[newtus]

Treating Apathy in Schizophrenia

by Jessica Hart, State Advocacy Manager
NAMI’s Ask the Doctor teleconference is a monthly series hosted by NAMI's Medical Director, Dr. Ken Duckworth. Typically, he is joined by another mental health professional or advocate who in turn presents on a topic in his or her area of expertise. Each month, two such calls are hosted; one focuses on adult issues, the other on child and adolescent issues.
In this month’s dialogue on adult issues, Dr. Stephen Marder, M.D. discussed treating apathy in schizophrenia. Dr. Marder defines apathy as a disinterest in daily activities like socializing, working and going to school. He spoke about the causes of apathy, negative symptoms and management strategies.
Causes of Apathy

• If a person is experiencing auditory or visual delusions and paranoia—“psychosis”—they are less likely to engage in day-to-day activities because the voices and suspiciousness are controlling the majority of their life.
• A person living with schizophrenia can still experience depression even when they are in recovery—the person will show signs of apathy, which can be attributed to the depression.
• Excessive doses of antipsychotics can contribute to apathy.

Negative Symptoms Associated with Schizophrenia

Between 40 and 50 percent of people living with schizophrenia who have been treated and are recovering will show evidence of negative symptoms. Negative symptoms include:

• Emotional flatness or lack of expressiveness.
• Inability to start and follow through with activities.
• Lack of pleasure or interest in life.

One distinction of some people living with schizophrenia is they do not expect enjoyable activities to give them pleasure, which likely causes them to not engage in pleasure-seeking behaviors. One example Dr. Marder uses to describe this behavior is through a brownie analogy. If a person living with schizophrenia was given a brownie they can enjoy eating it, but they do not anticipate the pleasure.
Management Strategies

• New drug treatments are nearing approval, which will help address negative symptoms.
• Psychosocial treatments:Cognitive Behavioral Therapy (CBT) has shown positive results in treating apathy and negative symptoms.
• Antidepressants will help improve apathy in some people.

for you guys

[faerie_moon_x]

One thing I'd like to get to document on myself more is my processing issues with emotions. Sometimes I seem to be fine other times it's like a slowness. I think it's something to do with my depression side. I know I have have a flat face that often makes people think I'm not happy or having no enjoyment, when actually that's not the case. Other times I feel I have too much expression but that is more due to mania. It's very weird and confusing.

[newtus]

ive always been told im slow acting. you know? idk how to explain what i mean.

[faerie_moon_x]

I get told I'm slow a lot too. Either I'm told I'm too slow or I'm rushing which causes errors.

Thanks for this, newtus!! That was enlightening. Negative symptoms are the hardest to deal with -- everyone should know this information.

[faerie_moon_x]

I was reading today that cognition problems especially slow processing, memory, and difficulty with focus are psychosis symptoms. I wonder if they go along with the flat emotions?

[emmamental]

i was reading an article on the main site that says smoking actually helps with negative symptoms of schizophrenia.

[newtus]

Originally Posted by emmamental

i was reading an article on the main site that says smoking actually helps with negative symptoms of schizophrenia.

yea from personal experience i would say it does a bit

@Faerie: Do you have the reference for what you read? I'm interested in learning more about cognitive problems in psychosis (I have a thread about it if you could post it there?) Thanks so much!

*Willow*

[faerie_moon_x]

Originally Posted by WeepingWillow23

@Faerie: Do you have the reference for what you read? I'm interested in learning more about cognitive problems in psychosis (I have a thread about it if you could post it there?) Thanks so much!

*Willow*

Erk... I want to give you the link but I can't remember my exact wording on google that lead me to the article. Blah! Stupid memory issue...

I also lost my car/work key thanks go my lovely cognition issues this weekend. Isn't that lovely?

Oh I'm sorry Faerie No worries, I'll try being more creative on google

*Willow*

[faerie_moon_x]

Oh, oh, I found it LOL!

Psychotic Disorders Symptoms, Causes, Treatment - What are psychotic disorder symptoms and signs? - MedicineNet

It stuck out to me because it was the first time I had ever seen cognitive problems listed as a symptom this way before. I've looked up a lot of things.

There are lots of pages. I didn't read them all. LOL...

Thanks so much Faerie!

*Willow*

Also, just a note? I used to take Benadryl a lot to make myself sleep/feel better when I'd go all nuts back when it was worse than it is now. And I noticed the day after, I wouldn't feel as "zonked" as I would if I didn't take it during an episode... Between talking with Costello how her son had a Benadryl problem & looking stuff up online -- evidently it lowers the serum level of medications if they are the cause of the negative symptoms. And it is also anticholinergic; supposed to "correct" dopamine similarly to how an antidepressant corrects norepinephrine/seratonin ratios, so it might actually HELP cognition if it's the instability or imbalance of neurotransmitters at play. It also notably decreases anxiety -- enough it can't be used as a placebo in trials. So if anxiety triggers slowness or episodes, it seems like a reasonable option. Nicotine is a nicotinic cholinergic agonist, so it helps in a similar but opposite way.