Disorders of affect and anosognosia

Question 1

Synonyms for apathy

Answer 1

initiation deficit, amotivation syndrome, avolition (lack of motivation), abulia (lack of willpower), anergia (lack of energy)

Question 2

Characteristics of apathy

Answer 2

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

Question 3

3 brain systems involved in apathy

Answer 3

valuation, mediating, and motor systems

Question 4

Valuation system

Answer 4

evaluation of the costs and benefits of a task based on the effort required to initiate and accomplish it

Question 5

Mediating system

Answer 5

integrates information about the costs and benefits, and activates the motor system toward particular goals

Question 6

Motor system

Answer 6

ACC transmits a go signal to supplementary motor areas for the execution of volitional behavior

Question 7

Neurological conditions with apathy

Answer 7

stroke (ACA or basal ganglia), TBI, frontotemporal dementia (mild-moderate), alzheimer’s (moderate-severe), parkinsons

Question 8

Treatments for apathy

Answer 8

methylphenidate; atypical antipsychotics; bromocriptine and amantadine (TBI); donepezil, galantamine, and memantine (AD); modafinil

Question 9

Affect in apathy vs depression

Answer 9

just flat; flat, sad, or tearful

Question 10

Mood in apathy vs depression

Answer 10

indifferent; sad

Question 11

Thought content in apathy vs depression

Answer 11

neutral; pessimistic and self-critical

Question 12

Response to prompting in apathy vs depression

Answer 12

comply; decline

Question 13

Synonyms for emotionalism

Answer 13

emotional incontinence, emotional lability, pseudobulbar affect, pathological laughing and crying, involuntary emotional expression disorder

Question 14

Pseudobulbar affect

Answer 14

uncontrolled or inappropriate episodes of laughing or crying

Question 15

Characteristics of laughing/crying episodes in emotionalism

Answer 15

rapid-onset, brief, intense, involuntary, can be emotionally congruent or incongruent, and typically provoked by a seemingly trivial event

Question 16

Affect in emotionalism vs depression

Answer 16

`incongruent or congruent (but exaggerated); congruent

Question 17

Onset in emotionalism vs depression

Answer 17

rapid; gradual

Question 18

Duration in emotionalism vs depression

Answer 18

typically seconds; hours to days

Question 19

Control in in emotionalism vs depression

Answer 19

involuntary; can be modulated

Question 20

Mood in emotionalism vs depression

Answer 20

normal range; sad

Question 21

Thought content in emotionalism vs depression

Answer 21

self-conscious of crying; pessimistic, self-critical

Question 22

Neurological conditions with emotionalism

Answer 22

amyotrophic lateral sclerosis (ALS), multiple sclerosis, stroke (brainstem or cerebellum)

Question 23

Treatments for emotionalism

Answer 23

distraction, explaining the condition to others, SSRIs, dextromethorphan/quinidine (DM/Q) or cough syrup

Question 24

Anosognosia

Answer 24

“without knowledge of disease”

Question 25

Range of anosognosia

Answer 25

from mild (underestimate degree of impairment) to severe (completely unaware); can be general or domain-specific

Question 26

Brain regions damaged in anosognosia

Answer 26

more damage in the right hemisphere and frontal cortex (especially ACC)

Question 27

Other explanations for having no knowledge of one’s disease

Answer 27

lack of feedback from others and psychological denial

Question 28

3 levels of awareness in Crosson’s hierarchical model

Answer 28

intellectual awareness, emergent awareness, anticipatory awareness

Question 29

Intellectual awareness

Answer 29

can accurately predict what’s safe and what’s not safe before doing a task

Question 30

Emergent awareness

Answer 30

can recognize trouble doing a task in the moment

Question 31

Anticipatory awareness

Answer 31

the patient can say that something is wrong with them (full awareness)

Question 32

Consequences of anosognosia

Answer 32

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)

Question 33

Treatments for anosognosia

Answer 33

education, experiential functional exercises guided by therapists, feedback on performance, positive reinforcement