Treating Apathy in Schizophrenia

Aug 27, 2013

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.

Dr. Marder currently serves as the Director of the VISN 22 Mental Illness Research, Education Clinical Center (MIRECC) for the Department of Veterans Affairs and the Director of the Section on Psychosis at the UCLA Semel Institute for Neuroscience and Human Behavior.