Apathy: Case Reports and a Selected Review of the Literature

By Ungvari, Gabor S.; Chiu, Helen F. K. et al. | Hong Kong Journal of Psychiatry, August 1997 | Go to article overview

Apathy: Case Reports and a Selected Review of the Literature


Ungvari, Gabor S., Chiu, Helen F. K., Lam, Linda C. W., Hong Kong Journal of Psychiatry


SUMMARY

Syndromes if apathy, demoralization and social breakdown in the elderly are long known but neglected concepts recently re-emerging, as differential diagnostic possibilities to depression particularly among the elderly. The definition and brief description of these largely ignored syndromes are provided together with two case vignettes of apathy to illustrate the diagnostic difficulties in geriatric depression.

Key words: geriatric depression, demoralization, apathy, social breakdown in the elderly

INTRODUCTION

Reliable ascertainment of geriatric depression has far-reaching implications for several reasons. First, depression is not only a socially disabling psychiatric condition but it significantly contributes to an Increase In mortality (Depression Guideline Panel, 1993). Second, depression affects around 10-15% of the general population in the western world (Tiemens, et al, 1996) and at least 3 % of the population in Hong Kong (Chen et al 1993). Last, but not least, depression is a tormenting subjective experience causing immeasurable suffering to patients and also their relatives. It is, therefore, of utmost importance to keep abreast with the new developments in the diagnosis of depression.

This paper attempts to explore a diagnostic conundrum at the borderland of depressive illness in the elderly. While dementia has been, and still is, the main differential diagnostic problem in geriatric depression (McLoughlin & Levy, 1996), recently increasing attention has been paid to apathy (Marin, 1991), demoralization (Figueiredo, 1993) and the social breakdown syndrome (Radebaugh et al, 1987). These psychopathologlcal entities are frequently encountered in geriatric and psychogeriatric clinical practice but probably go unnoticed or treated as depression since they are not well-known enough among even psychiatrists let alone geriatricians and general practitioners. The aim of the following case histories is to highlight the difficulties, in the diagnosis of geriatric depression and to call attention to the clinical concepts of apathy, domoralization and the social breakdown syndrome.

CASE REPORTS

CASE 1

Ms A, a 79-year old widowed Chinese housewife, was admitted from a nursing home for lack of motivation to the extent of neglect of personal hygiene, poor food intake, paucity of spontaneous speech and retarded movements. She preferred to stay in bed all day. When prompted she related multiple somatic complaints like headache and epigastric and back pain. In an uncertain and inconsistent manner she mentioned spirits disturbing her. No obvious psychosocial stressor was ever identified; she had a long and apparently happy marriage and up to recently she had lived an emotionally balanced and financially secure life. Following the death of her husband, her three daughters provided good support.

Over the past 3 years Ms A had three admissions to our psychogeriatric unit with similar presentation. In addition to an always prominent core symptomatology of loss of motivation, vague somatic complaints and motor slowness, she variously presented with a number of short-lived symptoms of insomnia, loss of appetite or hyperphagia, dysphoric mood and what appeared to be attention-seeking behaviour. She became increasingly detached even from her immediate family. During all her admissions, although alert, fully oriented and coherent in speech, she refused to comply with psychological testing.

Apart from longstanding hypertension well-controlled with 40 mg/day nifedipine, Ms A's medical history was, unremarkable. Physical examination yielded no abnormal findings. Routine laboratory tests including full blood picture, liver, thyroid and renal function tests, serum electrolytes and VDRL were within normal limits. EEG showed no abnormality. During her first admission a CT scan of the brain revealed generalized cerebral atrophy and hypodense areas in the right basal ganglia suggestive of old infarcts. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Apathy: Case Reports and a Selected Review of the Literature
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.