Anosognosia and related phenomena Flashcards
Name three disorders of awareness from mild to severe
Mild - denial - impaired self-awareness (ISA) - anosognosia Severe
What is anosognosia?
Complete unawareness of a lost neurological and/or neuropsychological function
What is impaired self-awareness (ISA)?
- partial syndrome of unawareness of the disturbed function
- patients with ISA show some awareness of their impairments
- may use both defensive and non-defensive approaches for coping with their limited awareness of an impaired function
What is denial? (4)
- a psychological method of coping with a loss or threat of loss that has personal significance to the individual
- transforms reality to suit the purposes and wishes of the individual
- ranges from a normal approach of coping to an unadaptive psychological defense
- presence of denial complicates patient management
What is the difference between:
ISA (without denial of disabilty)
and
Denial of disability (in absence or presence of ISA)
Patients with ISA (without DD):
- often perplexed when given feedback about their impairments
- no negative or positive reaction
Persons with DD (in absence or presence of ISA):
- often become irritated, if not agitated, when given feedback
- often disregard feedback
In what way can be shown that patients with anosognosia have implicit knowledge of their impairments?
- some patients with hemiplegia give worse estimates of bimanual abilities when questioned in first-person form than when questioned in third-person form
- patients deny paralysis but accept to stay in bed or wheelchair
- patients with anosognosia with hemiplegia may find excuses not to perform a bimanual tak even though they do not admit it is because of their paralyzed arms
What is neglect?
- failure to report, respond or attend to stimuli on the opposite side of space to the lesion
- impairment not caused by simple sensory or motor deficits
What is somatoparaphrenia?
- delusional belief whereby a patient feels that a part of one’s body (e.g. paralyzed limb) does not belong to his/her body
- typically associated with neglect
- often in anosognosia for hemiplegia
What is misoplegia?
Morbid dislike or hatred of paralysed limbs in patients with hemiplegia
What is anosodiaphoria?
Condition in which brain injured patients seem indifferent to the existence of their handicap
What is confabulation?
- memory disturbance characterized by verbal statements or actions that inaccurately describe history, background, and present situations
How is confabulation distinct from lying?
In confabulation there is no intent to decieve and because individuals are unaware that their information is incorrect
What is alexithymia?
Alteration in emotional processing characterized by:
- difficulty in identifying emotions and differentiating them from other physical states
- difficulty in describing emotions
- limited ability to fantasize scenarios with significant emotional context
- concrete cognitive style that disregards the complex emotional, motivational, and symbolic aspects of human behaviour
-> dysfunction in emotional awareness
Give two reasons why disorders of self-awareness like anosognosia and ISA negatively influence the process and outcome of neurorehabilitation
- affect patients’ desire/motivational to follow treatment instructions or hamper rehabilitation
- cause considerable frustration to relatives who try to provide assistance
Which two neuropyschological deficits have been discussed to contribute to anosognosia?
- episodic memory
- executive functioning
(also: motivation plays a role as it is required to engage in self-monitoring nd emotional activation marking errors as significant are often overlooked aspects of performance monitoring that may underlie anosognosia in some patients)
