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79-632: Melancholy was regarded as one of the four temperaments matching the four humours . Until the 18th century, doctors and other scholars classified melancholic conditions as such by their perceived common cause – an excess of a notional fluid known as "black bile", which was commonly linked to the spleen . Hippocrates and other ancient physicians described melancholia as a distinct disease with mental and physical symptoms, including persistent fears and despondencies, poor appetite, abulia , sleeplessness, irritability, and agitation. Later, fixed delusions were added by Galen and other physicians to

158-419: A chronic illness caused by the impact of black bile on the brain. He described melancholia's initial clinical manifestations as "suffering from an unexplained fear, inability to answer questions or providing false answers, self-laughing and self-crying and speaking meaninglessly, yet with no fever." In Middle-Ages Europe, the humoral, somatic paradigm for understanding sustained sadness lost primacy in front of

237-427: A neoclassical ballet , using the theory of the temperaments as a point of departure. The 19th-century French author Émile Zola used the four temperaments as a basis for his novel Thérèse Raquin . Abulia In neurology , abulia , or aboulia (from Ancient Greek : βουλή , meaning "will"), refers to a lack of will or initiative and can be seen as a disorder of diminished motivation . Abulia falls in

316-483: A randomized clinical trial , it was shown that CBT was less effective than medication in treating symptoms of melancholic depression after 12 weeks. Electroconvulsive therapy (ECT) was previously believed to be an effective treatment for melancholic depression. ECT has been more commonly used for patients with melancholic depression due to the severity. In 2010, a study found that 60% of depression patients treated with ECT had melancholic symptoms. However, studies since

395-479: A Punnett square of these characters, one can find an Active–Positive, Passive–Positive, Active–Negative, or Passive–Negative individual. This diagram was made after an influential study of the U.S. presidency, hence the name. Robert R. Blake created The Managerial Grid , wherein high concern for production relates to hot, low concern for production relates to cold, high concern for people relates to moist, and low concern for people relates to dry. If one were to make

474-427: A distinct clinical entity, but its status as a syndrome is unclear. Although abulia has been known to clinicians since 1838, it has been subjected to different interpretations – from 'a pure lack of will', in the absence of motor paralysis to, more recently, being considered 'a reduction in action emotion and cognition'. As a result of the changing definition of abulia, there is currently a debate on whether or not abulia

553-802: A gloomy interior. In music, the post-Elizabethan cult of melancholia is associated with John Dowland , whose motto was Semper Dowland, semper dolens ("Always Dowland, always mourning"). The melancholy man, known to contemporaries as a "malcontent", is epitomized by Shakespeare's Prince Hamlet , the "Melancholy Dane". A similar phenomenon, though not under the same name, occurred during the German Sturm und Drang movement, with such works as The Sorrows of Young Werther by Goethe or in Romanticism with works such as Ode on Melancholy by John Keats or in Symbolism with works such as Isle of

632-484: A long poem in blank verse by Edward Young was published in nine parts (or "nights") between 1742 and 1745, and hugely popular in several languages. It had a considerable influence on early Romantics in England, France and Germany. William Blake was commissioned to illustrate a later edition. In the visual arts, this fashionable intellectual melancholy occurs frequently in portraiture of the era, with sitters posed in

711-452: A melancholic depression diagnosis. Melancholic depression, due to some fundamental differences with standard clinical depression or other subtypes of depression, has specific types of treatments that work, and the success rates for different treatments can vary. Treatment can involve antidepressants and empirically supported treatments such as cognitive behavioral therapy and interpersonal therapy for depression. Melancholic depression

790-447: A mild case Alzheimer's disease to 61% in patients with a severe case of Alzheimer's disease, which most likely developed over time as the patient got older. Most current treatments for abulia are pharmacological, including the use of antidepressants. However, antidepressant treatment is not always successful and this has opened the door to alternative methods of treatment. The first step to successful treatment of abulia, or any other DDM,

869-930: A movement, a "counter-will" or "resistance" rises up to meet them. The clinical condition denoted abulia was first described in 1838; however, since that time, a number of different, some contradictory, definitions have emerged. Abulia has been described as a loss of drive, expression, behavior and speech output, with slowing and prolonged speech latency, and reduction of spontaneous thought content and initiative, being considered more recently as 'a reduction in action emotion and cognition'. The clinical features most commonly associated with abulia are: Especially in patients with progressive dementia, it may affect feeding. Patients may continue to chew or hold food in their mouths for hours without swallowing it. The behavior may be most evident after these patients have eaten part of their meals and no longer have strong appetites. Both neurologists and psychiatrists recognize abulia to be

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948-572: A sign of vice into a mark of genius. This fashionable melancholy became a prominent theme in literature, art, and music of the era. Between the late 18th and late 19th centuries, melancholia was a common medical diagnosis. In this period, the focus was on the abnormal beliefs associated with the disorder, rather than depression and affective symptoms. In the 19th century, melancholia was considered to be rooted in subjective 'passions' that seemingly caused disordered mood (in contrast to modern biomedical explanations for mood disorders). In Victorian Britain,

1027-433: A single temperament, while others had an admixture of two, a primary and secondary temperament. Modern medical science has rejected the theories of the four temperaments, though their use persists as a metaphor within certain psychological fields. Immanuel Kant (1724–1804), Erich Adickes (1866–1925), Alfred Adler (1879–1937), Eduard Spranger (1914), Ernst Kretschmer (1920), and Erich Fromm (1947) all theorised on

1106-467: A stroke patient is uninterested in performing tasks like walking despite being capable of doing so. It should be differentiated from apraxia , when a brain injured patient has impairment in comprehending the movements necessary to perform a motor task despite not having any paralysis that prevents performing the task; that condition can also result in lack of initiation of activity. A case study involving two patients with acute confusional state and abulia

1185-459: A synonym for depression. Sigmund Freud published a paper on Mourning and Melancholia in 1918. In 1907, the German psychiatrist Emil Kraepelin influentially proposed the existence of a condition he called ' involutional melancholia ', which he thought could help explain the more frequent occurrence of depression among elderly people. He surmised that in the elderly "the processes of involution in

1264-431: A systemic disorder that could be identified by depressive mood rating scales, verified by the presence of abnormal cortisol metabolism. They considered it to be characterized by depressed mood, abnormal motor functions, and abnormal vegetative signs, and they described several forms, including retarded depression , psychotic depression and postpartum depression . For the purposes of medical diagnostic classification ,

1343-528: A truncated rhombohedron . The image in turn inspired a passage in The City of Dreadful Night by James Thomson (B.V.) , and, a few years later, a sonnet by Edward Dowden . The most extended treatment of melancholia comes from Robert Burton , whose The Anatomy of Melancholy (1621) treats the subject from both a literary and a medical perspective . His concept of melancholia includes all mental illness, which he divides into different types. Burton wrote in

1422-455: Is a preliminary evaluation of the patient's general medical condition and fixing the problems that can be fixed easily. This may mean controlling seizures or headaches, arranging physical or cognitive rehabilitation for cognitive and sensorimotor loss, or ensuring optimal hearing, vision, and speech. These elementary steps also increase motivation because improved physical status may enhance functional capacity, drive, and energy and thereby increase

1501-463: Is a sign or a symptom of another disease, or its own disease that seems to appear in the presence of other more well-researched diseases, such as Alzheimer's disease. A 2002 survey of two movement disorder experts, two neuropsychiatrists, and two rehabilitation experts, did not seem to shed any light on the matter of differentiating abulia from other DDMs. The experts used the terms " apathy " and "abulia" interchangeably and debated whether or not abulia

1580-400: Is estimated to be about 25% to 30%. The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low. Four temperaments The four temperament theory is a proto-psychological theory which suggests that there are four fundamental personality types: sanguine , choleric , melancholic , and phlegmatic . Most formulations include

1659-453: Is in fact a case of diminished motivation . In recent years, imaging studies using a CT or MRI scan have been shown to be quite helpful in localizing brain lesions which have been shown to be one of the main causes of abulia. A lack of motivation has been reported in 25–50% of patients with Alzheimer's disease . While depression is also common in patients with this disease, abulia is not a mere symptom of depressions because more than half of

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1738-444: Is often considered to be a biologically based and particularly severe form of depression. Therefore, the treatments for this specifier of depression are more biomedical and less psychosocial (which would include talk therapy and social support). The general initial or "ideal" treatment for melancholic depression is antidepressant medication, and psychotherapy is added later on as support if at all. The scientific support for medication as

1817-422: Is subtitled "The Four Temperaments", each of the four movements being inspired by a sketch of a particular temperament. Paul Hindemith 's Theme and Four Variations for string orchestra and piano is also known as The Four Temperaments : although originally conceived as a ballet for Léonide Massine , the score was ultimately completed as a commission for George Balanchine , who subsequently choreographed it as

1896-544: The Encyclopédie of Diderot and d'Alembert , the causes of melancholia are stated to be similar to those that cause Mania : "grief, pains of the spirit, passions, as well as all the love and sexual appetites that go unsatisfied." During the later 16th and early 17th centuries, a curious cultural and literary cult of melancholia arose in England. In an influential 1964 essay in Apollo , art historian Roy Strong traced

1975-706: The spleen as the originating organ and cold and dry as related qualities. In astrology it showed the influence of Saturn , hence the related adjective saturnine . Melancholia was described as a distinct disease with particular mental and physical symptoms in the 5th and 4th centuries BC. Hippocrates, in his Aphorisms , characterized all "fears and despondencies, if they last a long time" as being symptomatic of melancholia. Other symptoms mentioned by Hippocrates include: poor appetite, abulia , sleeplessness, irritability, agitation. The Hippocratic clinical description of melancholia shows significant overlaps with contemporary nosography of depressive syndromes (6 symptoms out of

2054-442: The "relationship-oriented introvert" position traditionally held by the phlegmatic is declared to be a new "fifth temperament" called "Supine" (meaning "lying on the back"). This instrument is used by many Christian ministries The 18th-century classical composer Carl Philipp Emanuel Bach composed a trio sonata in C minor known as Sanguineus et Melancholicus (Wq 161/1). In the 20th century, Carl Nielsen 's Symphony No. 2 (Op.16)

2133-517: The 16 types of the Myers–Briggs Type Indicator (MBTI). They were renamed as Artisan (SP), Guardian (SJ), Idealist (NF), and Rational (NT). . C.G. Jung's Psychological Types surveys the historical literature of the 'four humors' and related discussions extensively and in depth and proposes a psychoanalytic integration of the material. (Different publishers use different names) Waldorf education and anthroposophy believe that

2212-473: The 17th century that music and dance were critical in treating mental illness. But to leave all declamatory speeches in praise of divine music, I will confine myself to my proper subject: besides that excellent power it hath to expel many other diseases, it is a sovereign remedy against despair and melancholy, and will drive away the devil himself. Canus, a Rhodian fiddler, in Philostratus, when Apollonius

2291-440: The 2000s have failed to demonstrate positive treatment results from ECT, although studies also indicate a more positive response to ECT in melancholic patients than other depressed patients. It has been observed in studies that patients with melancholic depression tend to recover less often than other types of depression. The prevalence of having the melancholic depression specifier among patients diagnosed with clinical depression

2370-466: The 9 included in DSM diagnostic criteria for a Major Depressive). In ancient Rome , Galen added "fixed delusions" to the set of symptoms listed by Hippocrates. Galen also believed that melancholia caused cancer. Aretaeus of Cappadocia , in turn, believed that melancholia involved both a state of anguish, and a delusion. In the 10th century Persian physician Al-Akhawayni Bokhari described melancholia as

2449-580: The Dead by Arnold Böcklin . In the 20th century, much of the counterculture of modernism was fueled by comparable alienation and a sense of purposelessness called " anomie "; earlier artistic preoccupation with death has gone under the rubric of memento mori . The medieval condition of acedia ( acedie in English) and the Romantic Weltschmerz were similar concepts, most likely to affect

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2528-638: The Greek temperaments. The four temperament theory was abandoned after the 1850s. Temperament theory has its roots in the ancient theory of humourism . It may have originated in Mesopotamia , but it was Greek physician Hippocrates (460–370 BC) (and later Galen ) who developed it into a medical theory. He believed that certain human moods, emotions, and behaviours were caused by an excess or lack of body fluids (called "humours"), which he classified as blood, yellow bile, black bile, and phlegm, each of which

2607-532: The Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it... Philosophically, Medicinally, Historically, Opened and Cut Up ) by Burton, was first published in 1621 and remains a defining literary monument to the fashion. Another major English author who made extensive expression upon being of an melancholic disposition is Sir Thomas Browne in his Religio Medici (1643). Night-Thoughts ( The Complaint: or, Night-Thoughts on Life, Death, & Immortality ),

2686-622: The Middle Ages, a sombre melancholy weighs on people's souls." In chronicles, poems, sermons, even in legal documents, an immense sadness, a note of despair and a fashionable sense of suffering and deliquescence at the approaching end of times, suffuses court poets and chroniclers alike: Huizinga quotes instances in the ballads of Eustache Deschamps , "monotonous and gloomy variations of the same dismal theme", and in Georges Chastellain 's prologue to his Burgundian chronicle, and in

2765-514: The ancient temperament names, and several paired extraversion with a different factor which would determine relationship and task-orientation. Examples are DISC assessment and social styles. One of the most popular today is the Keirsey Temperament Sorter , attributed to the work of David Keirsey, whose four temperaments were based largely on the Greek gods Apollo , Dionysus , Epimetheus , and Prometheus , and were mapped to

2844-418: The antidepressants tend to vary on how they work and what specific chemical messengers in the brain they target. SNRIs are generally more effective than SSRIs because they target more than one chemical messenger ( serotonin and norepinephrine ). Although psychotherapy treatments can be used such as talk therapy and cognitive behavioral therapy (CBT), they have shown to be less effective than medication. In

2923-409: The best treatment is that patients with melancholic depression are less likely to improve with placebos, unlike other depression patients. This indicates the improvements observed after medication actually come from the biological basis of the condition and the treatment. There are several types of antidepressants that can be prescribed including SSRIs , SNRIs , tricyclic antidepressants , and MAOIs ;

3002-564: The body are suited to engender mournful or anxious moodiness", though by 1913 he had returned to his earlier view (first expounded in 1899) that age-related depression could be understood in terms of manic-depressive illness . In 1996, Gordon Parker and Dusan Hadzi-Pavlovic described "melancholia" as a specific disorder of movement and mood. They attached the term to the concept of "endogenous depression" (claimed to be caused by internal forces rather than environmental influences). In 2006, Michael Alan Taylor and Max Fink also defined melancholia as

3081-580: The condition include problems with the HPA axis and sleep structure of patients. MRI studies have indicated that melancholic depressed patients have issues with the connections between different regions of the brain, specifically the insula and fronto-parietal cortex . Some studies have found that there are biological marker differences between patients with melancholic depression and other subtypes of depression. The research regarding melancholic depression consistently finds that men are more likely to receive

3160-881: The following only: It is important to note, however, that people who suffer from melancholic depression do not need to have melancholic features in every depressive episode. Melancholic depression requires at least one of the following symptoms during the last depressive episode : And at least three of the following: Melancholic features apply to an episode of depression that occurs as part of either major depressive disorder , persistent depressive disorder (dysthymia) , or bipolar disorder I or II . They are more likely to occur in patients who suffer from depression with psychotic features . People with melancholic depression also tend to have more physically visible symptoms such as slower movement or speech. The causes of melancholic depressive disorder are believed to be mostly biological factors that can be hereditary. Biological origins of

3239-415: The form of "the lover, with his crossed arms and floppy hat over his eyes, and the scholar, sitting with his head resting on his hand" – descriptions drawn from the frontispiece to the 1638 edition of Burton's Anatomy , which shows just such by-then stock characters. These portraits were often set out of doors where Nature provides "the most suitable background for spiritual contemplation" or in

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3318-448: The four seasons. Thus blood, which was considered hot and wet, corresponded to spring. Yellow bile, considered hot and dry, corresponded to summer. Black bile, cold and dry, corresponded to autumn. And finally, phlegm, cold and wet, corresponded to winter. These properties were considered the basis of health and disease. This meant that having a balance and good mixture of the humours defined good health, while an imbalance or separation of

3397-421: The four temperaments (with different names) and greatly shaped modern theories of temperament. Hans Eysenck (1916–1997) was one of the first psychologists to analyse personality differences using a psycho-statistical method called factor analysis , and his research led him to believe that temperament is biologically based. The factors that he proposed in his book Dimensions of Personality were neuroticism (N),

3476-427: The humours led to disease. Because the humours corresponded to certain seasons, one way to avoid an imbalance or disease was to change health-related habits depending on the season. Some physicians did this by regulating a patient's diet, while some used remedies such as phlebotomy and purges to get rid of excess blood. Even Galen proposed a theory of the importance of proper digestion in forming healthy blood. The idea

3555-467: The intellectual. Until the 18th century, writings on melancholia were mainly concerned with beliefs that were considered abnormal, rather than affective symptoms. Melancholia was a category that "the well-to-do, the sedentary, and the studious were even more liable to be placed in the eighteenth century than they had been in preceding centuries." In the 20th century, "melancholia" lost its attachment to abnormal beliefs, and in common usage became entirely

3634-591: The late 15th-century poetry of Jean Meschinot . Ideas of reflection and the workings of imagination are blended in the term merencolie , embodying for contemporaries "a tendency", observes Huizinga, "to identify all serious occupation of the mind with sadness". Painters were considered by Vasari and other writers to be especially prone to melancholy by the nature of their work, sometimes with good effects for their art in increased sensitivity and use of fantasy. Among those of his contemporaries so characterised by Vasari were Pontormo and Parmigianino , but he does not use

3713-498: The list of symptoms. In the Middle Ages , the understanding of melancholia shifted to a religious perspective, with sadness seen as a vice and demonic possession , rather than somatic causes, as a potential cause of the disease. During the late 16th and early 17th centuries, a cultural and literary cult of melancholia emerged in England, linked to Neoplatonist and humanist Marsilio Ficino 's transformation of melancholia from

3792-452: The middle of the spectrum of diminished motivation, with apathy being less extreme and akinetic mutism being more extreme than abulia. The condition was originally considered to be a disorder of the will, and aboulic individuals are unable to act or make decisions independently; and their condition may range in severity from subtle to overwhelming. In the case of akinetic mutism, many patients describe that as soon as they "will" or attempt

3871-440: The notion of melancholia as a disease evolved as it became increasingly classifiable and diagnosable with a set list of symptoms that contributed to a biomedical model for the understanding mental disease. However, in the 20th century, the focus again shifted, and the term became used essentially as a synonym for depression. Indeed, modern concepts of depression as a mood disorder eventually arose from this historical context. Today,

3950-530: The obsolete English wistly , meaning "intently"), and saturnineness (from Latin Saturninus : "of the planet Saturn ). The name "melancholia" comes from the old medical belief of the four humours : disease or ailment being caused by an imbalance in one or more of the four basic bodily liquids, or humours. Personality types were similarly determined by the dominant humor in a particular person. According to Hippocrates and subsequent tradition, melancholia

4029-555: The origins of this fashionable melancholy to the thought of the popular Neoplatonist and humanist Marsilio Ficino (1433–1499), who replaced the medieval notion of melancholia with something new: Ficino transformed what had hitherto been regarded as the most calamitous of all the humours into the mark of genius. Small wonder that eventually the attitudes of melancholy soon became an indispensable adjunct to all those with artistic or intellectual pretentions. The Anatomy of Melancholy ( The Anatomy of Melancholy, What it is: With all

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4108-403: The patient with physical rehabilitation or other interventions where a source of strong motivation would be necessary to succeed but would still be absent. The best way to diagnose abulia is through clinical observation of the patient as well as questioning of close relatives and loved ones to give the doctor a frame of reference with which they can compare the patient's new behavior to see if there

4187-433: The patients did not show any functional deficits at the follow-up one year after the stroke and were not depressed but did show diminished motivations. This result supports the idea that abulia may exist independently of depression as its own syndrome. The anterior cingulate circuit consists of the anterior cingulate cortex , also referred to as Brodmann area 24 , and its projections to the ventral striatum which includes

4266-459: The patients with Alzheimer's disease with abulia do not have depression. Several studies have shown that abulia is most prevalent in cases of severe dementia which may result from reduced metabolic activity in the prefrontal regions of the brain. Patients with Alzheimer's disease and abulia are significantly older than patients with Alzheimer's who do not lack motivation. Going along with that, the prevalence of abulia increased from 14% in patients with

4345-528: The possibility of mixtures among the types where an individual's personality types overlap and they share two or more temperaments. Greek physician Hippocrates (c. 460 – c. 370 BC) described the four temperaments as part of the ancient medical concept of humourism , that four bodily fluids affect human personality traits and behaviours. Modern medical science does not define a fixed relationship between internal secretions and personality, although some psychological personality type systems use categories similar to

4424-401: The prevailing religious perspective. Sadness came to be a vice (λύπη in the Greek vice list by Evagrius Ponticus, tristitia vel acidia in the 7 vice list by Pope Gregory I ). When a patient could not be cured of the disease it was thought that the melancholia was a result of demonic possession . In his study of French and Burgundian courtly culture, Johan Huizinga noted that "at the close of

4503-486: The qualities, yielding a total of nine temperaments. The word "temperament" itself comes from Latin " temperare ", "to mix". In the ideal personality, the complementary characteristics were exquisitely balanced among warm-cool and dry-moist. In four less-ideal types, one of the four qualities was dominant over all the others. In the remaining four types, one pair of qualities dominated the complementary pair; for example, warm and moist dominated cool and dry. These last four were

4582-400: The right hemisphere. Injuries to the frontal lobe and/or the basal ganglia can interfere with an individual's ability to initiate speech, movement, and social interaction. Studies have shown that 5-67% of all patients with traumatic brain injuries and 13% of patients with lesions on their basal ganglia experience some form of diminished motivation. It may complicate rehabilitation when

4661-481: The same Punnett square of these characters, one can find a Team Management, a Country Club Management, a Task Management, or an Ineffective Management individual. The National Christian Counselors Association of Richard and Phyllis Arno, licensed the FIRO-B istrument in the 1980's, and derived from it a theory of five temperaments, where the classical phlegmatic temperament is deemed to be a neutral temperament, whereas

4740-419: The side of the injury, but if there is bilateral damage, the patient will exhibit a more extreme case of diminished motivation, akinetic mutism . It s well documented that the caudate nucleus is involved in degenerative diseases of the central nervous system such as Huntington disease. In a case study of 32 acute caudate stroke patients, 48% were found to be experiencing abulia. Most of the cases where abulia

4819-415: The study of motivational processes been extended to integrate biological drives and emotional states in the explanation of purposeful behavior in human beings. Considering the number of disorders attributed to a lack of will and motivation, it is essential that abulia and apathy be defined more precisely to avoid confusion. Many different causes of abulia have been suggested. While there is some debate about

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4898-659: The temperamental categories which Galen named "sanguine", "choleric", "melancholic", and "phlegmatic" after the bodily humours. Each was the result of an excess of one of the humours which produced the imbalance in paired qualities. For example, if a person tends to be too happy or "sanguine", one can assume they have too much blood in proportion to the other humours, and can medically act accordingly. Likewise for being too calm and reserved or "phlegmatic" from too much phlegm; excessively sad or "melancholic" from too much black bile; and too angry or "choleric" from excess yellow bile. The properties of these humours also corresponded to

4977-452: The temperaments help to understand personality. They also believe that they are useful for education, helping teachers understand how children learn. Christian writer Tim LaHaye has attempted to repopularize the ancient temperaments through his books. James David Barber developed The Presidential Character , wherein active relates to hot, passive relates to cold, positive relates to moist, and negative relates to dry. If one were to make

5056-610: The tendency to experience negative emotions , and extraversion (E), the tendency to enjoy positive events, especially social ones. By pairing the two dimensions, Eysenck noted how the results were similar to the four ancient temperaments. In the field of physiology, Ivan Pavlov studied on the types and properties of the nervous system , where three main properties were identified: strength, mobility of nervous processes and balance between excitation and inhibition, and derived four types based on these three properties. Other researchers developed similar systems, many of which did not use

5135-472: The term "melancholia" and "melancholic" are still used in medical diagnostic classification, such as in ICD-11 and DSM-5 , to specify certain features that may be present in major depression. Related terms used in historical medicine include lugubriousness (from Latin lugere : "to mourn"), moroseness (from Latin morosus : "self-will or fastidious habit"), wistfulness (from a blend of "wishful" and

5214-403: The term of Michelangelo , who used it, perhaps not very seriously, of himself. A famous allegorical engraving by Albrecht Dürer is entitled Melencolia I . This engraving has been interpreted as portraying melancholia as the state of waiting for inspiration to strike, and not necessarily as a depressive affliction. Amongst other allegorical symbols, the picture includes a magic square and

5293-503: The terms "melancholia" and "melancholic" are still in use (for example, in ICD-11 and DSM-5 ) to specify certain features that may be present in major depression , referred to as depression with melancholic features such as: A specifier essentially is a subcategory of a disease, explaining specific features or symptoms that are added to the main diagnosis. According to the DSM-IV , the "melancholic features" specifier may be applied to

5372-474: The theory of temperaments in his Canon of Medicine , which was a standard medical text at many medieval universities. He applied them to "emotional aspects, mental capacity, moral attitudes, self-awareness, movements and dreams." Nicholas Culpeper (1616–1654) suggested that the humors acted as governing principles in bodily health, with astrological correspondences, and explained their influence upon physiognomy and personality. He proposed that some people had

5451-569: The validity of abulia as a separate disease, experts mostly agree that abulia is the result of frontal lesions and not with cerebellar or brainstem lesions. As a result of more and more evidence showing that the mesolimbic and the mesocortical dopamine system are key to motivation and responsiveness to reward, abulia may be a dopamine-related dysfunction. Abulia may also result from a variety of brain injuries which cause personality change, such as dementing illnesses, trauma, or intracerebral hemorrhage (stroke), especially stroke causing diffuse injury to

5530-423: The ventral-anterior and medial-dorsal nuclei traverse the internal capsule genu. These tracts are part of a complex system of cortical and subcortical frontal circuits through which the flow of information from the entire cortex takes place before reaching the basal ganglia. Cognitive deterioration could have occurred through the genu infarcts affecting the inferior and anterior thalamic peduncles. In this case study

5609-419: The ventromedial caudate . The loop continues to connect to the ventral pallidum , which connects to the ventral anterior nucleus of the thalamus. This circuit is essential for the initiation of behavior, motivation and goal orientation, which are the very things missing from a patient with a disorder of diminished motivation. Unilateral injury or injury along any point in the circuit leads to abulia regardless of

5688-495: Was a discrete entity, or just a hazy gray area on a spectrum of more defined disorders. Four of the experts said abulia was a sign and a symptom, and the group was split on whether or not it was a syndrome. Another survey, which consisted of true and false questions about what abulia is distinct from, whether it is a sign, symptom, or syndrome, where lesions are present in cases of abulia, what diseases are commonly associated with abulia, and what current treatments are used for abulia,

5767-463: Was caused by an excess of black bile, hence the name, which means "black bile", from Ancient Greek μέλας ( melas ), "dark, black", and χολή ( kholé ), "bile"; a person whose constitution tended to have a preponderance of black bile had a melancholic disposition. In the complex elaboration of humorist theory, it was associated with the earth from the Four Elements , the season of autumn,

5846-399: Was conducted to see if these symptoms were the result of an infarct in the capsular genu . Using clinical neuropsychological and MRI evaluations at baseline and one year later showed that the cognitive impairment was still there one year after the stroke. Cognitive and behavioral alterations due to a genu infarct are most likely because the thalamo-cortical projection fibers that originate from

5925-462: Was inquisitive to know what he could do with his pipe, told him, "That he would make a melancholy man merry, and him that was merry much merrier than before, a lover more enamoured, a religious man more devout." Ismenias the Theban, Chiron the centaur, is said to have cured this and many other diseases by music alone: as now they do those, saith Bodine, that are troubled with St. Vitus's Bedlam dance. In

6004-479: Was present were when the patients had a left caudate infarct that extended into the putamen as seen through a CT or MRI scan. Diagnosis for abulia can be quite difficult because it falls between two other disorders of diminished motivation, and one could easily see an extreme case of abulia as akinetic mutism or a lesser case of abulia as apathy and therefore, not treat the patient appropriately. If it were to be confused with apathy, it might lead to attempts to involve

6083-416: Was responsible for different patterns in personalities, as well as how susceptible one was to getting a disease. Galen (AD 129 – c. 200) developed the first typology of temperament in his dissertation De temperamentis , and searched for physiological reasons for different behaviours in humans. He classified them as hot/cold and dry/wet taken from the four elements . There could also be balance between

6162-501: Was sent to 15 neurologists and 10 psychiatrists . Most experts agreed that abulia is clinically distinct from depression, akinetic mutism, and alexithymia . However, only 32% believed abulia was different from apathy, while 44% said they were not different, and 24% were unsure. Yet again, there was disagreement about whether or not abulia is a sign, symptom, or syndrome. The study of motivation has been mostly about how stimuli come to acquire significance for animals. Only recently has

6241-428: Was that the two most important factors when digesting are the types of food and the person's body temperature. This meant that if too much heat were involved, then the blood would become "overcooked." This meant that it would contain too much of the yellow bile, and the patient would become feverish. Lack of sufficient heat was believed to result in an excess of phlegm. Persian polymath Avicenna (980–1037 AD) extended

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