Anosognosia

Anosognosia: The Broken Glass doesn’t know it is Broken

By- Ishita Saha

During a detour to my internship days, I remember meeting a very pretty girl with her goddess kind of beauty enchanting all of us. A half month was passed after that and then came a day that permanently left a mark on us. Her mother came running into the laboratory where her daughter sat on a wheelchair somewhat lost trying to use her right hand to pick up a beaker. Her mother kept shouting explaining to her about her stroke but her voice went to deaf ears. She kept trying to move the right side of her body and chanting with “they all are lying, I’m just fine” over and over. Her mom kept saying she’s in denial. But then our chief scientist talked to all of us and her mother introducing us to “Anosognosia” or “lack of insight” or “lack of awareness”.Anosognosia came from the Greek meaning “to not know a disease”. The French neurologist, Joseph Babinski, first described anosognosia in 1914.

What is Anosognosia?

Anosognosia is a mental illness that means that the patient is unaware of their condition specifically their medical condition. It is often seen in patients with severe mental health conditions as Schizophrenia and Bipolar disorders, Stroke patients, patients with tumor, patients of neurodegenerative disorders, and traumatic brain injury patients. This condition often leads to incidents of patients rejecting treatments, anxiety, psychosis, and maniac behavior. According to an NCBI resource, It is estimated that 50% of patients with schizophrenia and 40% of patients with bipolar disorder have anosognosia. 60% of patients with mild cognitive impairment and 81% of patients with Alzheimer’s disease appear to have some form of anosognosia. According to Sergio E. Starkstein, Daniel Tranel, in Handbook of Clinical Neurology, 2012 The frequency of anosognosia after stroke was reported to range between 10% and 58%

Causes of Anosognosia

When we get a new pimple we update the mental image of ourselves to a pimpled face so the next time when we look into the mirror we acknowledge the pimple but this ability to update the mental image of ourselves is lost in a person with Anosognosia. Why?

Because of some lesions in the right hemisphere specifically the ventromedial portions of the frontal lobe. The frontal lobe is part of the brain which is responsible for updating. So when the frontal lobe is impaired the new information of the patient’s illness is not processed and the new self-image is not updated.

Symptoms

As mentioned the prime symptom is the unawareness of the patient’s own illness. For example, observed in patients of paralysis who deny acknowledging their deficit and when asked to use the damaged part of the body they gave no response or showed psychosis. Same for patients with severe mental health conditions. As here the issue is that their illness is not physically visible so they often think that their family and loved ones are lying and result in emotional trauma and problems with friends, family, and caregivers. Sometimes this condition is confused with denial and stubbornness in the absence of a proper diagnosis.

According to an NCBI resource,

There are publications on an anosognosia rating scale, which rates the level of unawareness of patients with dementia suffering from this condition:

1. Patients easily admit memory loss.
2. Patients admit, sometimes inconsistently, to a small amount of memory loss.
3. Patients are not aware of any impairment in memory.
4. Patients angrily insist that no memory problem exists.

Diagnosis

It may be diagnosed by a mental health professional or a psychiatrist. Even small behavioral change or pattern is detectable.

Two most used methods for diagnosis according to Healthline are:

 

1. “LEAP” method, which is done by:

• listening to the person
• empathizing with the person
• agreeing with the person
• partnering with the person

1.  Scale to Assess Unawareness of Mental Disorder (SUM-D)

This tests the person’s

•  Awareness of their condition.
•  Understanding that they need treatment.
•  Attribution that their symptom results from a mental health condition.

The test results from these diagnostic tools may help identify Anosognosia but the most important thing is the trust between a doctor and patient where the patient can tell all their issues without any hesitation.

Treatment

Once diagnosed the condition is treated by mental health professionals with a combination of things.

1. Counseling and Therapy: The patient is counseled where the professional understands their concerns and help them to deal with them.

One such approach is Motivational enhancement therapy (MET). It motivates someone to either alter their self-image to accept that they have an illness and motivate them to get treatment. According to  Healthline MET often consists of helping someone look at their symptoms, behaviors, and relationships objectively. This often leads to a realization that facts point to the existence of a condition.

1.  According to NCBI resources, Vestibular stimulation seems to improve this condition temporarily. This maneuver probably influences awareness of the neglected side temporarily.
2. Antipsychotic Therapy

Medications work differently for different people.

Conclusion

Now we know what Anosognosia is. A condition that doesn’t let you identify yourself with an illness. A delusion. It usually is not permanent and goes after some time of the illness occurred but sometimes it can be permanent. It needs our support and understanding of the person suffering. Let’s keep our senses on alert to see such changes around and help people and ourselves too.

References

1. Anosognosia

https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Anosognosia

1. Encyclopedia of Neurological Science

https://www.sciencedirect.com/referencework/9780123851581/encyclopedia-of-the-neurological-sciences

1. Anosognosia

https://www.ncbi.nlm.nih.gov/

1. Anosognosia

https://www.healthline.com/health/anosognosia