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Anosognosia

Anosognosia Treatment in Delhi, India

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Overview

Anosognosia is a mental disorder characterised by a lack of comprehension, awareness, or acceptance of one's own mental health condition. It can occur in individuals who have experienced a brain injury or coexist with other mental health disorders such as schizophrenia and bipolar disorder. People with anosognosia may exhibit no awareness of their condition, making it challenging for healthcare professionals to provide effective treatment. Lack of awareness can lead to noncompliance with treatment regimens, further complicating the management of the individual's mental health.

Anosognosia Symptoms

The symptoms of anosognosia primarily revolve around the lack of comprehension, awareness, or acceptance of one's own mental health condition. Here are some key symptoms associated with anosognosia:

  • Denial or avoidance: Individuals with anosognosia may bluntly deny or avoid acknowledging their mental health condition. They may adamantly claim that nothing is wrong with them or actively avoid discussing their condition, believing that others do not believe them.
  • Inconsistent understanding: The understanding of their condition may fluctuate or change frequently. At times, individuals with anosognosia may have some awareness of their problem and seek treatment or follow medication regimens. However, due to their inability to perceive their condition, they may suddenly become unaware and neglect appointments or medication.
  • Selective recognition of symptoms: Some individuals with anosognosia may acknowledge certain symptoms of their condition while remaining oblivious to others. This selective awareness further contributes to their lack of overall comprehension of their mental health condition.
  • Emotional confusion or frustration: Individuals with anosognosia may experience confusion or frustration when others contradict their beliefs or provide evidence of their condition. They may struggle to reconcile their own perceptions with the information presented to them.

Anosognosia Causes

Anosognosia often results from damage to the frontal lobe of the brain. The frontal lobe plays a significant role in shaping our self-image and integrating new information about ourselves. However, due to various reasons, this area of the brain can become impaired.

As a result of frontal lobe damage, individuals gradually lose the ability to process and assimilate new information, including updates about their general health or mental condition. The inability to incorporate new information can lead to confusion or frustration when caregivers or healthcare providers are perceived as not taking their health concerns seriously. Anosognosia is frequently associated with illnesses like schizophrenia and bipolar disorder, which can damage the frontal lobe.

Anosognosia Diagnosis

To diagnose anosognosia, a doctor may evaluate the individual's level of awareness regarding their condition. They may utilize an Anosognosia rating scale (SUM-D) to assess awareness and the ease with which individuals acknowledge their symptoms. A mental status exam can also be conducted to determine where the person falls on a continuum of awareness:

  • Denial of any mental health issues.
  • Slight awareness of the illness but continued denial.
  • Awareness of the illness, attributing it to external factors.
  • Intellectual insight into the condition.
  • True emotional insight into their condition.

Rating scales aid in distinguishing anosognosia from denial, which is a psychological defence mechanism. Anosognosia is typically caused by physical brain injury, while denial is a psychological response.

Brain imaging techniques such as CT or MRI may be employed to identify brain damage that could be associated with anosognosia. The presence of brain damage can guide doctors in determining the appropriate treatment approach.

Anosognosia Treatment

The treatment for anosognosia depends on its underlying cause. The following are examples of common treatment approaches:

Early intervention and therapy:

  • Seeking treatment from a therapist or counsellor as soon as the individual receives a diagnosis is crucial.
  • Due to the lack of awareness or acceptance of their mental health condition, individuals with anosognosia may struggle to seek treatment on their own. The support of family and friends can be instrumental in helping them access the necessary treatment.

Antipsychotic therapy:

  • If anosognosia is secondary to other mental health conditions, such as schizophrenia or bipolar disorder, doctors may prescribe antipsychotic medications to manage symptoms.
  • Examples of antipsychotics that may be used include chlorpromazine and loxapine.
  • The choice of medication depends on the individual's specific symptoms and overall health, and it may require some trial and error to find the most effective medication.

Motivational enhancement therapy (MET):

  • MET aims to persuade individuals to change their self-image, acknowledge their disorder, and seek appropriate treatment.
  • It involves helping individuals honestly assess their symptoms, actions, and relationships, which can lead to the realization of their condition.

Vestibular stimulation and cognitive therapy:

  • Stimulating the vestibular system, which plays a role in balance and cognitive function, through techniques such as vestibular stimulation or cognitive therapy, may improve awareness in the affected area of the brain.
  • Cognitive therapy can also assist individuals with anosognosia in gaining a better understanding and awareness of their condition.

Communication and goal-oriented discussions:

  • In some cases, instead of trying to convince a loved one with anosognosia that they are sick, focusing on their goals, such as maintaining a career or living independently, may be more effective.
  • Engaging in open and supportive discussions can encourage individuals to consult with mental health experts, even if they don't believe they require treatment for their well-being.

Anosognosia Complications

Anosognosia can lead to several complications, including:

  1. Denial of treatment: Individuals may continue to deny treatment for their mental health disorders, which can worsen their condition and potentially lead to severe or life-threatening outcomes.
  2. Social isolation: The tendency to isolate oneself to avoid confrontation may exacerbate loneliness and contribute to the deterioration of mental health.

Anosognosia Risk Factors

The following are risk factors associated with anosognosia:

  1. Mental health illnesses: Conditions like bipolar disorder increase the risk of developing anosognosia.
  2. Neurological disorders: Individuals with neurological disorders are prone to anosognosia.
  3. Poor cardiovascular health: Reduced cardiovascular health can increase the likelihood of a stroke, which may cause damage to the frontal lobe and trigger anosognosia.
  4. Head injuries: Traumatic brain injuries can result in frontal lobe damage and contribute to the development of anosognosia.

Prognosis

Anosognosia does not have a cure, but early diagnosis and treatment can significantly improve outcomes. Therapies such as motivational enhancement therapy (MET) can enhance the quality of life by promoting practical thinking, leading to changes in perception and behaviour. With proper support and treatment, individuals with anosognosia may be more likely to follow treatment plans and manage their mental health effectively.

Reviewed & Updated On

Reviewed by Dr. Vivek Kumar, Senior Director, Neurosciences, Neurology on 13-Jun-2023.


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