What is Anosognosia? Causes, Symptoms, and Treatment

Anosognosia is a neuropsychiatric condition where a person is unconsciously in denial and unaware of a noticeable disability. It can occur in both psychiatric and neurologic disorders. According to the National Institutes of Health (NIH), it is linked with mental illness, dementia, and structural brain lesions, as is seen in right hemisphere stroke patients. [1]

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What Causes Anosognosia?

The exact causes of anosognosia are complex and can be attributed to various neurological and psychiatric factors. Here are the most common potential causes:

• Brain Lesions.
• Stroke.
• Traumatic Brain Injury (TBI).
• Alzheimer’s Disease.
• Other Dementia Disorders.
• Schizophrenia.
• Bipolar Disorder.
• Major Depressive Disorder.
• Epilepsy.
• Brain Tumors.
• Infection and Inflammation.
• Genetic Factors.
• Medication Side Effects.
• Psychiatric Medications.
• Aging
• Cerebral Hemispheric Asymmetry.
• Neurological Imbalances.

Anosognosia Tests and Diagnosis

Health professionals diagnose anosognosia at the bedside by assessing the patient’s understanding and insight of their symptoms. In subtle cases, it takes time and a long discussion with the patient to uncover anosognosia, as patients may rationalize semi-logical reasons for being unable to conduct activities. In dementia, patients do not recognize or underestimate their memory deficits. In the setting of mental illness, patients rationalize unusual behavior or psychiatric symptoms and often confabulate (i.e., unconsciously fabricate stories to compensate for memory loss). This involves the creation of a false answer or response by combining natural and imagined details.

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How Long Does Anosognosia Last?

When it happens because of a lesion from an injury to your brain, it’s more likely that anosognosia will improve independently. While it may go away in some patients, it’s also possible to be permanent. The lack of insight into one’s mental health condition can be persistent when it happens with mental health conditions or degenerative brain disorders.

Anosognosia Dementia

Anosognosia in dementia is when individuals are unaware or lack insight into their cognitive deficits despite evident impairments in memory, thinking, and other mental functions. This phenomenon is widespread in various forms of dementia, including Alzheimer’s disease and other neurodegenerative conditions.

Anosognosia Schizophrenia

In schizophrenia, the lack of insight into one’s mental health condition is a common symptom where individuals may not fully recognize the nature of their illness. Insight is crucial because it predicts treatment adherence, relapse frequency, symptom improvement, daily functioning, job attainment, and the risk of self-harm or harm to others.

To recognize schizophrenia, the most common signs and symptoms are:

• Hallucinations.
• Delusions.
• Disorganized Thinking.
• Abnormal Motor Behavior.
• Negative Symptoms (Reduced Emotional Expression, Social Withdrawal).
• Impaired Cognitive Functioning.
• Difficulty Concentrating.
• Memory Impairment.
• Lack of Insight.
• Social and Occupational Dysfunction.
• Emotional Flatness or Inappropriateness.
• Disrupted Sleep Patterns.
• Paranoia.
• Apathy.
• Poor Hygiene and Self-Care.

Anosognosia Bipolar

In bipolar disorder, anosognosia is like a cover that affects how someone perceives their condition. It’s not a deliberate choice but rather a result of changes in the brain. Imagine it as a fog that makes it challenging to see and understand the highs and lows in mood.

How is Anosognosia Treated?

There is no specific treatment for anosognosia, but vestibular stimulation seems to improve this condition temporarily. Vestibular stimulation involves personalized programs that can benefit those experiencing anosognosia, as it helps address problems related to balance and spatial orientation, contributing to an overall improvement in awareness and perception.

Where anosognosia persists, cognitive behavioral therapy can help patients better understand and compensate for their deficits.

It’s crucial to conduct a comprehensive safety assessment for the individual to prevent potential harm. Simplifying tasks, approaching situations with a positive attitude, expressing empathy and concern, and creating a structured environment can all play a key role in preventing adverse outcomes and ensuring the well-being of the person dealing with anosognosia.

There are no specific medications for the management of anosognosia. Because there are many causes and risk factors, the management is with an interprofessional team that includes a neurologist, psychiatrist, mental health nurse, primary care physician, and a psychotherapist.

How to Reduce the Risk of Developing Anosognosia?

Education on how to deal with and help avoid problems related to anosognosia for patients and family members of the patients with this dysfunction is of utter importance, and lack of collaboration from the sufferer is typical due to the patient’s failure to acknowledge or underestimation of their condition.

To reduce the risk of anosognosia for you and your loved one:

• Establish Trusting Relationships.
• Use Positive Communication.
• Involve Supportive Family and Friends.
• Educate about the Condition.
• Encourage Regular Medical Checkups.
• Simplify Information.
• Set Realistic Expectations.
• Be Patient and Understanding.
• Utilize Cognitive Behavioral Strategies.
• Explore Support Groups.
• Foster a Structured Environment.
• Emphasize Consistent Medication Adherence.
• Encourage Routine and Predictability.
• Address Co-occurring Conditions.
• Seek Professional Mental Health Guidance.

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What is Anosognosia? Symptoms, Lack of Self-Awareness, and How to Help Loved Ones? Informative Video