Barrett K
Department of Psychiatry, School of Postgraduate Medicine and Biological Science, Stoke on Trent, UK.
J Neurol Neurosurg Psychiatry. 1991 Aug;54(8):718-21. doi: 10.1136/jnnp.54.8.718.
Abulia refers to an impairment of will, or the inability to initiate behaviour and action. There are reports of successful treatment of akinetic mutism, the most severe form of abulia, with bromocriptine. Four case studies are presented describing the successful treatment of abulia at a lesser severity than akinetic mutism with bromocriptine. Abulia was caused by brain damage due to alcohol in two cases, Wilson's disease and basal ganglia infarct in one each. Maximum bromocriptine dose varied from 25-70 mg. All improved considerably. Withdrawal or reduction of medication in three produced deterioration. The prescription of a neuroleptic drug had a similar effect in the fourth. One patient with a previous history developed a depressive relapse and so the drug was withdrawn and lisuride introduced. This produced a similar improvement. These cases highlight the value of identifying the syndrome of organic abulia and suggest that dopamine agonists may have a place in its treatment, though controlled studies are needed.
意志缺失是指意志受损，即无法发起行为和行动。有报告称，使用溴隐亭成功治疗了运动不能性缄默症（意志缺失最严重的形式）。本文介绍了四个病例研究，描述了使用溴隐亭成功治疗比运动不能性缄默症程度较轻的意志缺失。两例意志缺失由酒精导致的脑损伤引起，另外两例分别由威尔逊氏病和基底节梗死引起。溴隐亭最大剂量从25毫克至70毫克不等。所有患者均有显著改善。三例患者停药或减药后病情恶化。第四例患者使用抗精神病药物也产生了类似效果。一名有既往病史的患者出现抑郁复发，因此停用该药并换用利苏瑞。这也产生了类似的改善效果。这些病例凸显了识别器质性意志缺失综合征的价值，并表明多巴胺激动剂可能在其治疗中占有一席之地，不过仍需要对照研究。
