Anosognosia & Bipolar Disorder

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

Mental illness can be challenging to treat, and it's even more complicated when a person doesn't recognize that they have a problem. In this lesson, we will learn about bipolar disorder and challenges in its treatment.

Bipolar Disorder

Nathan is a 40-year-old married man. He has been unemployed for quite some time and recently started working with a friend. He often stays up all night and will sleep only a few hours. He's been working all day and late at night with this friend but has yet to get paid to help his wife with the bills. Despite the challenges in his marriage, he has been overly optimistic and says he feels life is going to be so much better now and that everything is great. He can quickly turn from this excessive happy and hopeful person to being very angry and even hostile to his wife.

Bipolar disorder is a mental illness that is characterized by extreme highs and lows in a person's mood. The dramatic swing in their moods does not follow a set pattern and a person with bipolar can experience the same high or low mood several times before switching to the opposite. The mood swings can last a short time, such as a week, or even sometimes as long as years.

Mood Swings

Nathan has been diagnosed with bipolar disorder, and the symptoms he is portraying are related to the manic phase of bipolar. Manic refers to the extreme high moods in bipolar disorder. In addition to the symptoms described for Nathan, a person who is manic is overly confident, which often leads to poor decision making due to poor judgment. They become more impulsive and make big plans that aren't realistic. They are restless, speak very quickly, and have trouble concentrating. A person with bipolar is likely to abuse drugs and alcohol. In a manic phase, they have more energy and less need to sleep.

For the last three weeks, Nathan has insisted every day that he will be getting paid from this new job but hasn't. When he came home late last night, he ran out of gas and had no money. His wife wouldn't give him any money since he said his friend was coming to pay him. His friend didn't show up and Nathan was extremely angry, threatening, and insulting to his wife. He stayed up all night 'thinking' and then slept all the next day. When he woke, he told his wife he felt worthless and that he could never change.

Nathan is now exhibiting the depressive phase of bipolar disorder. In the depressive phase, the symptoms a person experiences are typical of depression. They have a loss of energy and need more sleep, although they might experience insomnia. They have feelings of sadness, hopelessness, and worthlessness. They no longer enjoy things they used to and have trouble concentrating. They may have uncontrollable crying, difficulty making decisions, irritability, and appetite changes. They may have thoughts of suicide and may attempt to take their own life.


During this depressive phase, Nathan's wife tells him that he needs to get help, and unlike in his manic phases, he seems to really listen this time and agrees. His wife gets him an appointment with a psychiatrist and the doctor starts him on medication for management of his bipolar disorder.

Medication management is the main treatment for bipolar disorder. There are medications that can stabilize moods, and antipsychotics and antidepressants may also be used. Ongoing psychotherapy is also recommended.

A couple of months later, Nathan's wife felt like he was doing much better until the last week. Nathan keeps mentioning that he thinks he is fine and doesn't need to take his medication anymore. He has missed his last two appointments with his psychiatrist, and his wife is starting to question if he is still taking his medications.

Unfortunately, many people with bipolar disorder do not believe they are ill. The medical term for this is anosognosia. If a person doesn't believe they are ill, they will often stop taking their medication.

Anosognosia is different from being in denial about your illness. A person will use denial as a way to avoid painful feelings associated with a stressful event or illness. In anosognosia, a person actually has a lack of awareness of being ill.

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