Apathy, Explained

Derick E. Vergne, MD


March 16, 2016

In This Article

Introduction, and a Case

A 77-year-old woman was brought to our clinic for an evaluation by her adult daughter, with the main complaint that "my mother is very anxious." The patient sat in the office listening to her daughter describe in detail how her mother "used to be someone completely different 2 years ago," but that "something" had happened around that time; all of a sudden, she had had a "nervous breakdown," after which she had not been the same. The nervous breakdown was further described as the onset of intense anxiety, mostly characterized by the patient's inability to make decisions on any activity.

The patient's inability to begin a task was also accompanied by excessive clinginess to her daughter. This clinginess was described as having to ask what to do for even basic actions, such as which shoes to wear for an outing.

The patient denied any sadness, and when asked to describe her current mood, said that she was "fine," as if she found the question to be out of place. The patient's response of "fine" was accompanied by a brief but noticeable smile that indicated moderate affect reactivity; her affect nevertheless could better be described as aloof. She appeared to not really be engaged in our conversation, but not necessarily because she disagreed—rather, as if she were present only to get through a chore her daughter had made her do.

The patient was described by her daughter as previously being a go-getter, an assertive and sometimes aggressive individual who always acted somewhat younger than her age and was never afraid of life's challenges. She had always been healthy, with no major medical complaints; however, something had happened that her family could not define. Even the patient's own primary care physician commented on the complete turnaround of her personality. Yet, there were no noticeable findings to explain a complete change that resulted in a seemingly different human being. All tests indicated a clean bill of health; a neurologist remarked that given the normalcy of her exams and brain imaging, the patient was "just lonely."


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