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Anosognosia & Schizophrenia

Instructor: Kristin Lundsten

Kristin has taught pediatric and psychiatric nursing and has a master's degree in nuring education

This lesson defines anosognosia and schizophrenia. The relationship between these two terms is explored, and further explanation of symptom and treatments is given.

What is Anosognosia?

Imagine you were born with a birthmark on your cheek. When you looked in the mirror every morning, you would expect to see the birthmark; even the mental image you had of yourself would be you with the birthmark.

Now, suppose you went to a doctor and had your birthmark removed. When you looked in the mirror, you would no longer anticipate seeing the birthmark, and your mental image of yourself would likely change as well.

But what if you woke up post-birthmark removal, looked in the mirror, and still saw the birthmark, even though it no longer existed? Your brain still perceived itself in the old state of being and had not yet caught up to your actual state of being.

Anosognosia, or lack of awareness illness, is the experience a person may have when the brain's old image of self does not match the current situation. It's much more than simply denying a truth because the reality is unpleasant or difficult to accept.

Relationship Between Anosognosia & Schizophrenia

Anosognosia is sometimes a symptom of schizophrenia, a serious, long-term mental illness in which a person suffers from disorganized thoughts, an inability to think clearly, and difficulty managing emotions and making decisions. People who have schizophrenia often suffer delusions and/or hallucinations, which can be visual, auditory, or even olfactory (smell).

Since most schizophrenics don't notice signs of the illness until early adulthood, it's easy to understand how they might have difficulty seeing themselves as sick. The brain still remembers the image of the healthy person and has not quite caught up with the image of a person with schizophrenia.

Treatment

Schizophrenics typically are treated with a combination of medications and therapy. The medications don't cure schizophrenia, but they can help reduce the troubling symptoms schizophrenics are often plagued with. For instance, a person with schizophrenia will likely be prescribed a type of medication known as an anti-psychotic drug. This class of medications can help improve some of the unclear thinking, disorganized thoughts, and hallucinations associated with schizophrenia. Other medication, such as drugs to help with depression and mood instability, may be prescribed as well.

Seroquel is an anti-psychotic drug used to treat schizophenia.
seroquel

Participation in individual and group therapy is also an important part of the treatment for schizophrenia. This helps patients understand the importance of medication compliance, recognize signs of worsening, and learn to function within society.

A person with both schizophrenia and anosognosia is at high risk for not complying with prescribed medication and therapy, though. Why would a person who strongly believes he's not ill agree to take medications that may have unpleasant side effects? Why would one bother to participate in therapy sessions when there is nothing to discuss?

You can see how the combination of these two illnesses can be quite troubling to the patient, caregivers, doctors, and nurses. In fact, medication noncompliance is one of the most worrisome results of anosognosia. A schizophrenic with anosognosia lacks the insight to determine whether one's thoughts are rational and may be at higher risk of harming himself or others.

Management

Careful monitoring and observation of a person with schizophrenia and anosognosia is critical. Laws vary from state to state, but generally speaking, it's not lawful to force someone to take medications if they're an adult and are not at risk for harming self or others. If the latter applies, however, the law may intercede and allow for hospitalization and medication without consent.

Ideally, someone who has earned the trust of a schizophrenic will be able to help the person gain insight into the disease and consent to medication. Another option is the delivery of anti-psychotic medication in an injectable form, which provides longer coverage. Many of the more commonly given anti-psychotic injections last for up to a month. This reduces the struggle around taking daily medications as well as the likelihood for noncompliance.

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