I think this presentation will be helpful for the medical students.

1. Amotivational Syndrome
Dr. Md. Waliul Hasnat SajibDr. Md. Waliul Hasnat Sajib
MD(Resident)MD(Resident)

2. Definition
Amotivational syndrome is a chronic psychiatric
disorder characterized by a variety of changes in
personality, emotion and cognitive functions
such as lack of activity,inward
turning,avolition,apathy,inchoherence,bluntted
affact,inability to concentrate and memory
disturbance.

3. HISTORY:
The syndrome was first described among those
patients with a history of longtime cannabis use in
the 1960's.Since then, there have been several
reports describing similar psychiatric disorders to
amotivational syndrome among patients with the
history of some other psychoactive substances use.
Therefore, the syndrome has been recognized as
one of the common psychiatric conditions that
might develop in patients with a history of any
psychoactive substance use.

4. The Phrase Amotivatinal Syndrome was first used
in 1972 by Dr. Louis west,chairman ,dept of
psychiatry at UCLA.
AM more likely to develop in adolescent than in
older people.

5. Causes:
No definite cause
No heridity.
Stressful event
OTC cough syp
Medical condition(Brain injury)
In chronic Schizoprenia
Mainly Psychoactive Substances.

6. In Chronic schizoprenia :
In Chronic schizoprenia toxic metabolites of dopamine
causes Nor adrenergic neurons damage results in a
flattening of basic motivations and an incapacity to
achieve higher cortical motivations and to perform high
cortical activities.As the source of the syndrome a
pathological gene might be involved.

7. In long term use of SSRIs therapy :
In long term use of SSRIs therapy the presence of
apathy in the absence of depression referred to as
Antidepressent Apathy Syndrome(AAS).It is a
unique syndrome distinict from depression.Its
recognition is very difficult.Usually AAS is late
occuring,dose related and reversible.

8. In AAS:
Serotonin increse in brain.serotonin is inhibitory.
Serotonin directly affects frontal lobe projections.
SSRIs indirectly modulate frontal lobe activity by
inhibiting the release of dopamine.

9. Psychoactive substances:
Are Chemical substances that crosses the blood brain barrier and
acts primarily upon the central nervous system where it affects
brain function resulting alterations in
perception,mood,conciousness,cognition and behaviour. Example:
Depressant: SSRI such as:
Fluoxetine
, Duloxetine
Coccaine or Marijuana
Stimulants
Narcotics or opiates
Psychedelics
Inhalants
Methamphetamine

10. Biological basis of amotivational
syndrome:
Several studies using MRI, SPECT or neuropsychological
measures have revealed :
•White matter changes
•Hypoperfusion in the frontal cortex of the brain actually
medial frontal lobe.
•Impairment of frontal lobe function.
Those findings suggest that amotivational syndrome might
be related to "hypo-frontality" of the brain.

11. It occures most often people who lack the normal amount of
serotonin and individuals who engage in smoking and ingesting
marijuana.
The existance of this syndrome has been mixed.But it is
generally believed that amotivation is rarely caused by a drug
alone.It is instead the result of a complex interaction among the
effects of the drug,the personality and experience of the
individuals and the context in which the drug is repeatedly
administered.

12. Symptoms:
Reduced energy :
The affected tends to become less energetic and
their attention is not full when you communicate
with them.
Passivity at work:
The person may become passive at work. Their
motivational force is not that effective that can
assist them to work properly

13. Symptoms(cont….)
Introversion:
The affected tends to become an introvert. This is
defined as keeping oneself less sociable and is
preoccupied to own thoughts. They avoid social
interactions as much as possible.
Reduced desire to work:
They tend to avoid competition, even though it is a
healthy one.

14. Symptoms(cont…)
Apathy:
The patient tends to be apathetic. They show restricted
emotions and feelings when the situation requires more
from them. Interest to such concerning event is somehow
neglected by the affected. This simply means that the
client is indifferent with every situation or scenario.

15. Symptoms(cont….)
Reduced concentretion:
Their concentration is disturbed. Concentration becomes
reduced in social activities.
Reducced motivation:
Their motivational force is not effective that can assist them
to work properly.

16. Symptoms(cont…)
Impaired desire to participate in social
interactions:
They Avoid social interaction as much as
possible.They are less sociable and is
preoccupied to own thoughts.

17. Treatment
No specific Treatment for amotivational syndrome.
Some treatment which is aimed in alleviating the said
manifestations by providing preventive measures.
Since there is no definite cause of the syndrome, the
following are proposed as helpful in the treatment
course:
Medication
Psychological treatment
Councelling

18. Medication:
Medication that increase serotonin level
such as:
•Some neuroleptics
•Tramadol(serotonin and norepinephrine
are profundly impacted by tramadol)
•Anti depressants

19. AAS caused by SSRIs can be managed by three ways:
•Decrease SSRis dose until apathy subside.
•Augment SSRIs with stimulant such as TCA drugs or
antidepressent with noradrenergic or dopaminergic
activity such as Bupropion.
•Switch to different class of antidepressent.MAO
inhibitors and TCA drugs do not cause AAS.

20. Antipsychotic drug Olanzapine can be use.
It enhence dopamine in the frontal cortex by
blocking serotonin induce inhibition of
dopamine.

21. Psychological treatment:
Emotional support from the family members
and close individuals of the affected should be
provided. This can assist the client in the
process of recuperation and in dealing with the
syndrome. As the syndrome tends to attack the
client, it is ideal that his or her close relations
are supportive in the healing process.
Spending time with family and friends who are
positive and motivated.

22. Councelling:
Behavior therapy is provided to clients in
order to reduce the stress and anxiety they are
experiencing. As these behavioral problems
may have caused the condition, they are
assisted with techniques that deal with these
unhealthy emotions. They are taught of
relaxation techniques and self-control
methods which are very helpful in the
process.

23. Preventive meassures:
Lifestyle change is a must. There are a number of unhealthy
practices which needs attention. Use of prohibited drugs
should be stopped in order to have a clean lifestyle and avoid
the probable existence of amotivational syndrome. The use of
cannabis should not be practiced.
Compliance with the treatment regimen and prescription
should be followed. With this, the patient can be assisted in
every way that he or she has difficulty with like in changing
one’s lifestyle. The follow up check-ups can also assist the
client to fast recovery and concerns about the treatment can be
taken action directly.

24. Preventive meassures(cont…)
When the client is a known cannabis user, they shall be a
required to attend a special rehabilitative therapy. This shall aim
on eradicating the addiction and to help the client to completely
lose the habit. The abuse of other drugs shall also be treated with
this therapy.
Psychoanalysis is also offered to clients who have problems with
addiction. This can help them in dealing with their emotional
problems.

25. The effect is permanently reversible and
normal motivational development can be
obtained by a 3-12 month period of
abstinance (in monkeys -- no time period for
humans is available.)
Prognosis is good.
Conclusion
Laboratory studies of humans and
primates offer very little support for
amotivational syndrome.

26. This is the end of the presentation