Study of Anosognosia
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NEGLECT and ANOSOGNOSIA a CHALLENGE for PSYCHOANALYSIS Psychoanalytic Treatment of Neurological Patients with Hemi-Neglect
Psychoanalytische Perspectieven, 2002, 20, 4: 611-631 NEGLECT AND ANOSOGNOSIA A CHALLENGE FOR PSYCHOANALYSIS Psychoanalytic treatment of neurological patients with hemi-neglect Klaus Röckerath1 Introduction This paper deals with two phenomena often observed in patients with a lesion to the right hemisphere of the brain: neglect and anosognosia. Fol- lowing an overview of the neglect syndrome from a neuroscientific per- spective I will present preliminary results and hypotheses formulated by our group based on the psychoanalytic treatment of seven such patients. It may be somewhat unusual for neurologically impaired patients to undergo psychoanalytic treatment. But in recent years, a combined effort to under- stand the underlying mechanisms of psychic phenomena has evolved in psychoanalysis and the neurosciences. Hence, the field of neuro-psycho- analysis established itself, studying the psychic implications of neurologi- cal damage in order to understand and gain insight into the "psychic appa- ratus", as constructed by Freud, from a different point of view. It is well known that Freud, a trained neurologist, hoped that one day the mecha- nism of psychic functions would be understood from a neurologist's point of view. He was convinced that the answer to the psychic problems he encountered with his patients must be rooted in the matter of the mind: the brain. That is why groups of psychoanalysts and neuroscientists all over the world have begun to exchange news and views about their common interest: the human mind. Both sciences basically deal with the same object. One way psychoanalysts can contribute is by looking at neurologically impaired patients in a psychoanalytic framework to establish what is dif- 1.The Neurops ychoanalytic Study Group Frankfurt/Cologne, Germany. -
Amsterdam Executive Functions
Executive function and behaviour Masud Husain Professor of Neurology & Cognitive Neuroscience, University of Oxford Lead for Neurological Conditions, Oxford NIHR Biomedical Research Centre Supported by The Wellcome Trust What are executive functions? They’re functions that are thought to be deployed when control needs to be exerted § Typically described as ‘supervisory’ or ‘controlling’ § Deployed when a situation is novel or difficult § When you need to pay attention because there isn’t an automatic / habitual response to the problem or the automatic response would be inappropriate Example: When the phone rings in someone else’s house, you don’t pick it up, even though the automatic tendency in your own home is to do so § When several cognitive processes need to be co-ordinated § Or when you need to shift from one type of process to another Orchestration of behaviour They’re functions that are thought to be deployed when control needs to be exerted § Initiate § Maintain / Sustain / Invigorate / Energise § Stop ongoing action § Inhibit inappropriate behaviour or prepotent response § Switch to a different behavioural set / set shifting / mental flexibility § Working memory: manipulation of items in short term memory § Monitor consequences of behaviour / error monitoring § Planning and prioritization § Multi-tasking § Social / emotional engagement When executive function breaks down There might be profound consequences Executive function Associated executive dysfunction Clinical presentation Task initiation Reduced self-generated behaviours -
Treatment of Unawareness of Deficits in Patients with Acquired Brain Injury
J Head Trauma Rehabil Vol. 29, No. 5, pp. E9–E30 Copyright c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Unawareness of Deficits in Patients With Acquired Brain Injury: A Systematic Review Anne-Claire Schrijnemaekers, MSc; Sanne M. J. Smeets, MSc; Rudolf W. H. M. Ponds, PhD; Caroline M. van Heugten, PhD; Sascha Rasquin, PhD Objective: To review and evaluate the effectiveness and methodological quality of available treatment methods for unawareness of deficits after acquired brain injury (ABI). Methods: Systematic literature search for treatment studies for unawareness of deficits after ABI. Information concerning study content and reported effectiveness was extracted. Quality of the study reports and methods were evaluated. Results: A total of 471 articles were identified; 25 met inclusion criteria. 16 were uncontrolled or single-case studies. Nine were of higher quality: 2 randomized controlled trials, 5 single case experimental designs, 1 single-case design with pre- and posttreatment measurement, and 1 quasi-experimental controlled design. Overall, interventions consisted of multiple components including education and multimodal feedback on performance. Five of the 9 high-quality studies reported a positive effect of the intervention on unawareness in patients with some knowledge of their impairments. Effect sizes ranged from questionable to large. Conclusion: Patients with ABI may improve their awareness of their disabilities and possibly attain a level at which they personally experience problems when they occur. At present, because of lack of evidence, no recommendation can be made for treatment approaches for persons with severe impairment of self-awareness in the chronic phase of ABI. We recommended developing and evaluating theory-driven interventions specifically focused on disentangling the components of treatment that are successful in improving awareness. -
The Riddle of Anosognosia: Does Unawareness of Hemiplegia Involve a Failure to Update Beliefs?
cortex 49 (2013) 1771e1781 Available online at www.sciencedirect.com Journal homepage: www.elsevier.com/locate/cortex Research report The riddle of anosognosia: Does unawareness of hemiplegia involve a failure to update beliefs? Roland Vocat a, Arnaud Saj b and Patrik Vuilleumier a,b,* a Laboratory for Behavioral Neurology & Imaging of Cognition, Department of Neuroscience, Medical School, University of Geneva, Switzerland b Clinic of Neurology, University Hospital of Geneva, Geneva, Switzerland article info abstract Article history: Anosognosia for hemiplegia (AHP) is defined as a lack of awareness for motor incapacity Received 1 February 2012 after a brain lesion. The causes of AHP still remain poorly understood. Many associations Reviewed 10 May 2012 and dissociations with other deficits have been highlighted but no specific cognitive or Revised 30 August 2012 neurological impairment has been identified as a unique causative factor. We hypothe- Accepted 20 October 2012 sized that a failure to update beliefs about current state might be a crucial component of Action editor Giuseppe Vallar AHP. Here, we report results from a new test that are compatible with this view. We Published online 27 November 2012 examined anosognosic and nosognosic brain-damaged patients, as well as healthy con- trols, on a task where they had to guess a target word based on successive clues, with Keywords: increasing informative content. After each clue, participants had to propose a word solu- Anosognosia for hemiplegia tion and rated their confidence. Compared to other participants, anosognosic patients were AHP abnormally overconfident in their responses, even when information from the clues was Awareness insufficient. Furthermore, when presented with new clues incongruent with their previous Denial response, they often stuck to their former “false” beliefs instead of modifying them. -
Incidence and Diagnosis of Anosognosia for Hemiparesis Revisited B Baier, H-O Karnath
358 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2004.036731 on 16 February 2005. Downloaded from PAPER Incidence and diagnosis of anosognosia for hemiparesis revisited B Baier, H-O Karnath ............................................................................................................................... J Neurol Neurosurg Psychiatry 2005;76:358–361. doi: 10.1136/jnnp.2004.036731 Background: In previous studies, the incidence of anosognosia for hemiparesis has varied between 17% and 58% in samples of brain damaged patients with hemiparesis. See end of article for Objective: To determine whether this wide variation might be explained by the different criteria used for authors’ affiliations ....................... diagnosing anosognosia. Methods: 128 acute stroke patients with hemiparesis or hemiplegia were tested for anosognosia for Correspondence to: hemiparesis using the anosognosia scale of Bisiach et al. Prof Hans-Otto Karnath, Results: 94% of the patients who were rated as having ‘‘mild anosognosia’’—that is, they did not Centre of Neurology, Hertie-Institute for Clinical acknowledge their hemiparesis spontaneously following a general question about their complaints— Brain Research, University suffered from, and mentioned, other neurological deficits such as dysarthria, ptosis, or headache. of Tu¨bingen, Hoppe- However, they immediately acknowledged their paresis when they were asked about the strength of their Seyler-Str 3, D-72076 Tu¨bingen, Germany; limbs. Their other deficits clearly had a greater -
Apraxia, Neglect, and Agnosia
REVIEW ARTICLE 07/09/2018 on SruuCyaLiGD/095xRqJ2PzgDYuM98ZB494KP9rwScvIkQrYai2aioRZDTyulujJ/fqPksscQKqke3QAnIva1ZqwEKekuwNqyUWcnSLnClNQLfnPrUdnEcDXOJLeG3sr/HuiNevTSNcdMFp1i4FoTX9EXYGXm/fCfl4vTgtAk5QA/xTymSTD9kwHmmkNHlYfO by https://journals.lww.com/continuum from Downloaded Apraxia, Neglect, Downloaded CONTINUUM AUDIO INTERVIEW AVAILABLE and Agnosia ONLINE from By H. Branch Coslett, MD, FAAN https://journals.lww.com/continuum ABSTRACT PURPOSEOFREVIEW:In part because of their striking clinical presentations, by SruuCyaLiGD/095xRqJ2PzgDYuM98ZB494KP9rwScvIkQrYai2aioRZDTyulujJ/fqPksscQKqke3QAnIva1ZqwEKekuwNqyUWcnSLnClNQLfnPrUdnEcDXOJLeG3sr/HuiNevTSNcdMFp1i4FoTX9EXYGXm/fCfl4vTgtAk5QA/xTymSTD9kwHmmkNHlYfO disorders of higher nervous system function figured prominently in the early history of neurology. These disorders are not merely historical curiosities, however. As apraxia, neglect, and agnosia have important clinical implications, it is important to possess a working knowledge of the conditions and how to identify them. RECENT FINDINGS: Apraxia is a disorder of skilled action that is frequently observed in the setting of dominant hemisphere pathology, whether from stroke or neurodegenerative disorders. In contrast to some previous teaching, apraxia has clear clinical relevance as it is associated with poor recovery from stroke. Neglect is a complex disorder with CITE AS: many different manifestations that may have different underlying CONTINUUM (MINNEAP MINN) mechanisms. Neglect is, in the author’s view, a multicomponent disorder 2018;24(3, -
Anosognosia As a Comorbidity in Mental Health Conditions
University of Central Florida STARS Honors Undergraduate Theses UCF Theses and Dissertations 2020 Awareness of the Unaware: Anosognosia as a Comorbidity in Mental Health Conditions Tiffany L. Baula University of Central Florida Part of the Nursing Commons, and the Psychiatric and Mental Health Commons Find similar works at: https://stars.library.ucf.edu/honorstheses University of Central Florida Libraries http://library.ucf.edu This Open Access is brought to you for free and open access by the UCF Theses and Dissertations at STARS. It has been accepted for inclusion in Honors Undergraduate Theses by an authorized administrator of STARS. For more information, please contact [email protected]. Recommended Citation Baula, Tiffany L., "Awareness of the Unaware: Anosognosia as a Comorbidity in Mental Health Conditions" (2020). Honors Undergraduate Theses. 671. https://stars.library.ucf.edu/honorstheses/671 AWARENESS OF THE UNAWARE: ANSOGNOSIA AS A COMORBIDITY IN MENTAL HEALTH CONDITIONS by TIFFANY LAUREN BAULA A thesis submitted in partial fulfillment of the requirements for the Honors in the Major Program in Nursing in the College of Nursing and in the Burnett Honors College at the University of Central Florida Orlando, Florida Spring Term 2020 ABSTRACT AWARENESS OF THE UNAWARE: ANOSOGNOSIA AS A COMORBIDITY IN MENTAL HEALTH CONDITIONS Integrative Literature Review The primary purpose of this integrative review of the literature is to describe healthcare provider’s recognition of anosognosia in individuals with comorbid mental health disorders, as a differentiating diagnosis needing preeminent early intervention. The secondary purpose is to examine how anosognosia influences outcomes in the population of individuals with severe mental illness. -
GLOSSARY Terms in the Field of Psychiatry and Neurology A
GLOSSARY Terms in the field of Psychiatry and Neurology A abreaction :An emotional release or discharge after recalling a painful experience that has been repressed because it was not consciously tolerable. abstract attitude: (categorical attitude) This is a type of thinking that includes voluntarily shifting one's mind set from a specific aspect of a situation to the general aspect; It involves keeping in mind different simultaneous aspects of a situation while grasping the essentials of the situation. abulia A lack of will or motivation which is often expressed as inability to make decisions or set goals. acalculia The loss of a previously possessed ability to engage in arithmetic calculation. acetylcholine A neurotransmitter in the brain, which helps to regulate memory, and in the peripheral nervous system, where it affects the actions of skeletal and smooth muscle. acting out This is the process of expressing unconscious emotional conflicts or feelings via actions rather than words. The person is not consciously aware of the meaning or etiology of such acts. Acting out may be harmful or, in controlled situations, therapeutic (e.g., children's play therapy). 1 actualization The realization of one's full potential - intellectual, psychological, physical, etc. adiadochokinesia The inability to perform rapid alternating movements of one or more of the extremities. This task is sometimes requested by physicians of patients during physical examinations to determine if there exists neurological problems. adrenergic This refers to neuronal or neurologic activity caused by neurotransmitters such as epinephrine, norepinephrine, and dopamine. affect This word is used to described observable behavior that represents the expression of a subjectively experienced feeling state (emotion). -
Parietal Lobes: Evolution, Neuroanatomy, and Function
Parietal Lobes: Evolution, Neuroanatomy, and Function Charles J. Vella, PhD May 3, 2017 Intent of this lecture Parietal lobe syndromes are mostly domain of neurology, not NP But these syndromes will affect NP performance on multiple tests There are lots of anatomical references: you can always use the pdf online as reference text There are lots of unusual, sometimes rare, syndromes My objective is to have you be aware of when parietal lobe functioning is involved in something you are seeing clinically in a patient The discovery of the Parietal Lobe Franciscus Sylvius (1614-1672) Physician, physiologist, anatomist, and chemist Professor at the University of Leidon (1641) Was in the chemistry lab at the University when he discovered the deep cleft (Sylvian Fissure). History of Parietal Lobe Discovery In 1874 Bartholow recorded odd sensation from legs on stimulating post central gyrus through skull wounds Djerine – alexia , agraphia -- angular gyrus lesion Hugo Liepmann--- ideomotor & ideational apraxia in (L) sided lesion Cushing in 1909 --- Electrical stimulation in conscious human beings –– mainly tactile hallucinations; first homunculus Critchley (1953) – 1st monograph on “ The Parietal Lobes” Siegel et al. (2003) – “The Parietal Lobes” Macdonald Critchley: Parietal Lobes Parietal Lobes No independent existence as anatomical / physiological unit Operates in conjunction with brain as a whole Strategically situated between other lobes Greater variety of clinical manifestations than rest of the hemisphere Ignored in -
The Right Hemisphere and Disorders of Cognition and Communication
The Right Hemisphere and Disorders of Cognition and Communication Theory and Clinical Practice The Right Hemisphere and Disorders of Cognition and Communication Theory and Clinical Practice Margaret Lehman Blake, PhD 5521 Ruffin Road San Diego, CA 92123 e-mail: [email protected] Website: http://www.pluralpublishing.com Copyright © 2018 by Plural Publishing, Inc. Typeset in 10.5/14 Palatino by Flanagan’s Publishing Services, Inc. Printed in the United States of America by McNaughton & Gunn All rights, including that of translation, reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, including photocopying, recording, taping, Web distribution, or information storage and retrieval systems without the prior written consent of the publisher. For permission to use material from this text, contact us by Telephone: (866) 758-7251 Fax: (888) 758-7255 e-mail: [email protected] Every attempt has been made to contact the copyright holders for material originally printed in another source. If any have been inadvertently overlooked, the publishers will gladly make the necessary arrangements at the first opportunity. Library of Congress Cataloging-in-Publication Data: Names: Blake, Margaret Lehman, author. Title: The right hemisphere and disorders of cognition and communication : theory and clinical practice / Margaret Lehman Blake. Description: San Diego, CA : Plural, [2018] | Includes bibliographical -
What Is Anosognosia?
_________________Treatment Advocacy Center Backgrounder______________ What is Anosognosia? (updated March 2014) Anosognosia is an awkward term introduced by neurologists a century ago “to denote a complete or partial lack of awareness of different neurological…and/or cognitive dysfunctions.” This definition comes from G.P. Prigatano, ed. The Study of Anosognosia, Oxford University Press, 2010, p.17. Anosognosia thus means lack of awareness or lack of insight. It is not the same as denial of illness; anosognosia is caused by physical damage to the brain and is thus anatomical in origin whereas denial is psychological in origin. Anosognosia is very difficult to imagine or understand. Oliver Sacks, in The Man Who Mistook His Wife for a Hat (p.5), explained anosognosia as follows: It is not only difficult, it is impossible for patients with certain right-hemisphere syndromes to know their own problems – a peculiar and specific ‘anosognosia,’ as Babinski called it. And it is singularly difficult, for even the most sensitive observer, to picture the inner state, the ‘situation’ of such patients, for this is almost unimaginably remote from anything he himself has ever known. Among neurological patients, anosognosia is seen most commonly in Alzheimer’s disease, Huntington’s disease, and traumatic brain injury and occasionally in patients with stroke (especially those involving the right parietal lobe) and Parkinson’s disease. Most patients with Alzheimer’s disease, for example, are aware that something is wrong early in the course of their illness but then lose all awareness of their illness as it progresses. Anosognosia is also very important in psychiatry since approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder have anosognosia. -
Prognosis for Patients with Neglect and Anosognosia with Special Reference to Cognitive Impairment
J Rehabil Med 2003; 35: 254–258 PROGNOSIS FOR PATIENTS WITH NEGLECT AND ANOSOGNOSIA WITH SPECIAL REFERENCE TO COGNITIVE IMPAIRMENT Peter Appelros,1,2 Gunnel M. Karlsson,1 A˚ ke Seiger2,3 and Ingegerd Nydevik2,3 From the 1Departments of Neurology and Geriatrics, O¨ rebro University Hospital, O¨ rebro, 2Neurotec Department, Karolinska Institutet, 3Stockholms Sjukhem, Stockholm, Sweden Objective: To describe prognosis in patients with unilateral variate statistics, so it is difficult to be certain about the neglect, anosognosia, or both, within a community based independence of predictors. stroke cohort. It is also known that anosognosia presents a risk for negative Methods: Patients (n = 377) were evaluated at baseline for stroke rehabilitation outcome (8, 9) as well as for activities of the presence of neglect and anosognosia. After 1 year, the daily living (ADL) function at hospital discharge (10). Results level of disability was established in survivors. Predictors for from a recent study have shown that patients with anosognosia in death and dependency were examined in multivariate the acute phase of stroke had a poorer functional outcome after 1 analysis. The following independent variables were used: year than patients who were aware of illness (11). Anosognosia age, consciousness, hemianopia, arm paresis, leg paresis, has been associated with cognitive impairment and subcortical sensory disturbance, aphasia, neglect, anosognosia, diabetes brain atrophy (12). Although the association between anosog- mellitus, cardiovascular disease, pre- and post-stroke nosia and general cognition has been emphasized, it is not cognitive impairment. known how close their relationship is in an unselected group of Results: Age, consciousness and sensory disturbance pre- patients.