Thant Thida, Yager Joel
Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado.
J Nerv Ment Dis. 2019 Sep;207(9):707-714. doi: 10.1097/NMD.0000000000000860.
Clinical observations regarding apathy and motivation derived from many psychiatric and neurological conditions have generated divergent descriptions of apathy-related syndromes. Stimulated by complex cases presenting with prominent apathy, uses of the term "apathy" and "related phenomena" in the Diagnostic and Statistical Manual of Mental Disorders, diagnostic proposals for apathy as a syndrome and disorder of motivation, Research Domain Criteria (RDoC) systems governing motivational processes, and their clinical intersections are reviewed. Clinical apathy and associated dysfunctions can be addressed using constructs suggested by the RDoC domain of Positive Valence Systems, including approach motivation and component processes of reward valuation, effort valuation/willingness to work, expectancy/reward prediction error, and responses to reward and reward learning. Although apathy syndromes have been validated, defining potentially distinct disorders of motivation (not simply subordinated to mood, psychotic, cognitive, or substance use disorders) will require additional research to better delineate etiology and pathogenesis, predictive validators, reliable diagnostic methods, treatments, and demonstrations of use for these diagnostic proposals.
源自多种精神和神经疾病的关于冷漠和动机的临床观察，产生了对与冷漠相关综合征的不同描述。受表现出明显冷漠的复杂病例的启发，本文回顾了《精神疾病诊断与统计手册》中“冷漠”和“相关现象”的使用情况、将冷漠作为一种动机综合征和障碍的诊断建议、管理动机过程的研究领域标准（RDoC）系统及其临床交叉点。临床冷漠及相关功能障碍可使用积极效价系统RDoC领域提出的概念来处理，包括趋近动机以及奖励评估、努力评估/工作意愿、预期/奖励预测误差和对奖励及奖励学习的反应等组成过程。尽管冷漠综合征已得到验证，但要定义潜在的不同动机障碍（不只是从属于情绪、精神病性、认知或物质使用障碍），还需要更多研究来更好地描述病因和发病机制、预测验证指标、可靠的诊断方法、治疗方法以及这些诊断建议的应用证明。
