What is Anosognosia?
Anosognosia meaning indicates it is a mental health condition where the individual cannot be aware of or accept their mental health disorder.
This is experienced by individuals who have bipolar disorder or schizophrenia, and refuse to take medicines prescribed by their doctors. Not taking the proper care and medication worsens symptoms, which causes Anosognosia. While it may seem to be similar to denial, it is quite different. Anosognosia typically means 'lack of awareness.' Their brain can't differentiate that their moods and thoughts don't reflect reality. When this rejection persists, they tend not to accept their diagnosis.
Previous research shows that about 40% of bipolar disorder patients and 50% of schizophrenia patients suffer from Anosognosia. It could also be associated with other neurological disorders, including brain tumors, stroke, Alzheimer's, and Huntington's disease.
Causes of Anosognosia
Anosognosia is a neurological condition caused by impairment to the brain's cerebral cortex in the frontal and parietal lobes of the right hemisphere. The frontal lobe in the brain is responsible for functions like memory, emotions, impulse control, problem-solving, socializing, motor function, and the constant process of reshaping your self-image.
When your brain gains new information ranging from your new hairstyle to a change in weight or even a scar on your face, it affects how you think about yourself. Whatever your age or condition may be, the most essential function of the frontal lobe is to remember the latest update about yourself. It is like your phone remembering to download the newest update and optimizing that to perform better or even do complex functions in more straightforward language.
Sometimes, mental health conditions can cause changes in the frontal lobe, causing the remaking of the tissue. The brain eventually loses the ability to take in new information and revamp its understanding of itself.
Unfortunately, this tends to affect the perception of their condition as well. They do not remember or accept that they are ill or need to be treated.
These changes in the frontal lobe and eventual development of Anosognosia can be caused by :
- Traumatic head injury
- Dementia resulting in cognitive impairment and memory loss.
- Stroke results in the interruption or reduction of the blood supply to the brain.
- Sclerosis is a chronic disease affecting the central nervous system.
One can also be affected by psychosocial factors like:
- Social environment
- The personality of the individual
- Values and beliefs held by the individual
Surprisingly, Anosognosia does not exist at the extremes of all or nothing.
Some individuals only partially lose the ability to correctly see themselves, while this understanding may not be entirely consistent in others. That means, on one occasion, one may completely understand their mental condition, while on another instance, they may completely forget.
This makes it even more difficult for the loved ones since when the client forgets about their condition, they are not going to use medication or therapy which can further worsen symptoms.
Symptoms of Anosognosia:
There are three major symptoms to identify this mental health disorder :
- Lack of awareness: The most critical symptom of Anosognosia is a lack of understanding, awareness, or acceptance. Added to this mix is consistent and robust denial about the necessity of seeking medical help. This may even be possible when you have medical evidence of the condition. Some bluntly prove that nothing's wrong with them, and others may avoid talking about the condition because they think no one believes them. Often clients are confused and frustrated because they are contradicted by what they believe to be true.
- Lack of consistency :Some individuals become aware of their condition and treat it with medication or doctor visits. They may then suddenly miss an appointment or forget to take medication because they can no longer believe that they are ill.
- Denial : Clients may acknowledge specific symptoms but not others and give illogical explanations to counter the medical evidence. For example - someone with bipolar disorder may not believe they have mood swings, but they might be aware that they have periods when extremely happy or sad. The critical distinction that needs to be made is the difference between denial and Anosognosia. Remember to track the behavior of your loved one before and after the diagnosis. Don't confuse a person's actual personality and Anosognosia symptoms. They may believe that they're fine when they aren't, so make sure to bridge communication with them. If they are extremely adamant about the lack of symptoms, refuse to take treatment, or show inconsistency in awareness, you should consult a mental health professional.
How is Anosognosia diagnosed?
A psychiatrist or other mental health specialist can monitor an individual's overall mental health and symptoms. Experienced professionals will be able to recognize Anosognosia at an early stage by even a tiny behavior change. Some common methods for diagnosis are :
The standard evaluation technique is the "LEAP" method, which is done by:
- Listening to the individual
- Empathizing with the individual
- Agreeing with the individual
- Partnering with the individual
Scale to assess Unawareness of Mental Disorder (SUM-D) is a diagnostic tool that places the idea of "insight" on a spectrum that includes:
- Awareness: Does the person recognize and notice the symptoms of their condition? Are they aware there may be social consequences of their situation?
- Understanding: Does the person realize that they are ill and need treatment?
- Attribution: Do they acknowledge that their symptoms result from a mental health condition?
The SUM-D test results will indicate if the individual has Anosognosia.
Diagnosis can open communication between a doctor and the individual with Anosognosia. This can further help to build confidence to initiate the treatment as soon as possible. This allows the patient to become aware of the situation and believe that people around them are supportive, understanding, and helping them for their good.
How to treat Anosognosia?
Every mental health disorder can be treated with the right professional help. Here are a few ways of Anosognosia treatment options. However, please consult your mental health practitioner for the best course of treatment.
- Motivational Enhancement Therapy: A therapist tries to approach the patient with motivational enhancement therapy (MET). This type of communication therapy is designed to help change the patient's behavior. The treatment is used to motivate people to either alter their self-image or accept the condition's existence and encourage them to get treatment.
- Medications: The doctor may recommend medicines known as antipsychotics to treat symptoms of conditions like schizophrenia or bipolar disorder.
Note: All medication must be taken only under the supervision of a licensed psychiatrist.
- Electroconvulsive therapy: It may be a brief electrical stimulation of the brain for patients with schizophrenia. This can help with dealing with the symptoms of Anosognosia as well.
- Repetitive Transcranial Magnetic Stimulation: In this therapy, an electromagnet delivers a pulse to stimulate nerve cells in patients recovering from a stroke. This stimulation further stimulates the brain cells.
How can you help your loved ones?
Treating Anosognosia can be a challenging process involving mental health professionals and the client's loved ones. Here is how you can help :
- Don't judge: It is a medical condition, not stubbornness or self-destructive tendencies.
- Be supportive: Some days may be better than others. No one purposely loses their perception of their condition. They need your support and consistency for treatment, appointments, and medications.
- Keep notes: Keeping a detailed diary of how a person reacts can help compile evidence of their condition. This can help the patient realize that they have Anosognosia and provide the doctor with a base for the treatment plan.
- Give them hope: NEVER try to convince an anosognosia patient that they're ill. Instead, encourage them about their goals, keep a job, or live independently. This might motivate them to meet with a professional, even if they don't think they need it for their well-being.
Like any other mental health disorder, Anosognosia can be challenging for clients and their loved ones. However, the important thing to remember is that it can be treated with both professional and personal support. Take your first step towards a better future!
How to help someone with anosognosia?
- Don't judge: Remember that this is a medical condition, not stubbornness or self-destructive tendencies.
- Be supportive: Some days may be better than others.
- Take notes: Keeping a detailed diary of what the person says and does can help you compile evidence of the condition.