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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical and epidemiological investigations of mentally ill patients in old and new cities of northern Tyumen Province have revealed a substantial and peculiar impact of demographic dynamics on the indices of hospital dynamics. Thus, the schizophrenia morbidity appeared more than threefold lower in fast-developing cities (Nizhnevartovsk, Surgut, Nefteiugansk) compared to the old ones (Tobolsk, Tyumen). In the former group of cities, the attack form of the disease prevailed. Characteristically, environmental factors played major role in the onset of the disease. The patients were highly adapted in social terms. Alcoholism turned malignant with adaptation disorders progressing rapidly and involving a peculiar type of anosognosia. Alcoholic delirium took shape on the background of an "incomplete" clinical picture of predisposing alcoholism. Adaptation disorders preceded the delirium in which psychotic disorders were colored psycho-organically.
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PMID:[Clinico-epidemiologic characteristics of mental diseases in one of the regions of western Siberia]. 321 21

Schizophrenic patients with (N = 17) and without (N = 14) tardive dyskinesia performed several neuropsychological tests. Most patients (88%) showed complete lack of concern or anosognosia with regard to their involuntary movement. A marginally significant difference was found in recall of pictures presented in the right hemispace. It is suggested that when patients with organic brain disorder and a low Mini-Mental State score are excluded, neuropsychological tests do not differentiate between tardive dyskinesia patients and nonhyperkinetic controls. The results are discussed in relation to hemispheric asymmetries in schizophrenia.
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PMID:Cognitive impairment in patients with tardive dyskinesia. 397 76

Poor insight in schizophrenia has been recently thought to be a reflection of prominent and enduring neurocognitive impairments. Reports supporting this theory have implicated prefrontal and parietal lobe functions, among other parameters. The results of other studies have negated the role of neuropsychological abnormalities in poor insight. The analogy between poor insight in schizophrenia and anosognosia in neurological illness as proposed by one set of workers has been elucidated in this review and it appears quite promising. However, the drawing of definite conclusions from all this work has been deferred by us, because of the need for more uniform and standardized methodologies for research on the subject. Nevertheless, attempts to improve the cognitive processes, which affect insight in schizophrenia, may be done to gain better treatment outcome in this disorder.
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PMID:Poor insight in schizophrenia: neurocognitive basis. 1070 71

This paper addresses the growing evidence that lack of insight, or unawareness of illness in people with schizophrenia, may actually be a medically based condition known as anosognosia. Major explanatory models and related research findings are discussed. A case scenario is presented, as well as current perspectives regarding assessment of insight and alternative treatment approaches. Implications for further research, nursing education, and practice also are included. With better understanding of the characteristics and treatment of diminished insight in individuals with schizophrenia, nurses can better assist clients to recover helpful insight that enables them to take an active role in managing their symptoms and problems.
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PMID:Anosognosia in individuals with schizophrenia: toward recovery of insight. 1496 44

In the nineties, Marin proposed to define apathy as a clinical syndrome due to a lack of motivation. The syndrome is characterized by a diminished goal-directed overt behaviors, a lack of interest or concern for social and personal activities and a lack of responsiveness to positive and negative events. Apathy is clearly distinct from depression and can be observed in many conditions, in healthy people as well as in psychiatric disorders such as depression or schizophrenia. It is very common in patients with brain lesions involving the frontal lobes, the right hemisphere, but also in degenerative diseases such as Alzheimer's disease. Motivation, considered as the source of apathy by Marin, is not a simple construct. It refers to a complex set of multiple affective and cognitive processes. However, it is considered, either in an energetic acception, as a single quantitative variable, a force which impulses action but not direct behavior or, in a more specific acception, as the factor which direct behavior towards specific actions. The description of apathy by Marin and the scales designed to its assessment, are based on the first acception. The term apathy is only descriptive, such as those of dysphasia or anosognosia. They do not allow to study the mechanisms underlying the motivation disorders, essential process for the management of apathetic patients. A tentative qualitative approach to assess motivation disorders is proposed, using a semi-structured interview. However, it should be stressed that motivation can not be directly assessed: motivation is a concept to explain some behavior disorders and an inference from the study of behavior.
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PMID:[Apathy: a useful but limited concept]. 1568 65

We start by assuming that the self is implemented in the brain as a functional unit, with a definite set of properties. We deduce the fundamental properties of the self from an analysis of neurological disorders and from introspection. We formulate a functionalist concept of the self based on these properties reduced to constraints. We use the formalism of schemas in our functionalist analysis, i.e. a symbolic level description of brain dynamics. We then reformulate the functionalist model at a connectionist level and address the emergent "context shifting" problem. We suggest how the model might be mapped onto the functional neuroanatomy of the brain, and how it could be used to give an account of a range of neurological disorders, including hippocampal amnesia, various forms of schizophrenia, multiple personality, autism, PTSD, hemineglect, and reversible anosognosia. Finally, we briefly discuss future perspectives and possible applications of computer implementations of the model.
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PMID:Fundamental principles and mechanisms of the conscious self. 1620 31

Insight into illness has been identified as a clinically important phenomenon, in no small part due to an association with treatment-adherence. An increasing number of studies, but not all, have observed poor insight to be a reflection of cognitive dysfunction in schizophrenia. A review of 34 published English-language studies found a significant number (i.e., 21) reporting a relationship between insight deficits and impaired performance on cognitive tasks primarily mediated by frontal cortex. A significant number of reviewed studies examined insight function in more than one psychiatric population, including bipolar and schizoaffective disorder. The most replicated findings from these studies were the correlations between insight deficits and impaired performance on the Wisconsin Card Sorting Test (WCST). More specifically, WCST perseverative errors correlated positively and the number of categories completed correlated negatively with poor insight, suggesting that impaired insight may be mediated by deficiencies in conceptual organization and flexibility in abstract thinking. Since the WCST requires the ability to demonstrate conceptual flexibility through the generation, maintenance and switching of mental sets along with the capacity to use verbal feedback to correct errors, it would appear that such 'executive' functions are most related to insight. In addition, recently identified structural correlates of poor insight in schizophrenia show some association with anosognosia in neurological patients. This review will discuss the implications of these findings and directions for future research.
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PMID:Insight and frontal cortical function in schizophrenia: a review. 1683 68

The lack of insight in schizophrenia has so far been interpreted as a primary symptom of the illness, namely a defensive mechanism rather than a neurologically-based condition. However, recent findings have emphasized its relationship with damage to specific brain areas as well as the domain specificity in which it may occur. This supports a neuropsychological interpretation of the lack of insight in schizophrenia. The present article reviews the foregoing data, and takes into account the most relevant anatomo-clinical results. There is evidence that the lack of insight in schizophrenia may occur as a neurological disease per se following brain damage that seems related to frontal lobe areas. Additionally, it could either be related to all aspects of the disease or be domain-specific, occurring for one kind of symptom but not for others. These data indicate several analogies with the phenomenon called anosognosia for a neurological deficit.
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PMID:Unawareness in schizophrenia: neuropsychological and neuroanatomical findings. 1695 34

Anosognosia or lack of illness awareness is a clinical manifestation of both schizophrenia and right hemispheric lesions associated with stroke, neurodegeneration, or traumatic brain injury. It is thought to result from right hemispheric dysfunction or interhemispheric disequilibrium, which provides a neuroanatomical model for illness unawareness in schizophrenia. Lack of insight contributes to medication nonadherence and poor treatment outcomes and is often refractory to pharmacological and psychological interventions. We present the first report of transient illness awareness (<8 hours) after individual bilateral electroconvulsive therapy treatments in the case of a 39-year-old man with antipsychotic refractory schizophrenia. Electroencephalography demonstrated frontal slow wave activity with shifting frontotemporal predominance, which was concurrent with the patient's transient level of insight. A systematic review of the literature on electroconvulsive therapy-induced illness awareness in schizophrenia and psychotic disorders produced zero relevant results. Future research should focus on the prospective role of focal interventions, such as transcranial magnetic stimulation, in the development of a neurophysiological model for anosognosia reversal in schizophrenia that may, in turn, contribute to novel therapeutic developments targeting lack of illness awareness.
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PMID:Transient insight induction with electroconvulsive therapy in a patient with refractory schizophrenia: a case report and systematic literature review. 2096 68

Becoming aware of errors that one has committed might be crucial for strategic behavioral and neuronal adjustments to avoid similar errors in the future. This review addresses conscious error perception ("error awareness") in healthy subjects as well as the relationship between error awareness and neurological and psychiatric diseases. We first discuss the main findings on error awareness in healthy subjects. A brain region, that appears consistently involved in error awareness processes, is the insula, which also provides a link to the clinical conditions reviewed here. Then we focus on a neurological condition whose core element is an impaired awareness for neurological consequences of a disease: anosognosia for hemiplegia (AHP). The insular cortex has been implicated in both error awareness and AHP, with anterior insular regions being involved in conscious error processing and more posterior areas being related to AHP. In addition to cytoarchitectonic and connectivity data, this reflects a functional and structural gradient within the insula from anterior to posterior. Furthermore, studies dealing with error awareness and lack of insight in a number of psychiatric diseases are reported. Especially in schizophrenia, attention-deficit hyperactivity disorder, (ADHD) and autism spectrum disorders (ASD) the performance monitoring system seems impaired, thus conscious error perception might be altered.
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PMID:Error awareness and the insula: links to neurological and psychiatric diseases. 2338 14


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