Motivation, impaired

After the acute psychotic episode has resolved, the patient typically has residual features (e.g., anxiety, suspiciousness, lack of volition, lack of motivation, poor insight, impaired judgment, social withdrawal, difficulty in learning from experience, and poor self-care skills). Patients often have comorbid substance abuse and are nonadherent with medications. 

The concept of bradyphrenia overlaps with that of apathy, defined as diminished motivation not attributable to diminished level of consciousness, cognitive impairment or emotional distress (Marin, 1990). Apathy is common in neurodegenerative disorders and is associated with orbito-frontal, medial frontal and anterior temporal dysfunction in Alzheimer s disease (Craig et al., 1996). Apathy is one of the most common neuropsychiatric symptoms in PD, and correlates with executive dysfunction (Aarsland, 1999b). However, apathy is even more common in PSP patients (Aarsland et al., 2001c), possibly related to the more marked involvement of the orbitofrontal and medial frontal circuits in PSP than in PD. 

For mild to moderate anxiety, we recommend the conservative approach of beginning with CBT and including medication if CBT is ineffective or only partially effective. However, severe anxiety that involves duress, prominent avoidance behavior, physiological symptoms, or marked impairment, requires a combination of CBT and medication as an initial intervention. Furthermore, children and families with low motivation (i.e., those unlikely to participate in CBT assignments) or having a poor subjective sense of anxiety may require medication treatment as one of the initial interventions. 

Since nonhuman animals lack a capacity for critical evaluation, they are not even prima facie candidates for either motivational compulsion or weakness. Addictions may move them contrary to their own good but not contrary to their own conceptions of the good. Nevertheless, when their addictive behavior displaces their natural appetites, they suffer from what might be called an appetitive impairment. 

In addition to considerations of impairment testing systems and the equipment and platform to administer the systems, the implementation of the testing system must also be considered. Test cost, frequency of administration, maintenance of stable patterns of performance (i.e., motivation), and worker acceptance are among the issues that merit consideration.11 In addition, concerns regarding the legal status of performance test systems, the manner in which labor unions and arbitrators might view such test systems, and whether there is a potential for misuse of the test system could affect system implementation.9... 

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