Anosognosia

 

SUMMARY: Anosognosia is a neurological syndrome that produces unawareness of illness. It is caused by damage to specific parts of the brain, especially the right hemisphere. The word comes from the Greek word for disease (nosos) and knowledge (gnosis) and literally means “to not know a disease.” The condition affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder and is the most common reason that individuals with schizophrenia and bipolar do not take their medications. When taking medications, awareness of illness improves in some patients.

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What is impaired awareness of illness?

Anosognosia is a neurological syndrome that produces unawareness of illness. It is caused by damage to specific parts of the brain, especially the right hemisphere. It is often called "unawareness of illness" or "lack of insight." The Treatment Advocacy Center in 2010 presented a workshop on anosognosia at the National Alliance on Mental Illness convention in Washington, DC. "
Confronting Anosognosia: How to Get Help to Those Who Don't Know They're Sick" may be viewed online.

How big a problem is anosognosia?
Many studies of individuals with schizophrenia report that approximately half of them have moderate or severe impairment in their awareness of illness. Studies of bipolar disorder suggest that approximately 40 percent of individuals with this disease also have impaired awareness of illness. Anosognosia in bipolar is most common among individuals whose disorder includes psychotic features.

Is this a new problem? 
Impaired awareness of illness in individuals with psychiatric disorders has been known for hundreds of years. Playwright Thomas Dekker in his 1604 play “The Honest Whore” has a character say, “That proves you mad because you know it not.” The term anosognosia was first used by a French neurologist in 1914. Among neurologists, unawareness of illness has long been recognized in some individuals with strokes, brain tumors, Alzheimer’s disease and Huntington’s disease. In psychiatry, impaired awareness of illness has only become widely discussed since the late 1980s.

Is impaired awareness of illness the same thing as denial of illness?
No. Denial is a psychological mechanism we all use at times to deflect or reject unpleasant information. Impaired awareness of illness has a biological basis and is caused by damage to the brain, especially the right brain hemisphere. The specific brain areas that appear to be most involved are the frontal lobe and part of the parietal lobe.

Can a person be partially aware of their illness?
Yes. Impaired awareness of illness is a relative, not an absolute, problem. Insight in some individuals may also fluctuate over time, with awareness being heightened during periods of remission but lost during periods of relapse.

Are there ways to improve a person’s awareness of their illness?
Studies suggest that approximately one-third of individuals with schizophrenia improve in awareness of their illness when they take antipsychotic medication. Studies also suggest that a larger percentage of individuals with bipolar disorder improve on medication.

Why is impaired awareness of illness important in schizophrenia and bipolar disorder?
Impaired awareness of illness is the most common reason why individuals with schizophrenia and bipolar disorder do not take medication. They do not believe they are sick, so why should they? Without medication, the person’s symptoms become worse. This often makes them more vulnerable to the 
consequences of non-treatment, which include arrest, incarceration, homelessness, victimization, suicide and violence.

Information courtesy of The Treatment Advocacy Center (http://treatmentadvocacycenter.org/problem/anosognosia)

For more information, read these two recommended books:

Losing Dad by Amanda LaPera

I Am Not Sick, I Don't Need Help! by Dr. Xavier Amador.

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