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Abstract
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OBJECTIVES: Disorders of the realization of an action are frequent and disturbing phenomena of psychiatry. Failure to act on a patient's environment quickly causes a disengagement of the human world. To act, we must have a minimum of vitality, a cognitive activity of making representations of actions and a motor organization of the movement. The daily clinical observation shows us however that changes can arise in the production line of action.
METHODS: The scientific, psychiatric, psychopathological and neurophysiological literature was reviewed to reconstitute the psychological ingredients necessary for the creation of an action and to identify the pathological abnormality. The presentation of eight clinical cases of patients with depression and suicidal activity invites us to extract abulia as being a separate psychopathological entity. The phenomenological reconstruction of the motor abstentions of these patients allows us to underscore the various mechanisms which undermine the realization of action.
RESULTS: To realize an action, we need a minimal essential interaction with the world, a cognitive activity of producing representations of action, organization and management of their sequencing and a cognitive-motor procedure to execute the movement. Anomalies may arise at different levels of this chain of action as apathy, athymormia, anhedonia, avolition, athymia, dissociation, procrastination, dyspraxia, impulsivity, etc. Sorting those various disorders allows to reset the aboulic disorder such as an inability to transform the idea of an act in real action and to close this action. The study reveals seven cognitive processes parasitizing the transition between idea and action: Wandering thoughts: Thoughts drift away and the patient feel an ideational instability; a cognitive saturation associated with a lack of inhibition of stray thoughts: The spirit of the patients is overrun by stray thoughts competing without one of them manages to triumph over the other; a cognitive incoordination: The patient is unable to keep his thoughts to bring order to; a negative anticipation of the effort: The patient already anticipates muscle load required for the action will be painful; a bias-end: The patient believes he will never be able to complete his task and the mission he gave himself will never close; a perfectionist or anxiety of failure: The patient does not act because of the uncertain anticipation of a potential failure; a sense of futility of the action: The patient experiences a kind of absurd state of things, all acts become vain and superficial.
CONCLUSIONS: The disorders of the realization of an action result from recognizable cognitive and psychopathological mechanisms although still widely underestimated. These psychological processes could constitute privileged therapeutic targets. © 2015 Elsevier Masson SAS.
Language: fr |