Case ReportsA Case of Abulia From Left Middle Cerebral Artery Stroke in an Adolescent Treated Successfully With Short Duration OlanzapineConnor, Andrew T. DO; Crawford, Alex MBBS; Levy, Rebecca J. MD, PhD; Schneider, Lauren M. PsyD; Hollander, Seth A. MD; Shaw, Richard J. MDAuthor Information Stanford University School of Medicine, Department of Psychiatry, Division of Child Psychiatry, Palo Alto, CA. Address correspondence and reprint requests to Richard J. Shaw, MD, Stanford University School of Medicine, Division of Child Psychiatry, 401 Quarry Rd, Suite 1122, Palo Alto, CA 94305-5719; E-mail: email@example.com Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare. Clinical Neuropharmacology: May/June 2020 - Volume 43 - Issue 3 - p 86-89 doi: 10.1097/WNF.0000000000000389 Buy Metrics Abstract Introduction Abulia is defined as a pathological state of amotivation, apathy, and global absence of willpower. It presents with a challenging array of overlapping symptoms, making effective identification and treatment difficult. Case Presentation We describe the first known report of an adolescent with a ventricular assist device who developed abulia following a left middle cerebral artery (MCA) stroke who responded successfully to treatment with olanzapine. Discussion The neurobiological etiology of abulia is still unclear but is postulated to be related to deficits in the dopaminergic reward circuitry in the frontal-subcortical-mesolimbic regions. There have been reports of poststroke patients with abulia being treated by modulating this dopamine circuitry and in some cases with short-term low-dose olanzapine. Conclusion Further research is needed to develop a better understanding of the pathophysiology of abulia leading to more effective treatment algorithms including more specific diagnostic tools and effective pharmacological interventions. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.