Ep. 010 - Lack of insight into mental illness: Are there any new leads?

This week's listener question was "is there any new research about curing anosognosia?" Anosognosia is a medical term derived from Greek root words that mean "lack of disease knowledge." Although anosognosia started off as a neurological concept, it's also very common for people with psychiatric conditions to have no awareness that their symptoms are unusual, or that they could indicate the presence of a mental illness. Emerging data suggest that impaired insight in mental illness might -- like neurological anosognosia -- involve those outer layers of the right side of the brain. It turns out that a unique form of brain stimulation that activates the right brain can temporarily reverse anosognosia in people who have had strokes... and in people with insight-impairing bipolar disorder or schizophrenia. The studies are small. And the findings are preliminary. But the results open the possibility of treating bipolar disorder or schizophrenia without medications. And the data also suggests very strongly that insight impairment in psychosis is more like the anosognosia typically seen in neurological disorders than the commonly assumed psychological denial or willful disregard. Companion YouTube video about vestibular stimulation as a possible mania-reducing, psychosis-reducing, and insight-improving treatment in bipolar disorder or schizophrenia.   Topics covered 1:01 – What is anosognosia? 1:45 – Is anosognosia a form of psychological denial? 3:19 – Psychological defense mechanisms versus willful denial of illness? 4:15 – The difference between denial and anosognosia 4:40 – History of the anosognosia concept 7:28 – What types of brain injury can cause anosognosia? 10:05 – What are some functions of the cerebral cortex? 12:03 – Can anosognosia be a feature of psychiatric conditions? 12:30 – Lack of illness awareness is common in psychiatric conditions 15:08 – An example of insight impairment in schizophrenia 18:26 – Can psychiatric treatment improve insight or illness awareness? 22:36 – What can family or friends do? 22:52 – The controversy of involuntary treatment 26:00 – Strong caring relationships are better than strong logical arguments 28:23 – Do neurological factors contribute to lack of illness awareness in psychiatric conditions? 29:45 – A simple procedure that can temporarily reduce symptoms and improve insight 34:13 – The possibly paradigm-shifting significance of vestibular stimulation studies   Quotes It's been said that people are persuaded by the strength of relationships more so than by the strength of logic. If you look at people that have had bipolar mania or manic episodes because of brain injuries, then you'll find that about 60% of those individuals have brain damage to the right side of the brain only, and about 10% have brain damage to the left side of the brain. We can temporarily create small windows of insight or temporarily eradicate anosognosia in stroke victims by this cold-water simulation in the left eardrum. And we can do the same thing with schizophrenia and mania, apparently.   Resources The book I Am Not Sick, I Don't Need Help! How to Help Someone Accept Treatment by Xavier Amador is one of the most helpful resources for friends or family members to understand anosognosia/illness unawareness and how to befriend, support, and effectively encourage someone to accept treatment.   About the Podcast: Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He's a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate.   Send us a question   Useful Links Dr. Erik's website and blog Podcast website Ask A Psychiatrist YouTube Channel

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