Disorders of affect and anosognosia Flashcards

1
Q

Synonyms for apathy

A

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

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2
Q

Characteristics of apathy

A

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

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3
Q

3 brain systems involved in apathy

A

valuation, mediating, and motor systems

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4
Q

Valuation system

A

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

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5
Q

Mediating system

A

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

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6
Q

Motor system

A

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

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7
Q

Neurological conditions with apathy

A

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

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8
Q

Treatments for apathy

A

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

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9
Q

Affect in apathy vs depression

A

just flat; flat, sad, or tearful

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10
Q

Mood in apathy vs depression

A

indifferent; sad

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11
Q

Thought content in apathy vs depression

A

neutral; pessimistic and self-critical

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12
Q

Response to prompting in apathy vs depression

A

comply; decline

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13
Q

Synonyms for emotionalism

A

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

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14
Q

Pseudobulbar affect

A

uncontrolled or inappropriate episodes of laughing or crying

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15
Q

Characteristics of laughing/crying episodes in emotionalism

A

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

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16
Q

Affect in emotionalism vs depression

A

`incongruent or congruent (but exaggerated); congruent

17
Q

Onset in emotionalism vs depression

A

rapid; gradual

18
Q

Duration in emotionalism vs depression

A

typically seconds; hours to days

19
Q

Control in in emotionalism vs depression

A

involuntary; can be modulated

20
Q

Mood in emotionalism vs depression

A

normal range; sad

21
Q

Thought content in emotionalism vs depression

A

self-conscious of crying; pessimistic, self-critical

22
Q

Neurological conditions with emotionalism

A

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

23
Q

Treatments for emotionalism

A

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

24
Q

Anosognosia

A

“without knowledge of disease”

25
Q

Range of anosognosia

A

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

26
Q

Brain regions damaged in anosognosia

A

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

27
Q

Other explanations for having no knowledge of one’s disease

A

lack of feedback from others and psychological denial

28
Q

3 levels of awareness in Crosson’s hierarchical model

A

intellectual awareness, emergent awareness, anticipatory awareness

29
Q

Intellectual awareness

A

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

30
Q

Emergent awareness

A

can recognize trouble doing a task in the moment

31
Q

Anticipatory awareness

A

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

32
Q

Consequences of anosognosia

A

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)

33
Q

Treatments for anosognosia

A

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