Disorders of affect and anosognosia Flashcards
Synonyms for apathy
initiation deficit, amotivation syndrome, avolition (lack of motivation), abulia (lack of willpower), anergia (lack of energy)
Characteristics of apathy
diminished goal-directed behavior; dependency on prompts from others; lack of interest in new experiences; loss of motivation or energy; lack of concern about personal problems; flat affect
3 brain systems involved in apathy
valuation, mediating, and motor systems
Valuation system
evaluation of the costs and benefits of a task based on the effort required to initiate and accomplish it
Mediating system
integrates information about the costs and benefits, and activates the motor system toward particular goals
Motor system
ACC transmits a go signal to supplementary motor areas for the execution of volitional behavior
Neurological conditions with apathy
stroke (ACA or basal ganglia), TBI, frontotemporal dementia (mild-moderate), alzheimer’s (moderate-severe), parkinsons
Treatments for apathy
methylphenidate; atypical antipsychotics; bromocriptine and amantadine (TBI); donepezil, galantamine, and memantine (AD); modafinil
Affect in apathy vs depression
just flat; flat, sad, or tearful
Mood in apathy vs depression
indifferent; sad
Thought content in apathy vs depression
neutral; pessimistic and self-critical
Response to prompting in apathy vs depression
comply; decline
Synonyms for emotionalism
emotional incontinence, emotional lability, pseudobulbar affect, pathological laughing and crying, involuntary emotional expression disorder
Pseudobulbar affect
uncontrolled or inappropriate episodes of laughing or crying
Characteristics of laughing/crying episodes in emotionalism
rapid-onset, brief, intense, involuntary, can be emotionally congruent or incongruent, and typically provoked by a seemingly trivial event
Affect in emotionalism vs depression
`incongruent or congruent (but exaggerated); congruent
Onset in emotionalism vs depression
rapid; gradual
Duration in emotionalism vs depression
typically seconds; hours to days
Control in in emotionalism vs depression
involuntary; can be modulated
Mood in emotionalism vs depression
normal range; sad
Thought content in emotionalism vs depression
self-conscious of crying; pessimistic, self-critical
Neurological conditions with emotionalism
amyotrophic lateral sclerosis (ALS), multiple sclerosis, stroke (brainstem or cerebellum)
Treatments for emotionalism
distraction, explaining the condition to others, SSRIs, dextromethorphan/quinidine (DM/Q) or cough syrup
Anosognosia
“without knowledge of disease”
Range of anosognosia
from mild (underestimate degree of impairment) to severe (completely unaware); can be general or domain-specific
Brain regions damaged in anosognosia
more damage in the right hemisphere and frontal cortex (especially ACC)
Other explanations for having no knowledge of one’s disease
lack of feedback from others and psychological denial
3 levels of awareness in Crosson’s hierarchical model
intellectual awareness, emergent awareness, anticipatory awareness
Intellectual awareness
can accurately predict what’s safe and what’s not safe before doing a task
Emergent awareness
can recognize trouble doing a task in the moment
Anticipatory awareness
the patient can say that something is wrong with them (full awareness)
Consequences of anosognosia
lack of concern or indifference; low engagement with rehabilitation; medication non-compliance; may require a supervised living arrangement; poor compensatory strategy use; euthymic (stable) or irritable but not dysphoric (unease)
Treatments for anosognosia
education, experiential functional exercises guided by therapists, feedback on performance, positive reinforcement
