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Carol's Corner - September 2008
By Carol Ziolo
Anosognosia: Lack of Insight
I just received my copy of the
Summer 2008 NAMI Advocate magazine. A very
interesting headline caught my attention: Beyond Denial and
Anosognosia: A
Biopsychosocial Model for Insight by Dr. Anand Paudya, MD. While
I was at the
NAMI convention I read the book by Xavier Amador, PhD., I am Not
Sick, I Don’t
Need Help: A Practical Guide for Families and Therapists.
Therefore, I was able
to acknowledge this unfamiliar word and know what it means.
However, I
wonder how many family members or consumers actually know what
anosognosia is and what it means to them.
Anosognosia means “unawareness of
illness” or “lack of insight” which is being
recognized as a syndrome seen in people with serious mental
illness or
neurological disorders. The person has a medically based
condition which
causes him or her to have poor to no insight and is unable to
comprehend that he
or she is ill. In fact, these people will explain their symptoms
using bizarre
explanations, may have a strong compulsion to prove they are not
ill and could
experience negative consequences in doing so (Psychiatric News).
Studies have indicated that about
fifty per cent of people with schizophrenia or
bipolar disorder have impaired insight about their illnesses.
There is also a
correlation between anosognosia and decreased functioning of the
prefrontal
area of the brain (Treatment Advocacy Center).
The Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, Text
Revision acknowledges that a majority of people with
schizophrenia lack insight
regarding the fact that they have a psychiatric illness. Studies
have indicated
that this poor insight leads to inadequate psychosocial
functioning, decrease in
work performance, lack of social relationships, noncompliance
with treatment,
and an increase in involuntary hospitalizations. Many family
members and
professionals still believe that a person’s lack of insight is a
result of the defense
mechanism of denial or lack of education while other people
think consumers are
being immature and stubborn. However, research indicates that
psychoeducation does not help this lack of awareness because it
comes from
neuropsychological deficits and the person may not have the
ability to have this
insight (Amador).
What can you do if you or your
loved one may have this syndrome called
anosognosia? This can be a very frustrating situation. People
with
schizophrenia may become very angry if anyone attempts to
explain or educate
them about their illness. They will not accept ownership of
their symptoms
because they have no insight that they have an illness that
would cause those
symptoms (Treatment Advocacy Center).
Instead, try to develop a bond with
your loved one on things you can agree on.
Listen to your loved one and allow him or her to discuss fears
and psychotic
thoughts. Allow your loved one to identify needs and what
motivates him or her
to accept treatment. This may be a very difficult chore since
you may not agree
with what your loved one thinks his or her needs are. Remember,
it is important
to gain trust in the relationship and work together as a team
(Treatment
Advocacy Center).
Does medication help?
Unfortunately, anosognosia is resistant to medications.
However, medications can reduce the positive symptoms of illness
such as
hallucinations and delusions. The best medication is the one
that is working for
the person and has the least side effects. This is
individualized, but the fewer
doses a person needs to take gives him or her fewer times to
forget or be
noncompliant with treatment. Many physicians prefer the long
acting injectable
medications to allow adherence to be more reachable (Amador).
Cognitive
Behavioral therapy has also been found to be helpful. However,
more research
is needed to move forward in the treatment of this syndrome.
Hope everyone is enjoying the
beautiful summer!
Carol Ziolo, RN, LCPC
Reference: Amador, Xavier. (2007). Poor Insight in
Schizophrenia: Overview and Impact on Medication Compliance.
Psychiatric News. (September 7,
2001). Anosognosia Keeps Patients From Realizing They’re Ill.
Volume 36 Number 17. page 13.
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