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What is Anosognosia? Causes, Signs & Effective Treatment

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Anosognosia isn’t easy to treat. But it might get better if you can persuade someone who has it to restart their treatment. Continue to read more about anosognosia and how to help your loved one.

By We Level Up FL Treatment Center | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: December 21, 2022

What is Anosognosia?

Anosognosia is a neurological condition in which the patient is unaware of their neurological deficit or psychiatric disorder. It is associated with mental illness, dementia, and structural brain lesion, as is seen in right-hemisphere stroke patients. It can affect the patient’s conscious awareness of deficits involving judgment, emotions, memory, executive function, language skills, and motor ability. [1] It is a “mental illness denial of reality.”

It’s well known that many people with serious mental illnesses, like bipolar disorder or schizophrenia, don’t take their prescribed medication. One primary reason for this behavior is anosognosia, a word of Greek origin that roughly translates to “without knowledge of the disease.” You may also hear it called “lack of insight.” What it boils down to is that the person is unaware of their condition and unable to accept it. Someone with this neuropsychiatric condition isn’t simply in denial or stubborn. Their brain can’t process the fact that their thoughts and moods don’t reflect reality.

Why Some People Stop Taking Their Mental Health Medications?

What is anosognosia definition? To be clear, denial is not a mental disorder; however, people mistakenly believe that anosognosia is denial. Also referred to as anosognosia psychosis. This word is often used to describe people who are not denying mental health problems but are unaware of their condition. Many people with severe mental conditions like bipolar disorder and schizophrenia struggle with this neuropsychiatric condition, which is often why they don’t take their medications.

One study on anosognosia in people with schizophrenia and bipolar disorder sampled 412 people and found that approximately 30% of the ones with schizophrenia and 20% of the ones with bipolar disorder experienced a “severe” lack of self-awareness of their diagnosis. Mental illness denial is very different from a lack of understanding or insight into your condition. [2]

As a mental therapy center in Florida, we understand how difficult it is to treat and care for patients with this neuropsychiatric condition. While a misdiagnosis of a mental illness can complicate matters, the situation becomes equally as difficult if the individual is unaware of their condition. Understanding this condition is crucial for ensuring that affected individuals get their needed help.

Anosognosia Schizophrenia

Early studies of anosognosia indicated that approximately 30% of people with schizophrenia and 20% of people with bipolar disorder experienced a “severe” lack of awareness of their diagnosis. For someone with anosognosia, their false insight appears authentic and compelling and may seem like other people’s capacity to perceive themselves. However, these misconceptions lead to interpersonal disputes and elevated anxiety. Lack of understanding frequently leads a person to forego treatment. This makes it the most frequent cause of medication discontinuation. Furthermore, because it often coexists with psychosis or mania, a lack of understanding can result in careless or unwelcome behavior.

Anosognosia is a common symptom of certain mental illnesses, perhaps the most difficult to understand for those who have never experienced it.
What is anosognosia meaning? Anosognosia is a common symptom of certain mental illnesses, perhaps the most difficult to understand for those who have never experienced it.

Anosognosia Bipolar

Anosognosia is the most common reason patients with bipolar disorder and schizophrenia are not compliant with their medications. It makes sense from the patient’s point of view – if you don’t believe you’re sick, why take medications? Unfortunately, taking medications is one of the most effective ways to lessen these symptoms and increase awareness of the illness. Patients with this condition are more likely to be hospitalized involuntarily and end up in the emergency room.

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What Causes Anosognosia?

Some experts believe that anosognosia is caused by brain damage in specific brain regions involved with self-reflection. The brain’s frontal lobe is responsible for memory, emotions, impulse control, problem-solving, socializing, motor function, self-reflection, and image. Regardless of your age or status, your self-image is constantly being updated. Whenever you gain new information – whether it’s a new haircut or weight changes – it affects how you think about yourself. As you can imagine, this is a never-ending, complex process. For this process to go smoothly, the frontal lobe of your brain has to absorb the new information, process it, and use it to “edit” your self-image.

When the brain’s frontal lobe is damaged, a common issue in people with schizophrenia and bipolar disorder, your self-image is affected. Your brain can no longer absorb and process new information to update how you see yourself. This can hinder recovery for a person who requires bipolar disorder or schizophrenia treatment.

However, anosognosia isn’t an either-or condition. Some people only partially lose the ability to see themselves clearly; in others, anosognosia comes and goes. This can be incredibly confusing to loved ones who are trying to help. It’s hard to understand how someone can completely understand their condition in one moment and then claim they’re perfectly fine in the next. That’s why people are constantly comparing anosognosia vs denial.

Anosognosia Statistics

Anosognosia isn’t easy to treat. It might get better if you can persuade someone who has it to keep taking or restart their medication. About one-third of people with schizophrenia who take their medication have improvements in insight into their condition.


98%

Anosognosia is incredibly common with certain mental health conditions. Experts estimate that it affects between 50% and 98% of people with schizophrenia.

Source: NCBI

40%

It affects about 40% of people with bipolar disorder.

Source: NCBI

80%

It affects more than 80% of people with Alzheimer’s disease. It also happens to 10% and 18% of people who have one-sided paralysis after a stroke.

Source: NCBI


Anosognosia Facts Sheet

The management of this condition is very difficult. Because there are many causes, the management is with an interprofessional team that includes a neurologist, psychiatrist, mental health nurse, primary care physician, and a psychotherapist. 


Anosognosia differs from denial, a psychological defense mechanism that involves avoiding or rejecting information that provokes stress or pain. With denial, the patient may acknowledge a deficit but minimize its consequences and avoid treatments geared to remedy the deficits. Anosognosia also differs from a more global derangement, such as encephalopathy where there may be problems with wakefulness and attention. It differs from other deficits, such as visual, sensory, and cognitive deficits, limiting patients’ ability to realize their deficits.

Anosognosia can impair rehabilitation and recovery because patients who lack awareness of a deficit may be less inclined to participate in rehabilitation therapy to tackle neurological dysfunction. Patients with this condition also may suffer more frequent falls due to their lack of awareness of their deficits. Health providers may need to take safety precautions that they see fit in order to avoid injury.

Are You Suffering From Anosognosia?

Denial is a natural human defense mechanism that kicks in when our mental or physical equilibrium is so powerfully disturbed that it makes us highly anxious and terrified to admit something exists. A form of emotional repression, denial is not a healthy way for someone to cope with disruptive and disturbing situations. But the human drive to maintain psychological and physiological homeostasis is so strong that when faced with seemingly insurmountable difficulties, your subconscious steps forward and asserts denial as a coping mechanism.

Denial is a way to repress unpleasant and trenchant emotions that possible severe psychological damage could affect those who can’t cope with unpleasant facts about themselves or others. Mentally ill individuals with anosognosia refuse to think about how their bipolar or schizoaffective disorder impacts family, friends, and themselves. Failing to acknowledge the consequences of not getting treatment for their mental illness is one way for people with anosognosia to avoid feeling a strong sense of guilt and responsibility.

When anosognosia is due to structural brain damage, neuroradiological findings typically show damage to the right parietal or right temporoparietal region. Less common are lesions in the thalamus, basal ganglia, or left parietal region. Neuroimaging in dementia typically shows more global brain atrophy.
When anosognosia is due to structural brain damage, neuroradiological findings typically show damage to the right parietal or right temporoparietal region. Less common are lesions in the thalamus, basal ganglia, or left parietal region. Neuroimaging in dementia typically shows more global brain atrophy.
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Identifying Anosognosia Symptoms

Why it Matters

Being able to define anosognosia symptoms in a loved one is essential. When someone with a severe mental disorder insists that they’re perfectly fine or aren’t as sick as they’re believed to be, the situation can quickly spiral out of control. When a person with a mental disorder develops this condition, they may not take their medications or complete their treatment. They’re thinking, “Why would I take a drug if there’s nothing wrong with me?”

As a result of not taking their medication, their symptoms may come back or get worse. Depending on their condition, they may begin to suffer from episodes of psychosis, mania, depression, or even engage in risky or reckless behaviors. Homelessness, arrest, and even suicide become more likely risks.

Symptoms

The most notable symptom of anosognosia is a lack of understanding, awareness, or acceptance of your condition. You can develop this condition even if there’s extensive evidence that you do.

Some other signs of anosognosia include:

  • Bluntly acknowledging that they think they’re okay or that nothing is wrong with them.
  • Avoiding talking about their condition because they think no one believes them
  • Becoming frustrated or confused when people contradict what they believe to be true
  • Missing appointments or treatments with their physicians or therapists
  • Skipping or forgetting to take their medication
  • Acknowledging some symptoms of their conditions, but not others

Remember that anosognosia isn’t an all-or-nothing condition but a spectrum on which people can move back and forth. Therefore, it’s essential to pay attention to the person’s behavior. While you may think they’re just trying to ignore their condition to cope, they may believe they’re fine when they aren’t. Be sure to communicate with them.

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Finding Mental Health Treatment

It’s estimated that 50% to 90% of people with schizophrenia and 40% with bipolar disorder suffer from anosognosia or severe lack of insight. If your loved one falls into these categories, we can help. We Level Up FL offers schizophrenia and bipolar disorder treatment, among a variety of other programs to assist as many patients as possible. [3]

Who’s at Risk?

Sometimes after a stroke, people are not able to recognize the effect that it has on them. So you may not know that you've lost movement in your arm or leg, for example. This is called anosognosia stroke.
Sometimes after a stroke, people are not able to recognize the effect that it has on them. So you may not know that you’ve lost movement in your arm or leg, for example. This is called anosognosia stroke.

Anosognosia is common in people with serious mental illnesses. Doctors think about 40% of people with bipolar disorder and 50% of those with schizophrenia have it. Some psychiatrists believe the numbers are even higher. They estimate that anywhere from 57%-98% of people with schizophrenia have it. Many people with neurological disorders have this condition. It isn’t unusual for someone with Alzheimer’s to get it. Stroke patients often do, too.

Emergency medical clinicians need to know of anosognosia. For instance, in acute stroke, the timing of symptom onset is crucial to administering thrombolytic therapy. If the patient has anosognosia in stroke and is unaware of their deficit, they may not give accurate information on the exact time of stroke symptom onset. In this situation, collateral history from a family member is crucial to making an informed treatment decision.

Anosognosia for hemiplegia is a syndrome in which a patient, typically following a stroke, fails to recognize his motor deficit. Patients may explain away the motor deficits with other reasons (a fall, arthritis, unwillingness to move at this time, etc.).

Anosognosia Schizophrenia

Poor insight is a cardinal symptom of schizophrenia that, while not universally and uniformly expressed in all patients, is among the most common manifestations. Schizophrenia is a functional psychotic disorder characterized by delusional beliefs, hallucinations, and disturbances in thought, perception, and behavior. Traditionally, symptoms have been divided into two main categories:

Positive Symptoms

  • Hallucinations
  • Delusions
  • Formal thought disorders

Negative Symptoms

  • Anhedonia
  • Poverty of speech
  • Lack of motivation

The diagnosis of schizophrenia anosognosia is clinical, made exclusively after obtaining a full psychiatric history and excluding other causes of psychosis. Risk factors include:

  • Birthing complications
  • Season of birth
  • Severe maternal malnutrition
  • Maternal influenza in pregnancy
  • Family history
  • Childhood trauma
  • Social isolation
  • Cannabis use
  • Minority ethnicity
  • Urbanization

Despite a low prevalence, schizophrenia’s global burden is immense. Over half of the patients have significant psychiatric and medical co-morbidities, making it one of the leading causes of disability worldwide. The diagnosis correlates with a 20% reduction in life expectancy, with up to 40% of deaths attributed to suicide. [4]

Anosognosia and Alzheimer’s

Alzheimer’s disease care involves seeking assistance to diagnose the suspected problem and creating a plan of action to be sure the person remains safe and healthy while maintaining dignity and social engagement. Alzheimer’s experts believe anosognosia occurs when the frontal lobes of the brain become damaged or deteriorate. This brain area is responsible for abstract thought, problem-solving, perception, and socialization skills. The lack of awareness associated with anosognosia in Alzheimer’s disease differs from the shock and denial many individuals and families experience following an initial diagnosis. Changes in the brain cause individuals with mental illness, brain tumors, stroke, Alzheimer’s disease, and other forms of dementia to believe there is nothing wrong with them.

Anosognosia and Dementia

Anosognosia dementia may be complete or selective. For instance, they may be entirely unaware of their impairment or even react with anger and defensiveness if confronted about their illness. It is challenging to diagnose anosognosia in dementia and differentiate it from simple denial. Here are some signs you can look for if you’re worried a loved one might have dementia with anosognosia:

  • Not keeping up with regular daily tasks or personal hygiene
  • Difficulty managing money or bills
  • Being more spontaneous or less inhibited in conversation without concern for their behavior
  • Becoming angry when confronted with forgetfulness, lack of self-care, or poor decision making
  • Confabulation: making up answers they believe are true, though sometimes the details may be imaginary, pertains to something that happened in the past, or even something they read or heard elsewhere.

Anosognosia and Narcissism

Some people may experience cognitive unawareness reflected in difficulty with memory, language, spatial and temporal orientation, calculation, abstract reasoning, and putting abstract ideas into practice. People with behavioral ignorance, meanwhile, become impulsive, have little understanding of safety, and tend to be more narcissistic. Language and functional deficits are less noticeable than in people with cognitive unawareness. People with behavioral ignorance often appear normal to all but close family and friends. They are attuned to their changing behavior.

People with behavioral unawareness are often misdiagnosed with bipolar disorder, narcissistic personality disorder, antisocial personality disorders, and other psychiatric disorders until their frontotemporal conditions, sometimes called frontotemporal dementia, progress beyond their early stages. They may exhibit reckless spending habits and spontaneous social outbursts, refuse treatment and diagnostic evaluations, and neglect their personal care. They may show a lack of empathy and increased self-centeredness, confounding family and social relationships, and can become hypersexual and manic. They commonly develop legal and financial problems, resulting in marital and family discord.

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Anosognosia Eating Disorder

In earlier studies about anosognosia anorexia, this lack of awareness of the problem was often called denial, having been first described when psychodynamic theories predominated. However, the condition has more recently been renamed anosognosia. Neurologists initially used this term to describe a neurological syndrome in which people with brain damage have a profound lack of awareness of a particular deficit. More recently, the term began also to be applied to psychiatric conditions such as schizophrenia and bipolar disorder. Brain imaging studies indicate a brain connection between anosognosia and these conditions.

Applying the term anosognosia to anorexia nervosa makes sense because we know that the brain is affected by malnutrition. The lack of concern for the potentially dangerous consequences of undernutrition suggests that alarming information might not be processed or reach an awareness.

Anosognosia Autism

Anosognosia defines as the reduced capacity to identify or realistically judge one’s abilities and deficits. Although the term was initially coined about a lack of awareness of motor deficits, it has subsequently been applied to various pathological conditions and etiologies. Autism is genetically related to schizophrenia (as well as bipolar), and some autistics have co-morbid schizophrenia.  So it stands to reason the brain differences in autistics can be such that they could also cause or contribute to anosognosia about their autism. [5]

Some autistics may deny their condition because they are newly diagnosed adolescents who are embarrassed about being seen as different than peers, or a late diagnosed adult who is struggling with the shock of re-evaluating their whole life through a new lens, or the individual may have co-morbid anxiety which makes them too scared to deal with it.  That’s not actual anosognosia, though; time usually resolves this reaction. Autistics commonly suffer from alexithymia, the difficulty in recognizing emotions and their reasons. This can also contribute to anosognosia. 

Anosognosia Bipolar Disorder

What is the meaning of anosognosia? Anosognosia is common in people with serious mental illnesses such as bipolar disorder. Bipolar disorder is a chronic illness typically experienced in early adulthood, although onset in childhood or older may also occur. Bipolar disorder can be divided into subtypes, including bipolar I and bipolar II.

Bipolar I disorder is distinguished by full-blown manic episodes that are more impairing than the hypomanic episodes that characterize bipolar II disorder. Depression, the presenting symptom of bipolar disorder in most patients, may impose a more significant disease burden, in terms of duration and impact, than manic symptoms.

Depressive symptoms may be similar in bipolar I and II disorder; therefore, bipolar II disorder should not be considered a “milder” illness than bipolar I. The form of the disease that individuals experience tends to be stable over their lifetime. For patients with either condition, the primary care physician can play an important role, often working with psychiatric consultants, in managing treatment, monitoring the bipolar disorder, and ensuring that other healthcare needs are met, including preventive care and driving chronic comorbid medical conditions. [6]

Anosognosia Test/Anosognosia Questionnaire

Typically, health professionals diagnose anosognosia at the bedside by assessing the patient’s knowledge and insight into their symptoms. In subtle cases, it takes time and a long conversation with the patient to uncover anosognosia, as patients may rationalize semi-logical reasons for not being able to perform activities on the affected side. In the “anosognosia questionnaire dementia,” patients do not acknowledge or minimize their memory deficits. In the setting of mental illness, patients rationalize aberrant behavior or psychiatric symptoms and often confabulate (i.e. unconsciously prevaricate). This involves the creation of a false answer or response by combining natural and imagined details.

For individuals with anosognosia due to schizophrenia, there is no diagnostic test to assess schizophrenia. A doctor will diagnose it by observing how the person behaves. They will also ask about their history of physical and mental health. That said, they may recommend some tests to rule out other possible causes of the symptoms, such as a tumor, brain injury, or another mental health condition, such as bipolar disorder.

According to the criteria, a person must have at least two of the following symptoms for a month:

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms, such as lack of speech, emotional flatness, or lack of motivation

At least one of these must be 1, 2, or 3.

They must also experience considerable impairment in their ability to function in school or at work, interact with others, or carry out self-care tasks. They must also have symptoms that persist for six months or more. The symptoms must also not be due to another health condition, a prescribed medication, or the use of other substances. The symptoms must also not be due to another health condition, a prescribed medication, or the use of other substances.

Searching for “asomatognosia vs anosognosia?” Anosognosia (i.e., denial of hemiparesis) and asomatognosia (i.e., inability to recognize the affected limb as one’s own) occur more frequently with right cerebral lesions. However, the incidence, relative recovery, and underlying mechanisms remain unclear.

Asomatognosia designates the experience that one’s body has faded from awareness. It is typically a somaesthetic experience but may target the visual modality (“asomatoscopy”). Frequently associated symptoms are the loss of ownership or agency over a limb.

Treatment for Anosognosia

The management of anosognosia is very difficult. Because there are many causes, the management is with an interprofessional team that includes a neurologist, psychiatrist, mental health nurse, primary care physician, and psychotherapist. There is no specific treatment for anosognosia, but vestibular stimulation temporarily improves this condition. This maneuver probably influences awareness of the neglected side temporarily.

Where anosognosia persists, cognitive behavioral therapy can help patients better understand and compensate for their deficits. The prognosis in most cases is poor if the cause is a stroke, dementia, or a mass lesion. If the reason is related to a mental health disorder, the condition leads to difficulty in medication compliance, resulting in poor overall quality of life.

The definition of anosognosia is complex in many conditions. Therefore, anosognosia isn’t easy to treat. It might get better if you can persuade someone who has it to keep taking or restart their medication. About one-third of people with schizophrenia who take medication have improved insight into their condition.

A therapist can also try motivational enhancement therapy (MET). This type of talk therapy is designed to help someone understand the benefits of changing their behavior.

Don't let Anosognosia stop you from getting treatment and start reclaiming your life from mental illness. Contact us for a free assessment.
Don’t let Anosognosia stop you from getting treatment and start reclaiming your life from mental illness. Contact us for a free assessment.

If a loved one has anosognosia, sometimes it’s best not to try to convince them that they’re ill. Instead, talk about their goals, such as keeping a job or living independently. This might encourage them to meet with a mental health professional, even if they don’t think they need it for their health and well-being. Someone with anosognosia can be at risk of harming themselves or others. If this is the case, a family member or mental health professional may have to take legal action. Laws vary by state, but you might have to admit someone with a severe mental illness to the hospital against their will.

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Reclaim your life from Anosognosia, We Level Up Center Florida

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Effective approaches to anosognosia will allow patients, families, and care providers to engage in a collaborative paradigm rather than the antagonistic tug-of-war that characterizes relationships with illness-denying individuals and often tragically concludes with the losses of those relationships altogether. Successful efforts should permit early disease recognition, aggressive and sustained treatment, and chronicity and social disability prevention.

Call us now for a free mental health assessment! In addition, for the substance abuse or dual diagnosis approach, our inpatient treatmentinpatient medical detox, and residential primary addiction treatment may be available at our affiliated facility. For more anosognosia treatment resources, call us about your symptoms, and we can help you determine the cause and develop a treatment plan.

5 Most Anosognosia Frequently Asked Questions

  1. What is an example of anosognosia?

    A well-known anosognosia example is often found in hemispatial neglect patients. A stroke usually causes this condition to the right parietal lobe, and it disrupts attention and spatial awareness of the left side of the space. They often behave as if the left side of the world does not exist.

  2. How to pronounce anosognosia?

    Anosognosia pronounced as “uh·naa·suh·now·zhuh,” is seen most commonly in Alzheimer’s disease, Huntington’s disease, and traumatic brain injury. Anosognosia pronunciation is anosog·nosi·a with silent G.

  3. What does anosognosia mean in simple terms?

    Anosognosia also called “lack of insight,” is a symptom of severe mental illness experienced by some that impair a person’s ability to understand and perceive his or her illness. It is the single largest reason why people with schizophrenia or bipolar disorder refuse medications or do not seek treatment.

  4. What is the difference between denial and anosognosia?

    Anosognosia is caused by physical damage to the brain and is thus anatomical in origin; denial is psychological in origin.

  5. How do you test for anosognosia?

    Usually, the presence and severity of anosognosia are assessed using structured interviews or questionnaires. For a proper diagnosis of the underlying causes, you have to speak with a mental health professional.

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Source

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[2] The Effects of Offline Anosognosia For Spatial Neglect on Neglect Rehabilitation – https://clinicaltrials.gov/ct2/show/NCT05145855

[3] We Level Up NJ » Mood and Personality Disorder Treatment

[4] Hany M, Rehman B, Azhar Y, et al. Schizophrenia. [Updated 2022 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539864/

Lehrer DS, Lorenz J. Anosognosia in schizophrenia: hidden in plain sight. Innov Clin Neurosci. 2014 May;11(5-6):10-7. PMID: 25152841; PMCID: PMC4140620.

[5] Pacella V, Scandola M, Beccherle M, Bulgarelli C, Avesani R, Carbognin G, Agostini G, Thiebaut de Schotten M, Moro V. Anosognosia for the theory of mind deficits: A single case study and a review of the literature. Neuropsychologia. 2020 Nov;148:107641. DOI: 10.1016/j.neuropsychologia.2020.107641. Epub 2020 Oct 13. PMID: 33058921; PMCID: PMC7116409.

[6] Culpepper L. The diagnosis and treatment of bipolar disorder: decision-making in primary care. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01609. DOI: 10.4088/PCC.13r01609. Epub 2014 Jun 19. PMID: 25317368; PMCID: PMC4195640.

[7] Krystal JH, State MW. Psychiatric disorders: diagnosis to therapy. Cell. 2014 Mar 27;157(1):201-14. DOI: 10.1016/j.cell.2014.02.042. PMID: 24679536; PMCID: PMC4104191.

[8] National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Mental Illness and the Brain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20369/

[9] Malla A, Joober R, Garcia A. “Mental illness is like any other medical illness”: a critical examination of the statement and its impact on patient care and society. J Psychiatry Neurosci. 2015 May;40(3):147-50. DOI: 10.1503/jpn.150099. PMID: 25903034; PMCID: PMC4409431.

[10] About Mental Health – Centers for Disease Control and Prevention