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Updating Apathy

Using Research Domain Criteria to Inform Clinical Assessment and Diagnosis of Disorders of Motivation

Thant, Thida MD; Yager, Joel MD

The Journal of Nervous and Mental Disease: September 2019 - Volume 207 - Issue 9 - p 707–714
doi: 10.1097/NMD.0000000000000860
Original Articles
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Clinical observations regarding apathy and motivation derived from many psychiatric and neurological conditions have generated divergent descriptions of apathy-related syndromes. Stimulated by complex cases presenting with prominent apathy, uses of the term “apathy” and “related phenomena” in the Diagnostic and Statistical Manual of Mental Disorders, diagnostic proposals for apathy as a syndrome and disorder of motivation, Research Domain Criteria (RDoC) systems governing motivational processes, and their clinical intersections are reviewed. Clinical apathy and associated dysfunctions can be addressed using constructs suggested by the RDoC domain of Positive Valence Systems, including approach motivation and component processes of reward valuation, effort valuation/willingness to work, expectancy/reward prediction error, and responses to reward and reward learning. Although apathy syndromes have been validated, defining potentially distinct disorders of motivation (not simply subordinated to mood, psychotic, cognitive, or substance use disorders) will require additional research to better delineate etiology and pathogenesis, predictive validators, reliable diagnostic methods, treatments, and demonstrations of use for these diagnostic proposals.

Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado.

Send reprint requests to Thida Thant, MD, Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, MS-F546, Building 500, Room E2322, Aurora, CO 80045. E-mail: thida.thant@ucdenver.edu.

Online date: September 25, 2018

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