Langer Karen G, Bogousslavsky Julien
Department of Rehabilitation Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY 10016, USA.
Neurocenter, Swiss Medical Network, Clinique Valmont, Montreux, Switzerland.
Brain Sci. 2025 Jun 28;15(7):694. doi: 10.3390/brainsci15070694.
Striking belief distortions may accompany various disorders of awareness that are predominantly associated with right hemispheric cerebral dysfunction. Distortions may range on a continuum of pathological severity, from the unawareness of paralysis in anosognosia for hemiplegia, to a more startling disturbance in denial of paralysis where belief may starkly conflict with reality. The patients' beliefs about their limitations typically represent attempts to make sense of limitations or to impart meaning to incongruous facts. These beliefs are often couched in recollections from past memories or previous experience, and are hard to modify even given new information. Various explanations of unawareness have been suggested, including sensory, cognitive, monitoring and feedback operations, feedforward mechanisms, disconnection theories, and hemispheric asymmetry hypotheses, along with psychological denial, to account for the curious lack of awareness in anosognosia and other awareness disorders. This paper addresses these varying explanations of the puzzling beliefs regarding hemiparesis in anosognosia. Furthermore, using the multi-dimensional nature of unawareness in anosognosia as a model, some startling belief distortions in other right-hemisphere associated clinical syndromes are also explored. Other neurobehavioral disturbances, though perhaps less common, reflect marked psychopathological distortions. Startling disorders of belief are notable in somatic illusions, non-recognition or delusional misattribution of limb ownership (asomatognosia, somatoparaphrenia), or delusional identity (Capgras syndrome) and misidentification phenomena. Difficulty in updating beliefs as a source of unawareness in anosognosia and other awareness disorders has been proposed. Processes of belief development are considered to be patterns of thought, memories, and experience, which coalesce in a sense of the bodily and personal self. A common consequence of such disorders seems to be an altered representation of the self, self-parts, or the external world. Astonishing nonveridical beliefs about the body, about space, or about the self, continue to invite exploration and to stimulate fascination.
显著的信念扭曲可能伴随各种意识障碍，这些障碍主要与右半球脑功能障碍相关。扭曲的程度可能在病理严重程度的连续体上有所不同，从偏瘫失认症中对瘫痪的无意识，到否认瘫痪时更惊人的干扰，即信念可能与现实明显冲突。患者对自身局限性的信念通常代表着试图理解局限性或赋予不协调事实以意义。这些信念往往基于过去记忆或先前经历的回忆，即使有新信息也很难改变。人们提出了各种关于无意识的解释，包括感觉、认知、监测和反馈操作、前馈机制、分离理论、半球不对称假说，以及心理否认，以解释失认症和其他意识障碍中奇怪的意识缺失。本文探讨了对失认症中偏瘫相关令人困惑信念的这些不同解释。此外，以失认症中无意识的多维度性质为模型，还探讨了其他与右半球相关临床综合征中一些惊人的信念扭曲。其他神经行为障碍虽然可能不太常见，但反映出明显的精神病理扭曲。信念的惊人障碍在躯体幻觉、肢体所有权的非识别或妄想性错误归因（自体失认症、躯体妄想症）、或妄想性身份识别（卡普格拉综合征）及错误识别现象中很明显。有人提出，在失认症和其他意识障碍中，信念更新困难是无意识的一个根源。信念发展过程被认为是思维、记忆和经验的模式，它们在身体和个人自我的感觉中融合。这些障碍的一个常见后果似乎是自我、自我部分或外部世界的表征发生改变。关于身体、空间或自我的惊人的非真实信念，继续引发探索并激发人们的兴趣。
