to fully understand what it threatens you with and be afraid for your life. And there really is something to be afraid of. Apathy is a common cause of suicide. It leads to decline in all areas of life and turns a person into a pale shadow.

While you have not yet lost the ability to be afraid, use it to help yourself. At the most advanced stage of apathy, there is no longer even fear.

Try to be useful

Apathy most often affects self-centered and infantile people. And all because man is a thoroughly social creature. Consciousness is given to us to effectively manage ourselves in the interests of the species, therefore everything that a person does for the benefit of other people is generously rewarded. This is an evolutionary mechanism that is built into our brain.

An individual who is constantly self-obsessed and wants only to receive something from others without contributing to the common good is useless for evolution. He will constantly experience interruptions in energy, suffer from depression and apathy, and suffer from lack of fulfillment.

To get out of apathy, you need to shift the focus from yourself to other people. First of all, on those closest to you. Think about what good you can do for them right now. Show sincere attention to your parents, relatives, and friends. Be generous and help them for free without expecting anything in return. You yourself need this to a greater extent.

When you have a little more strength and capabilities, you can expand your sphere of influence. Help those in need, participate in charity events.

Work hard

Work is the best cure for all psychological ailments. Apathy is no exception. Find something to do that you can do whenever possible. At first not long, then longer and longer.

Excuses like “I don’t feel like it” and “I don’t have any strength at all” are not accepted. You will have to pull yourself together with the last of your strength and start acting. If you sit and wait for the desire to work to suddenly dawn on you, you will never get out of apathy.

Perceive work as an inevitable necessity. Like a bitter medicine that you need to drink regularly to get well. You need to start with microdoses and then build up. Even half an hour of productive work a day will produce results.

Normalize your regimen

People who adhere to a healthy daily routine and monitor sleep hygiene are much less likely to suffer from apathy. Take them as an example. Set yourself a normal daily routine and stick to it. Here are a few rules that you should memorize as “Our Father”:

1. Sleep 7–8 hours a night.
2. Go to bed and wake up at the same time every day.
3. Avoid daytime naps and night vigils.
4. 2 hours before bedtime, eliminate physical activity, rich food, and gadgets.
5. Take regular rest breaks during the workday.
6. Alternate mental and physical activity.

This is the minimum that simply must be observed if you want to put your psyche in order.

Take care of your appearance

A person’s image is the area of ​​life in which investments most quickly bring results. I don’t mean monetary investments, but investments of energy, time, and internal resources. If your image has been neglected for a long time and you suddenly start actively working on it from scratch, then very soon you will receive the first fruits. And they, in turn, will help swing the pendulum of motivation.

Buy a gym membership, lose a couple of kilograms, if you are overweight, start taking care of yourself, choose the right clothes. And you will see that people will begin to perceive you differently. Give compliments, be interested in your person. And you will begin to like yourself more. The positive emotions received from such feedback will slightly revive your usual swamp and stimulate you to continue moving in the right direction.

I have used this advice many times in my life, and it works flawlessly. As soon as I feel that my emotions are dulling and my taste for life is disappearing, I urgently direct my attention to upgrading my image: I buy face masks, make an appointment with a cosmetologist, and start actively training. Usually a week is enough to bring yourself to your senses.

Travel

Traveling will help you shake things up a little. Buy a ticket and go somewhere you've never been before. If you don't want to, get over yourself. As you know, appetite comes with eating.

New stimuli will refresh your perception of reality, making it more positive and flexible. The more active you spend your time, the better. You can go rafting or camping. You can rush to the mountains. For lovers of urban tourism, I recommend going on a tour of European cities. It is very rich, informative and interesting.

You will return from your trip full of new impressions, thoughts, and plans. On this wave, try to row out of the swamp called “apathy” and never get there again.

Challenge yourself

Another way to shake yourself up is to do something you've always wanted to do but were afraid to do. For example, jump with a parachute, sing on stage, publicly admit something, etc. Think about what could somehow revive your emotions.

I propose to turn this action into a ritual and give it a symbolic meaning. Let it mark the end of your old life and the beginning of a new one, in which there is no place for apathy. The adrenaline rush you get from the process will help you get out of the hole.

Connect with passionate people

Spend as much time as possible around enthusiastic, active, sparkling people. They will charge you with their emotions and love of life. Their inner fire is burning, but yours is barely glowing. Borrow some fire for your energy stove.

Try to revive abandoned hobbies

In apathy, a person loses the desire to engage in even the most beloved activities. Nevertheless, traces of the emotions you experienced during the activity remain in your brain. Reviving the memory of them is much easier than trying to get emotions from an unfamiliar matter.

When you are faced with choosing a life-saving activity, give preference to those you already know and once loved.

The syndrome and symptom of apathy are of great interest to psychiatrists and neurologists, since, as a model of interdisciplinary research, they also affect the field of gerontology.

In the literature, the term “apathy” is used to describe various conditions. Thus, it can be a special personal characteristic, manifested in low social and professional activity and be an important characteristic of normal development and aging [1, 2], a clinical variant of depression [3, 4], a specific negative disorder in schizophrenia [5, 6], component of the clinical picture of somatic and neurological diseases (AIDS, Lyme disease, endocrine disorders, Pick's disease, Alzheimer's disease (AD), various dementias, etc.), part of neuroleptic-induced akinesia [7], a consequence of long-term treatment with SSRIs - “SSRI-induced indifference "[8-11]. It forms the basis of the psychopathological concept of “beautiful indifference” (la belle indifference) [12]. Apathy can be observed under certain conditions and in healthy people [13].

Below is a summary of neurological, mental and somatic diseases in which apathy can develop.

The first difficulty that arises in assessing apathy is the question of the term used to designate the disorder in question. Like any complex mental phenomenon, apathy does not have a single canonical definition, which leads to a variety of approaches to its interpretation.

For many psychiatrists, apathy is a symptom that involves diminished interests and emotions. It is usually considered a sign of depression or a nonspecific symptom of other diseases. This definition is given in many psychiatric dictionaries [14] and in the works of some authors [15]. When considering apathy in this way, its most characteristic features are lack of interests, feelings, indifference, flattening of affect and emotional insensitivity.

However, the absence of emotions or interests, according to R. Marin (1996) [16], does not fully correspond to its definition. Firstly, considering apathy in this understanding is not entirely correct, since emotions and interest, although related, are different concepts. Secondly, the term “apathy” is often used to describe patients whose condition differs significantly from this definition. Thus, if in schizophrenia the concept of apathy is applicable to patients with negative symptoms, for whom a lack of emotions and interests is a characteristic feature, then patients with depression may report a lack of interests, but at the same time show strong negative emotions (which cannot be regarded as their complete absence) or, conversely, be characterized by flattened emotional reactions, but retain interests and hobbies.

According to R. Marin [16], the emphasis in understanding apathy should be placed on a decrease in goal-directed behavior, which moves this term into the area of ​​motivation-related psychological functioning of a person. In this understanding, the term “apathy” represents an inversion of motivation, and in a clinical sense, a lack of motivation. At the same time, motivation includes not only issues of conscious and intentional mental act, but also unconscious psychological and biological processes responsible for goal-directed behavior. Lack of initiative, ambition or persistence, despite intact intelligence and physical capabilities, and decreased responsiveness to rewards or incentives are some of the main psychological characteristics that suggest impaired motivation. Given the central role of motivation in human behavior, diagnosing a patient as apathetic implies clinical deterioration at the level of dysfunction of many body systems, which is fundamental to adaptation processes [17].

Apathy is a common symptom of depression, which, along with anhedonia and motor retardation, is reflected in multivariate analytical studies [18, 19]. Apathy is often present in cases of depression in adolescence [20], anaclitic depression in children [21], depressive disorders of the involutionary period, as well as in elderly people [22-24], whose depression, as a rule, does not meet the criteria for major depressive disorder [25] and are considered subsyndromal depression or subdepressive disorders.

The range of opinions regarding the psychopathological structure, typology, and nosological affiliation of apathetic depression is extremely wide. Some authors [26-29] consider apathy as one of the main variants of depressive affect, the clinical picture of which is dominated by a lack of motivation with a drop in vitality, and the remaining activity partly masks the emerging “flaw” (outwardly, the lifestyle and nature of activity do not change significantly, but at the same time, all actions seem to lose their inner meaning, they are performed out of necessity, “out of habit,” “automatically”). Other researchers [30] point to apathy as “the initial, basic manifestation of endogenous depression” or the main personality trait of patients with depression [31]. Still others [32] focus on “motivational oppression” within the framework of a melancholy-apathetic decline in mood. S.Yu. Tsirkin [15] classifies apathy as a disorder of emotions, considering it a modification of anhedonia and sadness. The decrease in motivation is explained by the inability to anticipate the fruits of one’s activities, i.e. anhedonia. A.B. Smulevich [33], within the framework of the psychopathological model of depression, based on the correlation of psychopathological formations belonging to two categories that are polar in clinical significance, considers apathy as a symptom related to the negative spectrum of affective pathology with alienation phenomena.

Apathetic depression is assessed [34, 35] as one of the components of the structure of complex depression with various outcomes, or is considered [36-39] as unfavorable protracted forms of depression.

Since the 90s of the last century, much attention has been paid in the literature on psychiatry to apathy as an independent clinical disorder that can occur in many diseases of the central nervous system: stroke, PD, progressive paralysis, Huntington’s disease, AD, vascular and frontotemporal dementia [40 ]. It has been noted [41, 42] that dysfunction in the frontal-subcortical pathways, especially those connecting the ventromedial prefrontal cortex with the basal ganglia, plays a leading role in their pathogenesis.

The first definition of apathy as a syndrome occurring in various mental and neurological disorders was given by R. Marin [23, 43]. According to his definition, apathy is a syndrome of loss of motivation, i.e. initiatives not associated with emotional or cognitive impairment or decreased level of consciousness. To diagnose it, conditions such as abulia, akinesia and akinetic mutism, depression, dementia, and delirium must be excluded. The main signs of apathy, according to R. Marin, are 1) loss or weakening of motivation; 2) absence or weakening of spontaneous goal-directed activity” (lack of initiative, effort, persistence and productivity); 3) loss or weakening of purposeful cognitive activity” (lack of independent ideas, interest in news, events in the lives of friends or loved ones, one’s condition, financial problems); 4) loss or weakening of emotional reactions to positive and negative stimuli, dulling of affect, emotional indifference. R. Marin [16] identified several subtypes of the syndrome: cognitive, motor, sensory and affective. In his opinion, they are determined by various pathogenetic mechanisms. The author identified three directions for further research on apathy: 1) studying the patient’s behavior with the absence or decrease in its focus; 2) assessing the reduction in the level of emotional reactivity and emotional experiences; 3) assessment of cognitive functioning associated with the process of goal setting (lack of plans for the future, inability to form and put forward goals in any activity).

In contrast to the considered definition of apathy syndrome by D. Stuss et al. [44] paid attention to a decrease in spontaneous behavior (absence of a self-initiated reaction). R. Levy and B. Dubois [45] believed that apathy syndrome is not just a “decreased motivation,” which, in their opinion, is a subjectively interpreted, vague psychological concept. Studying the mechanisms of apathy, these authors identified three pathogenetic processes underlying its development: 1) “emotional-affective” (associated with a disruption of the relationship between emotional-affective signals and ongoing or upcoming behavior caused by damage in the midfrontal prefrontal cortex and associated with its areas - the limbic system within the basal ganglia); 2) “cognitive” (in which there are difficulties in developing a plan for current or upcoming actions), possibly due to disturbances in the dorsolateral prefrontal cortex and associated areas of the basal ganglia (“associative territory”); 3) “decreased self-activation” (an inability to “self-activate” thoughts or actions is noted, with a relatively intact ability to respond to motivating stimuli from the outside). This most severe variant, caused by lesions in the two areas of the brain mentioned above, was called “mental akinesia” by the authors.

In 2009, a special group of scientists was created in France [46] to develop diagnostic criteria for apathy syndrome that should be widely used in clinical practice. Based on the results of her work, apathy was defined as a decrease in motivation that persists for a long time and meets the following requirements: 1) the basic symptom (decreased motivation) must be present for at least 4 weeks; 2) two of the other three symptoms of apathy must be present—decreased goal-directed cognitive activity, decreased goal-directed behavior, and decreased emotional responsiveness; 3) identifiable functional impairment must be recorded. To facilitate the identification of apathy, it has been proposed to use a special scale, the Apathy Evaluation Scale (AES).

The identification of apathy syndrome led to the emergence of a large number of epidemiological studies aimed at studying its prevalence in various diseases. Thus, S. Starkstein et al. [47] examined 164 patients with PD. 52 (32%) of them met diagnostic criteria for apathy, 83% of patients with apathy had concomitant depression, and 56% had dementia. Only 5% of patients had apathy without concomitant depression or dementia. Similar results were obtained by other authors [48]: of 232 people with PD, 38% had apathy, 11% had it combined with depression and dementia, 10% had depression only, 6.5% had dementia only, and in 9% it was without depression or dementia. We also examined 175 patients with a newly diagnosed PD and 165 without it (controls). Apathy was diagnosed using the NPI (Neuropsychiatric Inventory) scale. The results of this study showed that of 22.9% of patients with PD, 37.5% had clear depressive symptoms. In the control group, not a single case of apathy was identified.

As a result of a 4-year follow-up [49] of 79 patients with PD, 29 showed no symptoms of apathy, 11 had apathy constantly, and 39 developed it during the observation period.

The connection between apathy and AD was established many years ago [50]. It was later found [2, 51-53] that its prevalence in this disease is high and amounts to 29-88%. One such study examined 150 patients with AD and found that 20% had disorders that met criteria for both apathy and depression, 7% had apathy only, and 31% had depression only. At the same time, apathy did not have a significant effect on the severity of depressive disorder, but was associated with more severe cognitive impairment [53]. In another study [54], in a study of 734 patients with AD, the prevalence of depression was 47.9% of cases, apathy - 41.6%, comorbidity of depression and apathy - 32.4%.

In vascular dementia, apathy syndrome was identified in 41% of cases [55]. S. Starkstein et al. [56], using a shortened version of the AES, found that 11% of patients with acute cerebrovascular accident had apathy, 11% had major depression with severe apathy, and 23% had depression only without apathy. Summary data on the prevalence of apathy are presented in Table. 1

.

It is currently believed [13] that neurological diseases of any etiology, the focal symptoms of which are associated with damage to the frontal lobes of the brain, lead to changes in personality and behavior associated with a lack of motivation, which can be designated as apathetic syndrome [13]. Multiple sclerosis, Pick's disease, other non-Alzheimer's type frontal dementias, frontal tumors, strokes and hydrocephalus, etc. are examples of pathological processes leading to the development of frontal syndrome [90]. Lack of initiative and persistence, decreased interaction with the social environment and lack of empathy, which are clinical manifestations of damage to the frontal lobes, contribute to the development of apathy syndrome. According to J. Campbell et al. [91] and M. Mega et al. [92], three subtypes of frontal syndromes are associated with apathy. Mesencephalic-frontal damage and destruction of the cingulate gyrus lead to the apathy syndrome itself. In dorsolateral frontal lesions, apathy is associated with impairment of executive cognitive abilities needed to plan and control goal-directed behavior. Patients with damage to the lateral orbitofrontal cortex experience personality changes (irritability, angry outbursts, or sexual disinhibition) that occur “against a background of abulia or apathy” [93]. The “indifference reaction” occurs in approximately 25% of patients with right hemisphere stroke [94, 95] and approximately 10% with left hemisphere stroke [94].

Being associated with a decrease in the functional activity of patients, apathy is of great importance for their adaptive behavior [96, 97], affecting the effectiveness of treatment of the underlying disease, aggravation of the condition and difficulty in caring for patients [98]. Apathy can accelerate the development of cognitive impairment in neurodegenerative diseases, worsen the quality of life, reduce patients’ awareness of their condition and motivation for treatment [53, 97, 99-101]. In the works of K. Pedersen et al. [48, 49] confirmed the association of apathy with more severe depressive symptoms and more severe motor symptoms in PD.

Despite the similar understanding of apathy by various researchers, there is still no unified approach to defining the corresponding term that would be acceptable for psychiatric and neurological practice. In DSM-IV [100], apathy is not included in the glossary at all and is mentioned only as a symptom that occurs in various disorders. Many authors [47, 102, 103] point out the insufficiency of diagnostic criteria for apathy and the need to create additional diagnostic scales.

From the point of view of clinical practice, it is significant that apathy syndrome and depression (including apathetic) often accompany each other, have similar manifestations [96] and therefore their differential diagnosis is required. This is especially true for elderly patients, in whom depression and apathy are variables that correlate with each other [22-24, 104]. Some studies have shown that apathy is associated with a high score on the depression scale [79, 88, 89, 105-107], while it is noted [25] that apathy syndrome is most often observed in the structure of subsyndromal depression, and some symptoms (decreased interests , psychomotor retardation, lack of energy) is common to these conditions. The accuracy of diagnosis of such subsyndromal depressions and their differentiation from apathetic syndrome are important for determining therapeutic tactics.

The work of O.S. is devoted to the issues of differential diagnosis of depression and apathy. Levin [108], in which the difference between apathy as an independent syndrome and depression is seen in the absence of melancholy and anxious affect in the first disorder. Differential diagnosis of depression and apathy according to O.S. Levin is presented in table. 2

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S. Ishii et al. [100] provide slightly different differential diagnostic criteria for the syndrome of apathy and depression, highlighting their features and common features (Table 3)

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The authors include a blunted emotional response, indifference, low social activity, decreased motivation and inertia as symptoms characteristic only of apathy.
For depression, differential diagnostic criteria are dysphoria, suicidal and pessimistic thoughts, feelings of guilt, and feelings of hopelessness. The most used differential zone in diagnosing either apathy or depression is the assessment of the patient's emotionality and his thinking.

J. Ishizaki et al. [40] consider depression to be a “disorder of emotion,” while apathy is a “disorder of impulse.” Patients with apathy show weakened emotional reactions in response to both positive and negative stimuli, while patients with depression react selectively to negative stimuli. A similar situation is observed in the area of ​​thinking: patients with depression are characterized by negative thoughts about the past, present and future [109], while with apathy there is a lack of such concern and a general decrease in interests. A decrease in interests in patients with depression is associated with a pessimistic assessment of their capabilities and the expectation of failure; in patients with apathy, on the contrary, the importance of the goals themselves is devalued. Patients with apathy rarely come to the doctor with complaints about their well-being; rather, this will worry those caring for such patients [16], while for patients with depression, their condition is subjectively intolerable, for which they usually seek help.

Some modern instrumental techniques such as positron emission tomography (PET) have been used to differentiate apathy from depression. PET studies have shown that in patients with early onset AD, the appearance of apathy is associated with a significant decrease in glucose metabolism in the left fronto-orbital regions, while the occurrence of depression is due to hypometabolism in the prefrontal dorsolateral region [110]. It has been suggested [111] that affective apathy involves neural pathways involving the cingulate cortex, amygdala, while cognitive apathy is hypothesized to reflect pathways involving the lateral posterior frontal cortex, and finally motor apathy involves pathways involving the motor components of the “motivational pathway” ( pedunculopontine nucleus, nucleus accumbens shell) or motor areas in the striatum. This suggests that apathy as a symptom of depression and apathy as a syndrome are clinically and anatomically independent [45].

Differential diagnosis of apathy within neurological diseases from apathy associated with depression is essential for the choice of therapeutic tactics. For example, antidepressants, especially those with a noradrenergic mechanism of action, may be effective for apathy that occurs as part of depression. At the same time, serotonin reuptake inhibitors have less effect, and in elderly patients, according to J. Ishizaki et al. [40], may even aggravate the manifestations of apathy.

When treating apathetic syndrome, it is important to select etiologically and pathogenetically substantiated treatment [40]. Several therapeutic strategies are being considered for this purpose. Prescription of antidepressants from the group of dopamine reuptake blockers (for example, sertraline and bupropion) leads to a reduction in vegetative symptoms and depressed mood, but the apathetic syndrome in the form of lack of interest, anergy, reduced emotional reactivity and initiative remains intact. In such cases, it is advisable to prescribe psychostimulants (methylphenidate or amphetamines) [112-114], dopaminergic agents and cholinesterase inhibitors [41, 91, 115]. This has been confirmed in a number of studies. Thus, in a randomized placebo-controlled trial [116] of methylphenidate for apathy syndrome in asthma, a marked improvement on the apathy scale was observed in 17 out of 57 patients. In another similar study [117], improvement was observed in 40% of patients. The effect of piribedil (a dopamine receptor stimulant) was studied in a placebo-controlled study [118] in 37 patients with AD. After 12 weeks of treatment, the total apathy score decreased by 34.6% in the piribedil group and by 3.2% in the placebo group. Described [119-121] are cases of marked improvement in the condition of patients after the use of ropinirole (D2/3 receptor agonist) in a patient with severe apathy after a stroke and selegeline in patients with apathy after severe traumatic brain injury. There is [98, 122] convincing evidence of the effectiveness of acetylcholinesterase inhibitors for apathy in AD and PD. Thus, rivastigmine in patients with severe and moderate apathy in PD and donepezil prescribed for asthma were superior in effectiveness to placebo [123, 124]. Another drug that has been proposed for the treatment of apathy is memantine, but it was not superior to placebo in a placebo-controlled study [125].

Regarding the effectiveness of non-pharmacological strategies for apathy syndrome, data are rather scattered. A. Lane-Brown et al. [126], having summarized the relevant data, concluded that in these cases it is preferable to use cognitive techniques that were most effective in patients with moderate cognitive impairment. In patients with severe dementia, good results have been reported with music therapy [127]. Multisensory stimulation has a certain effect in patients with apathy in the late stage of dementia [128].

Thus, research interest in the problem of apathy has increased significantly over the past decades, which is associated with significant progress in understanding some of the physiological mechanisms of the development of this clinical phenomenon, in particular in the aspect of frontal-subcortical dysfunction. Consensus in the definition of apathy and standardization of its diagnostic criteria are essential, promoting homogeneity in the conduct of relevant research, and differential diagnosis with apathetic depression is the key to choosing adequate therapeutic strategies. Treatment of apathy requires the development of interdisciplinary approaches based on an understanding of its biomedical (including neuroanatomical, psychophysiological), clinical and psychological aspects. The lack of clinical guidelines for patients with apathy may be explained by the lack of large, placebo-controlled clinical trials of potentially beneficial pharmacological and psychological interventions. Identification of modifiable factors in the development of apathy can lead to the development of effective preventive programs to prevent it.

Who needs to fear apathy?

Not all people are equally susceptible to apathy. An emotionally unstable person is more likely to be susceptible to this condition, unlike a balanced person. There are several types of people at risk:

• emotionally excitable, impressionable;
• suspicious;
• maximalists;
• perfectionists;
• hypochondriacs;
• people with low self-esteem;
• teenagers;
• those who have just retired (cannot find a new occupation, experience a lack of communication);
• a responsible person who took on a lot but couldn’t cope;
• women, especially during pregnancy.

If you find your type on this list, then try to pay more attention to yourself and relax more often. We sometimes spend so little time on ourselves.

How can we overcome apathy?

Staying in a state of apathy for a long time will not end well. In some cases, the problem grows like a snowball. New external stimuli may be superimposed on an existing situation. Very often it happens that the reason for this whole “holiday” is not one, but a whole bunch.

But we cannot always organize a trip to the doctor quickly. Moreover, knowing our “love” for visiting medical institutions. What can we do on our own? Many things. Often a person himself understands what bothers him, but does not always have the opportunity to remove it from his life. Sometimes it’s impossible to even think about it without shuddering.

This may not be a favorite, hateful job - even the thought of which plunges you into a slight shock. And changing it is either very scary or really impossible. The first option is a little easier. We must still try to find an alternative. I agree – situations are not simple.

If there are absolutely no options, then you can try to change your attitude towards this work. You know that at this time you need it for such and such a reason and there is no alternative. So try to distance yourself from irritating factors, put a barrier.

This is also not easy, but since there is no replacement at the moment, you can try. Some meditation practices and auto-training can help. And you still need to look for an option to replace this workplace.

Definition of a concept in simple words

Apathy is a psycho-emotional state that is characterized by a complete loss of interest in life and lack of motivation. The term “apathy” comes from the ancient Greek word apatheia, which translates as “impassion.”

In a state of apathy, a person is indifferent to everything: work, hobbies, entertainment, food, communication. What previously evoked positive emotions ceases to be of interest with the onset of apathy. No events or stimuli can cause an emotional reaction in a person. This is why apathy is sometimes called a rehearsal for death.

Apathy is not considered an independent deviation. It is included in the symptom complex of many diseases. The causes of apathy are different - from quite harmless to quite serious. We will definitely look at them, but first we will deal with the symptoms.

Causes of apathy

All the reasons why apathy appears can be divided into two large groups: external and internal.

External causes are factors that act on the brain from the external environment or from other areas of the body. What causes apathy in such people:

1. Severe stress - loss of a loved one, dismissal from work, man-made or natural disaster; may lead to the development of post-traumatic stress disorder.
2. Emotional burnout - chronic stress, work with high responsibility, stressful lifestyle; there is a high probability of developing neurasthenia, there may be reactive depression.
3. Somatic diseases are diseases of organs that indirectly affect the brain; for example, vascular atherosclerosis, which causes stroke
4. Endocrine disorders.
5. Side effects of medications: drugs that lower blood pressure, sleeping pills, contraceptives.

Important
Apathy can be a symptom of a number of mental and neurological disorders: depression, schizophrenia, Alzheimer's disease.

All of the above is not uncommon for a person who lives in a modern city. The emotional reaction in the form of situational apathy in these cases is a variant of the norm and goes away with the elimination of the stress factor.

Why does apathy set in towards everything that happens when there are no external causes or reasons? Here internal reasons come to the fore. Apathy can be a symptom of a number of mental and neurological disorders: depression, schizophrenia, Alzheimer's disease.

Apathy with depression. Apathy can occur both in major depressive disorder and in dysthymia and masked depression. The latter is a type of depression in which somatic complaints (pain in the spine, itching, breathing problems) come to the fore in the absence of objective signs of the corresponding diseases. These are the so-called “masks” of depression; such conditions often cause difficulties in making a diagnosis.

Apathy in simple schizophrenia. This form of schizophrenia is characterized by slow progressive development and loss of natural mental functions. Emotional coldness, pathological indifference, and thinking disorders come to the fore. Delusions and hallucinations are not observed at all or hardly at all, which is why the disease can go undetected for a long time. Without the intervention of a specialist, it leads to complete social isolation and personality disintegration.

Apathy in Alzheimer's disease. Alzheimer's disease is a neurodegenerative disease that primarily affects the frontal lobes. The occurrence of apathy is associated with damage to these particular parts of the brain, as well as with the development of dementia. Apathy develops in most patients with this disease.