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Avolition in Schizophrenia: 4 Things You Need to Know
Posted on Oct 31, 2019 in Symptoms, Treatment | Comments Off on Avolition in Schizophrenia: 4 Things You Need to Know
When people think of schizophrenia, they often immediately think of hallucinations and delusions. Those are, in fact, the main symptoms of schizophrenia. But some people also experience avolition. This article will help you understand what it is, how it is treated, and how friends or family members can help someone with schizophrenia who is experiencing it.
Avolition is a lack of motivation to do even simple, everyday tasks, such as caring for personal hygiene or eating meals. It is considered a negative symptom of schizophrenia because it refers to skills or actions that a person is lacking or unable to do. It differs from apathy. People experiencing apathy just don't care about doing something. People with avolition want to do things but cannot find the energy or motivation they need to carry out the tasks.
What Are the Signs of Avolition?
Lack of Eye Contact
The person may not make eye contact while speaking or being spoken to. This can also be a symptom of other conditions, such as autism. In the case of autism, eye contact can be uncomfortable and can distract the person from what they are saying or hearing. In the case of avolition, the person may just not be able to bring themselves to meet someone else's eyes.
Speech Changes
The person with avolition may speak haltingly or speak much less frequently than they used to. They may have difficulty finding the energy to put their thoughts into words. They may answer questions with one or two words, or not answer at all.
Failure to Take Care of Responsibilities
The person may fail to pay their bills because they cannot motivate themselves to go through all the steps required to do so. They may refuse to answer their phone, or avoid making phone calls. They might not go to their appointments or may fail to make follow-up appointments. They may not show up for scheduled events or activities. They may stop taking care of their home, or begin neglecting their children or pets.
Neglecting Personal Hygiene
The steps required to take care of themselves may be overwhelming, so the person may avoid them altogether. They may not shower or bathe. Their clothes may be dirty, or they may remain in their pajamas. Their hair may appear unkempt.
Refusal to Participate in Activities
A person experiencing avolition may stop doing the things that they used to enjoy. They may not show up to gatherings with friends or family members. They may stop attending school or work functions. If they do participate in activities, they may not show any enthusiasm.
How Is It Treated?
One of the complications of avolition is that it is difficult to treat with medication. Antipsychotic medications control the positive symptoms of schizophrenia. This means they are meant to eliminate or reduce unwanted thoughts and behaviors, such as hallucinations, delusions, or agitation. There are currently no drugs that are specifically able to control the negative symptoms of schizophrenia, such as avolition. In fact, some antipsychotic medications can even increase avolition.
"I was feeling unmotivated to pay my bills, so I did not pay my bills. The consequence was that my electricity got turned off."
This does not mean that avolition cannot be treated at all. Psychotherapy can be helpful. Cognitive Behavioral Therapy, or CBT, has been shown to have positive results. In CBT, patients learn how their thoughts and feelings influence their behaviors and understand the consequences of those behaviors. For instance, one might realize, "I was feeling unmotivated to pay my bills, so I did not pay my bills. The consequence was that my electricity got turned off."
Making that connection may help them find the energy to do tasks despite their avolition. CBT can also be used to help people practice the skills needed to do activities such as going to a job interview, going to the doctor, interacting with friends and family members, etc.
Cognitive Enhancement Therapy is another newer type of therapy that can be used to treat avolition and other negative symptoms of schizophrenia. In this type of therapy, patients work in pairs to complete cognitive tasks on a computer. They also participate in highly structured small groups that focus on social and cognitive skills.
One added challenge is that people experiencing this may lack the motivation to make, or go to, their therapy appointments. This can make treatment difficult.
How Can I Help Someone Experiencing this?
If you are a friend, family member, or caregiver of someone with schizophrenia who is experiencing avolition, there are several things you can do to help them.
Help Them Create a Schedule
Make a timetable to remind them of even simple, everyday tasks. The schedule can include things such as meals, personal hygiene, taking medication, and bedtime.
Make Sure They Take Their Medication
Even though medication may not help with avolition, it is important for them to take it to control other symptoms of schizophrenia. Because people with avolition may not be motivated to get up and take their medication, they may neglect to do so. Help them set up a reminder on their phone, using their phone's timer or a medication reminder app. You could even call them or check in on them at a certain time each day to make sure they've taken it.
For people who consistently forget or refuse to take their medication, some schizophrenia medications like Risperdal, Haldol and Olanzapine can be administered with a periodic injection at the doctor's office. Many people with schizophrenia prefer this method and appreciate the easiness of injections.
Offer to Make a Doctor’s Appointment for Them
If the avolition is a new symptom, the person should discuss it with their doctor. But the avolition makes them less likely to pick up the phone to make an appointment with their doctor. So, offer to make the phone call for them. You could say, "I think you should talk to your doctor about this. Would it help if I called and made the appointment right now?" You could also offer to drive them to their appointment and even attend the appointment with them to help them communicate with the doctor.
Keep Communication Simple
The person may need help with tasks such as paying their bills or reading their mail. Help them understand these tasks. Keeping instructions and explanations simple may help them focus long enough to complete, or at least participate in the completion of, important tasks.
Remember That They Are Not Just Lazy
It can be frustrating to see someone neglecting their self-care and responsibilities. It can be tempting to tell them to stop being lazy or beg them to try harder. Keep in mind that the person does not have control over their symptoms. Telling the person to just get up and take care of things can be similar to telling a person with two broken legs to just stand up and walk across the room. They want to, but they are unable to.
Keep Them Company
The person with avolition usually is not avoiding spending time with friends and family members because he or she doesn't care about them. He or she often does not have the energy and motivation to go through the series of actions involved to spend time with them. For example, even a simple activity such as meeting a friend for coffee would involve waking up on time, getting washed up, changing clothes, putting on shoes, finding a purse or wallet, finding car keys, driving to the coffee shop, socializing for an hour, and then driving home.
These may seem easy to most people, but for someone with avolition, all of these tasks can seem insurmountable. Consider going to the person's house to spend some time sitting with them, even if all you do is watch TV without talking. Or bring them a meal and eat with them. Let them know you care about them. This act of kindness will mean a lot.
Help Them Get Help
If the person's avolition symptoms are persistent, they may need more help than you are able to provide. There are services available, such as Community Supported Services and Assertive Community Treatment (ACT) teams, that can help support people with serious and chronic mental health conditions. The person may be eligible for assistance with things like keeping their house clean, making meals, and getting to appointments. ACT teams help individuals with schizophrenia develop daily living skills and even make sure they take their medications every day.
However, if they are dealing with avolition, they are unlikely to have the mindset to be able to figure out how to get these services set up for themselves. If you have schizophrenia and struggle with avolition, ask a close family member or friend to help you connect with these organizations. Your local National Alliance on Mental Illness (NAMI) can be a good resource for helping you get supportive services set up.
While many of the positive symptoms of schizophrenia can be very difficult to deal with, negative symptoms such as avolition can be just as harmful, or more so. Learning as much as you can about avolition can be a first step in fighting it. Be aware of the symptoms of avolition and realize that it is different from laziness or apathy. If you are a caregiver or friend of a person dealing with avolition, find ways to support them and let them know that you care.
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