Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group.

摘要: Background:Apathy is a very common behavioural and psychological symptom across brain disorders. In the last decade, there have been considerable advances in research on apathy motivation. It thus important to revise diagnostic criteria published 2009. The main objectives were to: a) definition of apathy; b) update list dimensions; c) operationalise criteria; d) suggest appropriate assessment tools including new technologies.Methods:The expert panel (N = 23) included researchers health care professionals working disorders apathy, representative regulatory body, pharmaceutical industry. revised for developed two-step process. First, following standard Delphi methodology, experts asked answer questions via web-survey two rounds. Second, all collected information was discussed occasion 26th European Congress Psychiatry held Nice (France).Results:Apathy defined as quantitative reduction goal-directed activity comparison patient’s previous level functioning (criterion A). Symptoms must persist at least four weeks, affect three dimensions (behaviour/cognition; emotion; social interaction; criterion B). Apathy should cause identifiable functional impairments C), not be fully explained by other factors, such effects substance or major changes environment (Criterion D).Table 1Apathy 2018.CRITERION A: A either behavioral, cognitive, emotional these areas. These may reported patient himself/herself observation others.CRITERION B: presence 2 3 period weeks present most time B1. BEHAVIOUR & COGNITION Loss of, diminished, behaviour cognitive evidenced one following: General activity: has reduced home work, makes less effort initiate accomplish tasks spontaneously, needs prompted perform them. Persistence He/she persistent maintaining an conversation, finding solutions problems thinking alternative ways them if they become difficult. Making choices: interest takes longer make choices when different alternatives exist (e.g., selecting TV programs, preparing meals, choosing from menu, etc.) Interest external issue: reacts news, good bad, doing things Personal wellbeing: interested his/her own wellbeing personal image (general appearance, grooming, clothes, etc.). B2. EMOTION emotion Spontaneous emotions: shows spontaneous (self-generated) emotions regarding their affairs, appears events that matter him/her people he/she knows well. Emotional reactions environment: expresses reaction response positive negative well go responding jokes, program movie, disturbed do would prefer do). Impact others: concerned about impact actions feelings around him/her. Empathy: empathy others becoming happy sad someone sad, being moved need help). Verbal physical expressions: verbal reveal states. B3. SOCIAL INTERACTION diminished engagement interaction initiative: initiative spontaneously proposing leisure activities family others. Environmentally stimulated interaction: participates less, comfortable more indifferent suggested Relationship with members: members know what happening them, meet arrangements contact them). likely withdraws soon it Homebound: He /She stays frequently than usual getting out people.CRITERION C symptoms (A - B) clinically significant impairment personal, social, occupational, areas functioning.CRITERION D are exclusively due disabilities (e.g. blindness loss hearing), motor disabilities, consciousness, direct physiological drug abuse, medication), environment.Conclusions:The provide clinical scientific framework increase validity construct. This also help pave path interventional target.