Anosognosia

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Anosognosia
ICD-9 780.9

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Anosognosia

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List of terms related to Anosognosia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Anosognosia is a condition in which a person who suffers disability due to brain injury seems unaware of or denies the existence of their handicap. This may include unawareness of quite dramatic impairments, such as blindness or paralysis. It was first named by neurologist Joseph Babinski in 1914, although relatively little has been discovered about the cause of the condition since its initial identification. The word comes from the Greek words "nosos" disease and "gnosis" knowledge.

Neurology

Anosognosia is relatively common following brain injury (e.g. 20-30% in the case of hemiplegia/hemiparesis after stroke), but can appear to occur in conjunction with virtually any neurological impairment. However, it is not related to global mental confusion (see delirium), cognitive flexibility, or other major intellectual disturbance. Anosognosia can be selective in that an affected person with multiple impairments may only seem unaware of one handicap, while appearing to be fully aware of any others. Those diagnosed with dementia of the Alzheimer's type often display this lack of awareness and insist that "There is nothing wrong with me!"

The condition does not seem to be directly related to sensory loss and is thought to be caused by damage to higher level neurocognitive processes which are involved in integrating sensory information with processes which support spatial or bodily representations (including the somatosensory system). Anosognosia is thought to be related to unilateral neglect, a condition often found after damage to the non-dominant (usually the right) hemisphere of the cerebral cortex in which sufferers seem unable to attend to, or sometimes comprehend, anything on a certain side of their body (usually the left).

Psychiatry

Although largely used to describe unawareness of impairment after brain injury, the term 'anosognosia' is now also used to describe the lack of insight shown by some people who suffer from psychosis, and who may be unaware that their outlandish beliefs and experiences are in any way unusual. Those in a manic phase of bipolar disorder may also exhibit anosognosia. The Treatment Advocacy Center has compiled information that Anosognosia is the most likely reason individuals with severe psychiatric conditions such as disorders do not take their psychiatric medication as prescribed.[1] Further, a collection of studies show that close to 50 percent of those diagnosed with schizophrenia or bipolar disorder, including those who have never been treated, show signs of anosognosia.[2]

Differential Diagnosis of Anosognosia

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Trauma No underlying causes
Miscellaneous No underlying causes

Treatment

There are currently no long-term treatments for anosognosia, although, like unilateral neglect, Caloric reflex testing (squirting ice cold water into the left ear) is known to temporarily ameliorate unawareness of impairment. It is not entirely clear how this works, although it is thought that the unconscious shift of attention or focus caused by the intense stimulation of the vestibular system temporarily influences awareness. Most cases of anosognosia appear to simply disappear over time, while other cases can last indefinitely. Normally, long-term cases are treated with cognitive therapy to train the patient to adjust for their inoperable limbs (though it is believed that these patients still are not "aware" of their disability).


See also

Footnotes

  1. Anosognosia as a cause of violent behavior in individuals with severe psychiatric disorders. Retrieved on 2007-10-02.
  2. Schizophrenia and bipolar disorder are diseases of the brain. Treatment Advocacy Center. Retrieved on 2007-10-03.

Further reading

  • Prigatano, G. and Schacter, D. (eds) (1991) Awareness of Deficit After Brain Injury: Clinical and Theoretical Issues. Oxford: Oxford University Press. ISBN 0-19-505941-7
  • Anosognosia: The neurology of beliefs and uncertainties. Vuilleumier, P. (2004) Cortex, 40, 9-17.
  • Vilayanur S. Ramachandran (1998) Phantoms in the Brain New York: Quill (HarperColling Publishing). ISBN 0-688-17217-2
  • Clare, L., & Halligan, P.W. (Eds.) (2006). Pathologies of Awareness: Bridging the Gap between Theory and Practice. Neuropsychological Rehabilitation.
  • Amador, X.F., David, A.S. (2004) Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders (2nd ed). Oxford: Oxford University Press. ISBN 0198525680it:Anosognosia

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