Anosognosia

from Wikipedia, the free encyclopedia
Classification according to ICD-10
R41.8 Other and unspecified symptoms affecting cognition and awareness: anosognosia
ICD-10 online (WHO version 2019)

Anosognosia ( Greek ἁ- a- [ negative particle ] νόσος nosos , Disease and γνῶσις Gnosis , knowledge ') refers to the pathological failure to detect an apparent hemiplegia , a cortical blindness , a hemianopia or deafness . This disorder is linked to damage to certain areas of the brain . It is often associated with a stroke . This term is now also used to designate a considerable lack of insight into the disease in the schizophrenic group of forms.

Forms of anosognosia

Peters distinguishes between two forms:

  1. i. e. S. Failure to recognize , e.g. B. paralysis of one side of the body;
  2. i. w. S. Not wanting to recognize bodily disorders, in general.

The disorder in the broadest sense is a psychopathological phenomenon, while the failure to recognize in the narrow sense is a neurological, predominantly organically caused disorder. When neglect is such a disorder, which is characterized by cerebral lesions of non-language dominant (usually the right) hemisphere. The most frequent location of this damage is the inferior parietal lobule .

Subspecies:

Patients with anosognosia behave as if the damage did not exist. When asked about the disorder, confabulations , excuses and rationalizations are made on the part of the patient .

The disorder usually occurs in patients who have a right hemisphere disorder and whose speech center is left hemisphere. Since the patients with anosognosia from the right hemisphere do not receive any information corresponding to their previous view of the world, the left hemisphere sticks to the previous body diagram and the disorders are explained away. In this context, more frequent phantom pain in the paralyzed extremity appears to be explainable.

In the majority of cases, the anosognosia and the acute symptoms of the disease regress within days to a few weeks.

The term has now also gained acceptance to denote the lack of insight in people suffering from psychosis that they are suffering from the diagnosed mental illness at all. It is discussed that the schizophrenic's anosognosia may be the result of frontal lobe damage. Empirical studies on seriously mentally ill people show that anosognosis-related lack of insight into the disease significantly coincides with non-compliance with antipsychotic medication. Fifteen percent of severely mentally ill people who refused medication due to anosognosis required some form of coercive use to take the medication. A study with voluntary and compulsory inpatients came to the result that patients requiring treatment needed coercive measures because they could not recognize their own need for care. Logically, forcibly admitted patients had a significantly lower insight into the disease than voluntarily admitted patients. Schizophrenic anosognosia is closely related to other cognitive dysfunction that interferes with continued drug use. Further research suggests that attitudes towards medication may improve after involuntary treatment. The previously forcibly admitted patients then voluntarily request treatment at a later point in time.

literature

  • Hans-Otto Karnath : Anosognosia . In: Wolfgang Hartje, Klaus Poeck (Ed.): Clinical Neuropsychology . 6th edition. Georg Thieme Verlag, Stuttgart 2006, ISBN 3-13-624506-7 .

Individual evidence

  1. ↑ Peters, Uwe Henrik : Dictionary of Psychiatry and Medical Psychology . Urban & Schwarzenberg, Munich 3rd edition 1984, page 38.
  2. ^ Poeck, Klaus : Neurology. Springer-Verlag - 8th edition 1992, Berlin, ISBN 3-540-53810-0 , page 140
  3. ↑ Pia L, Tamietto M: Unawareness in schizophrenia: neuropsychological and neuroanatomical findings . In: Psychiatry Clin. Neurosci. . 60, No. 5, 2006, pp. 531-7. doi : 10.1111 / j.1440-1819.2006.01576.x . PMID 16958934 .
  4. ^ McEvoy J: The Relationship Between Insight in Psychosis and Compliance With Medications . In: Xavier F. Amador & Anthony S. David eds (Eds.): Insight and Psychosis . Oxford University Press US, 1998, ISBN 978-0-19-508497-9 , p. 299.
  5. ↑ David, Anthony S .; Amador, Xavier Francisco: Insight and psychosis: Awareness of illness in schizophrenia and related disorders . Oxford University Press, Oxford [Oxfordshire] 2004, ISBN 0-19-852568-0 , p. 293.
  6. ↑ a b McEvoy JP, Applebaum PS, Apperson LJ, Geller JL, Freter S: Why must some schizophrenic patients be involuntarily committed? The role of insight . In: Compr Psychiatry . 30, No. 1, 1989, pp. 13-7. doi : 10.1016 / 0010-440X (89) 90113-2 . PMID 2564330 .
  7. ↑ Kane JM, Quitkin F, Rifkin A, Wegner J, Rosenberg G, Borenstein M: Attitudinal changes of involuntarily committed patients following treatment . In: Arch. Gen. Psychiatry . 40, No. 4, 1983, pp. 374-7. PMID 6838317 .