Motivation is the driving force to activate goal-orientated behaviour. Dysfunctions in motivation include inactivity, lethargy, loss of initiative and avolition (a general lack of desire, drive, or motivation to pursue meaningful goals). They present themselves readily at observation, but are subjective and should be checked with the patient and by hetero-anamnestic information. Dysfunctions in behaviour include symptoms such as loss of decorum (inappropriate social behaviour), “Witzelsucht” (telling inappropriate jokes), cursing, quarrelsome behaviour and uninhibited expression of sexuality or aggression.
- Inactivity, lethargy and loss of initiative are indicative of schizophrenia (indicative of the negative symptom cluster), a depressive disorder and dementia.
- Avolition is typical of schizophrenia (indicative of the negative symptom cluster).
- Loss of decorum is indicative of dementia or schizophrenia.
- “Witzelsucht” is indicative of mania and fronto-temporal brain disorders, and so is quarrelsome behaviour (contentiousness), and lack of inhibition of sexuality and/or aggression.
- Impulsive acts or impulsive behaviour – this type of behaviour is a direct expression of an impulse, whereby no consequences are considered. It may involve self-mutilation, suicide attempts, fits of anger, excessive risky behaviour, etc.
- Urge-driven behaviour – this type of behaviour is not alien (egosyntonic) to the patient, but there is a constant desire to act on the urge. Postponement of the act gives the patient a feeling of thrill or excitement, and performing the act usually gives pleasure, satisfaction or relief. Paraphilia, binge eating, stealing, starting an unlawful fire, gambling, hair pulling and substance abuse.
- Compulsive behaviour: repetitive acts that must be carried out by someone who is consciously aware that performing these acts is not what he wants. These compulsions are performed to ward off unacceptable thoughts or desires. They are alien to the patient, as opposed to impulsive and urge-driven behaviour.
Patient behaviour also yields a range of symptoms of a more neurological nature to be observed and recorded, such as all sorts of movement disorders (tremors, tics, akathisia and catatonia), nystagmus, coordination disorders, dystonias and dyskinesias. For details of these symptoms we refer to the specific literature.
