6 Facts About Schizophrenia and Anosognosia

Christina Bruni Apr 24th, 2014 (updated Jun 16th, 2015)
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For nearly 15 years, the DSM has recognized anosognosia as a symptom of schizophrenia: first in the DSM IV-TR (p. 304) and now in the DSM V (p. 101). Here is a detailed analysis of anosognosia, or the lack of awareness that you have an illness (also observed in stroke victims and in bipolar.)  It's one of the hidden symptoms not often talked about, yet is a real symptom, frequently more disabling than the others.

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50 percent of people with schizophrenia have anosognosia
50 percent of people with schizophrenia have anosognosia

Anosognosia, the lack of awareness that you have an illness, is the root of the lack of insight that causes people to believe their delusions are true.   For instance the problem is the CIA has implanted a computer chip in their brain.  This belief makes perfect sense to a person afflicted with anosognosia. 

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Anosognosia is caused by frontal lobe lesions in the brain
Anosognosia is caused by frontal lobe lesions in the brain

The areas of the brain that appear ruptured in individuals with anosognosia are the medial frontal lobe (including the anterior cingulate), and insula, and the inferior parietal lobule, especially on the right side.  These areas are part of the brain network involved in the schizophrenia disease process.

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Lack of awareness is one of the greatest barriers to treatment
Lack of awareness is one of the greatest barriers to treatment

Some individuals with schizophrenia have complete awareness of their illness, others have partial awareness and a significant number have no awareness.  It depends on the specific brain areas affected for that person.  In times of remission, a person could have good awareness.  In a relapse, he might not be aware because he is symptomatic. 

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The LEAP technique is a useful treatment
The LEAP technique is a useful treatment

LEAP (Listen-Empathize-Agree-Partner) technique is used to combat a person's resistance to treatment.  The LEAP Institute helps families help their loved ones get and stay in treatment using the LEAP technique.   

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Your loved one's treatment team might not be aware of anosognosia
Your loved one's treatment team might not be aware of anosognosia

Obviously, arguing with your loved one and trying to convince him he's sick isn't going to work. You need to ascertain that your loved one's treatment team is skilled in using techniques to combat anosognosia, like LEAP and motivational interviewing.  

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Professionals must assess the level of anosognosia to develop the most effective treatment plan
Professionals must assess the level of anosognosia to develop the most effective treatment plan

Psychiatrists and other mental health staff should routinely assess whether their patients have anosognosia in order to create the most effective treatment plans.  The first line of defense might be a long-acting injectable drug, as opposed to pill form, for a person experiencing anosognosia.