ANOSOGNOSIA AND TREATMENT

WHAT IS ANOSOGNOSIA?

Anosognosia is a lack of ability to perceive the realities of one’s own condition. It’s a person’s inability to accept that they have a health condition according to their symptoms or a formal diagnosis.

This happen when there is an evidence of a certain diagnosis including  a second or even third medical opinions confirming the validity of a particular diagnosis.

Anosognosia is a result of changes to the brain. It’s not just stubbornness or outright denial, which is a defense mechanism some people use when they receive a difficult diagnosis to cope with. Anosognosia may be similar  to schizophrenia or bipolar disorder.

With Anosognosia someone may reject a diagnosis of a mental disorder, they deny even taking medicines.

To be clear, denial is not a mental disorder; however, people often mistakenly believe that anosognosia is denial. 

Anosognosia is a Greek word that simply means “without knowledge of disease” or “lack of insight.” 

This word is often used to describe people who are not denying mental health problems, but they don't know exactly about their health condition.Some people with severe mental illness may not clearly know the situation they are going through even they choose to deny their health condition.

They may instead be experiencing a lack of insight into mental illness versus denial of mental illness. People like this are otherwise referred to as Anosognosiacs. 

Some experts believe that anosognosia is caused by brain damage in certain regions of the brain involved with self-reflection. The frontal lobe of the brain is responsible for functions like memory, emotions, impulse control, problem-solving, socializing, motor function, and of course, self-reflection and image.

Regardless of your age or status, your self-image is constantly being updated. Whenever you gain new information – whether it’s a new haircut or weight changes – it affects how you think about yourself. As you can imagine, this is a never-ending, complex process. For this process to go smoothly, the frontal lobe of your brain has to absorb the new information, process it, and use it to basically “edit” your self-image.

When the brain’s frontal lobe is damaged, which is a common issue in people with conditions like schizophrenia and bipolar disorder, your self-image is affected. Your brain can no longer absorb and process new information to update how you see yourself. For a person who requires schizophrenia or bipolar disorder treatment, this can be a hindrance to their recovery.

However, anosognosia isn’t an either-or condition. Some people only partially lose the ability to see themselves clearly, and in others, the condition comes and goes. This can be especially confusing to loved ones who are trying to help. It’s hard to understand how someone can completely understand their condition in one moment and then claim they’re perfectly fine in the next. That’s why people are always comparing anosognosia vs denial.

SYMPTOMS

*When a person with a mental disorder develops anosognosia, they may not take their medications or complete their treatment. In their head, they’re thinking, “Why would I take a drug if there’s nothing wrong with me?

*Lack of understanding, awareness, or acceptance of your condition. It’s even possible for you to develop this condition even if there’s extensive evidence that you do.

*Acknowledging that they think they’re fine or that nothing is wrong with them

*Avoiding talking about their condition because they think no one believes them

*Becoming frustrated or confused when people contradict what they believe to be true

*Missing appointments or treatments with their physicians or therapists

*Skipping or forgetting to take their medication

*Acknowledging some symptoms of their conditions, but not others

OTHER SYMPTOMS

Signs and symptoms may  depend on the particular disorder, circumstances and other factors that can affect emotions, thoughts and behaviors.

*Feeling sad or down

*Confused thinking or reduced ability to concentrate

*Excessive fears or worries, or extreme feelings of guilt

*Extreme mood changes of highs and lows

*Withdrawal from friends and activities

*Significant tiredness, low energy or problems sleeping

*Detachment from reality (delusions), paranoia or hallucinations

*Inability to cope with daily problems or stress

*Trouble understanding and relating to situations and to people

*Alcohol or drug abuse

*Major changes in eating habits

*Sex drive changes

*Excessive anger, hostility or violence

*Suicidal thinking

DIAGNOSIS 

Your doctor may recommend that you see a psychiatrist or other mental health specialist if you or a loved one have been diagnosed with a condition that may be associated with anosognosia. A specialist can monitor your overall mental health and any symptoms that arise.

A specialist may also recognize anosognosia early on. Even small behavior changes can be detected by a specialist.

Evaluation technique

*listening to the person

*empathizing with the person

*agreeing with the person

*partnering with the person

This method helps open a dialogue between a doctor and the person with anosognosia. This allows the person to develop an awareness of the objective facts of their situation as well as understand that people around them are supportive and understanding.

Scale to Assess Unawareness of Mental Disorder

*Awareness. 

>Does the person recognize that they have a condition? 

>Do they notice the symptoms of their condition? 

>Do they know that there may be social consequences of their condition?

Understanding. 

>Does the person realize that they need treatment?

Attribution. 

*Do they believe that their symptoms result from a mental health condition?

CAUSES

Anosognosia, in general, are thought to be caused by a variety of genetic and environmental factors:

*Inherited traits. Anosognosia is more common in people whose biological (blood) relatives also have a anosognosia. Certain genes may increase your risk of developing it, and your life situation may trigger it.

*Environmental exposures before birth. Exposure to viruses, toxins, alcohol or drugs while in the womb can sometimes be linked to mental illness.

*Brain chemistry. Biochemical changes in the brain are thought to affect mood and other aspects of mental health. Naturally occurring brain chemicals called neurotransmitters play a role in some mental illnesses. In some cases, hormonal imbalances affect mental health.

RISK FACTORS

Certain factors may increase your risk of developing anosognosia, including:

*Having a biological (blood) relative, such as a parent or sibling, with a mental illness

*Experiences in the womb — for example, having a mother who was exposed to viruses, toxins, drugs or alcohol during pregnancy

*Stressful life situations, such as financial problems, a loved one's death or a divorce

*A chronic medical condition, such as cancer

*Brain damage as a result of a serious injury (traumatic brain injury), such as a violent blow to the head

*Traumatic experiences, such as military combat or being assaulted

*Use of illegal drugs

*Being abused or neglected as a child

*Having few friends or few healthy relationships

*A previous mental illness

COMPLICATIONS

*Unhappiness and decreased enjoyment of life

*Weakened immune system, so your body has a hard time resisting infections

*Family conflicts

*Relationship difficulties

*Social isolation

*Problems with tobacco, alcohol and other drugs

*Missed work or school, or other problems related to work or school

*Poverty and homelessness

*Self-harm and harm to others, including suicide or homicide

*Increased risk of motor vehicle accidents

*Heart disease and other medical conditions

*Ceasing treatment without a doctor's concern or forgetting instructions given by a doctor.

PREPARING FOR YOUR APPOINTMENT

Whether you schedule an appointment with your primary health care provider to talk about Anosognosia concerns or you're referred to a mental health provider, such as a psychiatrist or psychologist, take steps to prepare for your appointment.

TESTS AND DIAGNOSIS

To determine a diagnosis and check for any related complications, you may have:

*A physical exam. Your doctor will try to rule out physical problems that could cause your symptoms.

*Lab tests. These may include a check of your thyroid function or a screening for alcohol and drugs, for example.

*A psychological evaluation. A doctor or mental health provider talks to you about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.

Determining which mental illness you have

Sometimes it's difficult to find out which mental illness may be causing your Anosognosia. But taking the time and effort to get an accurate diagnosis will help determine the appropriate treatment.

The defining symptoms for each mental illness are detailed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Classes of mental illness

The main classes of mental illness are:

*Neurodevelopmental disorders. This class covers a wide range of problems that usually begin in infancy, childhood or the teenage years. Examples include autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD) and learning disorders.

*Schizophrenia spectrum and other psychotic disorders. Psychotic disorders cause detachment from reality (delusions, paranoia and hallucinations). The most notable example is schizophrenia, although other classes of disorders can be associated with detachment from reality at times.

*Bipolar and related disorders. This class includes disorders with alternating episodes of mania — periods of excessive activity, energy and excitement — and depression.

*Depressive disorders. These include disorders that affect how you feel emotionally, such as the level of sadness and happiness. Examples include major depressive disorder and premenstrual dysphoric disorder.

*Anxiety disorders. Anxiety is an emotion characterized by the anticipation of future danger or misfortune, accompanied by feeling ill at ease. This class includes generalized anxiety disorder, panic disorder and phobias.

*Obsessive-compulsive and related disorders. These disorders involve preoccupations or obsessions and repetitive thoughts and actions. Examples include obsessive-compulsive disorder, hoarding and hair-pulling disorder (trichotillomania).

Trauma- and stressor-related disorders. These are adjustment disorders in which a person has trouble coping during or after a stressful life event. Examples include post-traumatic stress disorder (PTSD) and acute stress disorder.

*Dissociative disorders. These are disorders in which your sense of self is disrupted, such as with dissociative identity disorder and dissociative amnesia.

*Somatic symptom and related disorders. A person with one of these disorders may have physical symptoms with no clear medical cause, but the disorders are associated with significant distress and impairment. The disorders include somatic symptom disorder (previously known as hypochondriasis) and factitious disorder.

*Feeding and eating disorders. These disorders include disturbances related to eating, such as anorexia nervosa and binge-eating disorder.

*Elimination disorders. These disorders relate to the inappropriate elimination of urine or stool by accident or on purpose. Bedwetting (enuresis) is an example.

*Sleep-wake disorders. These are disorders of sleep severe enough to require clinical attention, such as insomnia, sleep apnea and restless legs syndrome.

*Sexual dysfunctions. These include disorders of sexual response, such as premature ejaculation and female orgasmic disorder.

*Gender dysphoria. This refers to the distress that accompanies a person's stated desire to be another gender.

*Disruptive, impulse-control and conduct disorders. These disorders include problems with emotional and behavioral self-control, such as kleptomania or intermittent explosive disorder.

*Substance-related and addictive disorders. These include problems associated with the use of alcohol, caffeine, tobacco and drugs. This class also includes gambling disorder.

*Neurocognitive disorders. Neurocognitive disorders affect your ability to think and reason. This class includes delirium, as well as neurocognitive disorders due to conditions or diseases such as traumatic brain injury or Alzheimer's disease.

*Personality disorders. A personality disorder involves a lasting pattern of emotional instability and unhealthy behavior that causes problems in your life and relationships. Examples include borderline personality disorder and antisocial personality disorder.

Paraphilic disorders. These disorders include sexual interest that causes personal distress or impairment or causes potential or actual harm to another person. Examples are sexual sadism, voyeuristic disorder and pedophilic disorder.

Other mental disorders. This class includes mental disorders that are due to other medical conditions or that don't meet the full criteria for one of the above disorders.

TREATMENT

People living with Anosognosia do not look for treatment. They believe that everything is ok concerning their health. 

Therefore, these people need support from their families visit a doctor. Treatment will depend on a kind of a particular health situation.

Your treatment depends on the type of mental illness you have, its severity and what works best for you. In many cases, a combination of treatments works best.

If you have a mild mental illness with well-controlled symptoms, treatment from one health care provider may be sufficient. 

However, often a team approach is appropriate to make sure all your psychiatric, medical and social needs are met. This is especially important for severe mental illnesses, such as schizophrenia.

*Your treatment team

*Your treatment team may include your:

*Family or primary care doctor

*Nurse practitioner

*Physician assistant

*Psychiatrist, a medical doctor who diagnoses and treats mental illnesses

*Psychotherapist, such as a psychologist or a licensed counselor

*Pharmacist

*Social worker

*Family members

*Medications

Although psychiatric medications don't cure mental illness, they can often significantly improve symptoms. Psychiatric medications can also help make other treatments, such as psychotherapy, more effective. The best medications for you will depend on your particular situation and how your body responds to the medication.

Some of the most commonly used classes of prescription psychiatric medications include:

*Antidepressants. Antidepressants are used to treat depression, anxiety and sometimes other conditions. They can help improve symptoms such as sadness, anxiety, hopelessness, lack of energy, difficulty concentrating and lack of interest in activities. Antidepressants are not addictive and do not cause dependency.

*Anti-anxiety medications. Anti-anxiety medications are used to treat anxiety disorders, such as generalized anxiety disorder and panic disorder. They may also help reduce agitation and insomnia. Long-term anxiety medications consist mostly of antidepressants that also work for anxiety. There also are fast-acting anti-anxiety medications, which help with short-term relief —but they have the potential to cause dependency and ideally would be used short term.

*Mood-stabilizing medications. Mood stabilizers are most commonly used to treat bipolar disorder, which involves alternating episodes of mania and depression. Sometimes mood stabilizers are used with antidepressants to treat depression.

*Antipsychotic medications. Antipsychotic medications, also called neuroleptics, are typically used to treat psychotic disorders such as schizophrenia. Antipsychotic medications may also be used to treat bipolar disorders or used with antidepressants to treat depression.

Psychotherapy

Psychotherapy, also called talk therapy, involves talking about your condition and related issues with a mental health provider. During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behavior. With the insights and knowledge you gain, you can learn coping and stress management skills.

There are many types of psychotherapy, each with its own approach to improving your mental well-being. Psychotherapy often can be successfully completed in a few months, but in some cases, long-term treatment may be needed. It can take place one-on-one, in a group or with family members.

Brain-stimulation treatments

Brain-stimulation treatments are sometimes used for depression and other mental health disorders. They're generally reserved for situations in which medications and psychotherapy haven't worked. They include electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation and an experimental treatment called deep brain stimulation.

Make sure you understand all the risks and benefits of any recommended treatment.

Hospital and residential treatment programs

Sometimes mental illness becomes so severe that you need care in a psychiatric hospital. This is generally recommended when you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else.

Options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a temporary supportive place to live. Another option may be intensive outpatient treatment.

Substance abuse treatment

Substance abuse commonly occurs along with mental illness. Often it interferes with treatment and worsens mental illness. If you can't stop using drugs or alcohol on your own, you need treatment. Substance abuse treatments include:

*Psychotherapy, to learn more about your condition and gain insight

*Medications, which may help ease withdrawal symptoms or reduce cravings

*Inpatient treatment, such as withdrawal (detox) treatment

*Outpatient treatment programs, which require regular attendance for a set period of time

*Support groups or 12-step programs, such as Alcoholics Anonymous (A.A.)

*Participating in your own care

Working together, you and your health care provider can decide which treatment may be best, depending on your symptoms and their severity, personal preferences, medication side effects, and other factors. In some cases, a mental illness may be so severe that a doctor or loved one may need to guide your care until you're well enough to participate in decision-making.

LIFESTYLE AND HOME REMEDIES

There's no sure way to prevent mental illness. However, if you have a mental illness, taking steps to control stress, to increase your resilience and to boost low self-esteem may help keep your symptoms under control. Follow these steps:

*Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.

*Get routine medical care. Don't neglect checkups or skip visits to your family health care provider, especially if you aren't feeling well. You may have a new health problem that needs to be treated, or you may be experiencing side effects of medication.

*Get help when you need it. Mental health conditions can be harder to treat if you wait until symptoms get bad. Long-term maintenance treatment also may help prevent a relapse of symptoms.

*Take good care of yourself. Sufficient sleep, healthy eating and regular physical activity are important. Try to maintain a regular schedule. Talk to your provider if you have trouble sleeping or if you have questions about diet and exercise.

COPING AND SUPPORT

Coping with a mental illness can be challenging. Talk to your doctor or therapist about improving your coping skills, and consider these tips:

*Learn about your mental illness. Include your family, too — this can help the people who care about you understand what you're going through and learn how they can help. Your doctor or therapist may provide information directly or may recommend classes, books or websites.

*Join a support group. Connecting with others facing similar challenges may help you cope. Support groups for mental illness are available in many communities and online. One good place to start is the National Alliance on Mental Illness.

*Stay connected with friends and family. Try to participate in social activities, and get together with family or friends regularly. Ask for help when you need it, and be upfront with your loved ones about how you're doing.

*Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what triggers or improves your symptoms. It's also a healthy way to explore and express pain, anger, fear and other emotions.

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