Assessing awareness of deficits: Recent research and applications.

Abstract

t has been known for many years that brain damage can produce I profound changes in behavior, cognition, and physical functioning that can persist well beyond the acute phase of recovery. Patients are often unaware of these changes and minimize the impact of their limitations on everyday activity. Although some patients steadfastly deny any suggestion that they are impaired, others simply do not appreciate their deficits and exhibit unconcern, disbelief, or triviality when confronted by them. It then comes as no surprise that altered self-awareness creates a major obstacle in rehabilitation and psychosocial adjustment (Ben-Yishay et al., 1985;Bond, 1984;Bond & Brooks, 1976;Ford, 1976;. Moreover, unawareness may create serious problems for family members who have trouble managing patients (Lezak, 1978(Lezak, , 1988. Given these problems, routine assessment of awareness disturbances appears critical for effective treatment and aftercare planning.Unawareness of deficit generally refers to patients' lack of insight or appreciation of a particular deficit or cluster of impairments. The term unawareness is often used interchangeably with anosognosiu and denial of illness, despite differences in the original meanings of these designations (for review, see McGlynn & Schacter, 1989; Prigatano & Schacter, 1991). Impaired awareness can manifest in different forms, be produced in various kinds of brain damage, and differ with respect to the type of assessment procedure used

Impacto de los deterioros neuropsicológicos asociados al consumo de sustancias sobre la práctica clínica con drogodependientes

“…La no conciencia del déficit (anosognosia) ha sido descrita en numerosos síndromes neuropsicológicos, neurológicos y psicopatológicos de perfil frontal como la heminegligencia atencional o la enfermedad de Alzheimer, y es de crucial relevancia para la práctica clínica, ya que los pacientes que carecen de conciencia acerca de sus propios déficits pueden sufrir falta de motivación hacia el tratamiento, fracasar en la utilización de estrategias compensatorias recomendadas, establecer metas no realistas o experimentar problemas de adaptación social (McGlynn y Schacter, 1989;Wagner y Cusham, 1994;Campodonico y McGlynn, 1995). Pese a que en sujetos consumidores de sustancias han sido consistentemente detectados diversos déficits cognitivos, apenas existen estudios relacionados con la anosognosia en estos pacientes.…”