ABSTRACT
Patients who present with severely impaired memory functioning without a discernable
neurological cause typically have experienced one or more severely stressful life
events. These patients, who are described as having “psychogenic” or “dissociative”
amnesia, typically differ from patients with the neurologic amnestic syndrome in that
memory for their personal life histories is much more severely affected than is their
ability to learn and retain new information; that is, they have isolated retrograde
amnesia. Recent cognitive and brain imaging research has begun to reveal some of the
cerebral mechanisms underlying functional amnesia, but this disorder remains best
conceptualized as a relatively rare form of illness-simulating behavior rather than
a disease. Neuropsychological assessment is often useful in revealing the circumscribed
nature of the patient's performance deficits, the spared functions that can be brought
to bear in rehabilitation, and the emotional disorders requiring psychiatric treatment.
Controlled treatment trials are nonexistent, but case reports suggest that supportive
psychotherapy, systematic relaxation training, hypnosis, and sedative/anxiolytic medications
are useful in facilitating recovery. These treatments are often combined with a psychoeducational
approach that essentially reteaches the patient his or her life story.
KEYWORDS
Psychogenic - memory loss - amnesia - emotional disorder - depression
REFERENCES
- 1
Baxendale S.
Memories aren't made of this: amnesia at the movies.
BMJ.
2004;
329
1480-1483
- 2
Gouvier W D, Prestholdt P H, Warner M S.
A survey of common misconceptions about head injury and recovery.
Arch Clin Neuropsychol.
1988;
3
331-343
- 3
Kopelman M D, Christensen H, Puffett A, Stanhope N.
The great escape: a neuropsychological study of psychogenic amnesia.
Neuropsychologia.
1994;
32
675-691
- 4
Barbarotto R, Laiacona M, Cocchini G.
A case of simulated, psychogenic or focal pure retrograde amnesia: did an entire life
become unconscious?.
Neuropsychologia.
1996;
34
575-585
- 5
Domb Y, Beaman K.
Mr. X: a case of amnesia.
Br J Psychiatry.
1991;
158
423-425
- 6
Kritchevsky M, Chang J, Squire L R.
Functional amnesia: clinical description and neuropsychological profile of 10 cases.
Learn Mem.
2004;
11
213-226
- 7
Kanzer M.
Amnesia: a statistical study.
Am J Psychiatry.
1939;
96
711-716
- 8
Schacter D L, Wang P L, Tulving E, Freedman M.
Functional retrograde amnesia: a quantitative case study.
Neuropsychologia.
1982;
20
523-532
- 9
Abeles M, Schilder P.
Psychogenic loss of personal identity: amnesia.
Arch Neurol Psychiatry.
1935;
34
587-604
- 10
Wong C K.
Too shameful to remember: a 17-year-old Chinese boy with psychogenic amnesia.
Aust N Z J Psychiatry.
1990;
24
570-574
- 11
Kopelman M D, Kapur N.
The loss of episodic memories in retrograde amnesia: single-case and group studies.
Philos Trans R Soc Lond B Biol Sci.
2001;
356
1409-1421
- 12
Crimlisk H L, Ron M A.
Conversion hysteria: history, diagnostic issues, and clinical practice.
Cognit Neuropsychiatry.
1999;
4
165-180
- 13 Slavney P R. Perspectives on “Hysteria”. Baltimore; The Johns Hopkins University
Press 1990
- 14 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders.
4th ed. Washington, DC; American Psychiatric Association 1994
- 15
McHugh P R.
Witches, multiple personalities, and other psychiatric artifacts.
Nat Med.
1995;
1
110-114
- 16
Elzinga B M, van Dyck R, Spinhoven P.
Three controversies about dissociative identity disorder.
Clin Psychol Psychother.
1998;
5
13-23
- 17 Kilhlstrom J F, Schacter D.
Functional amnesia. In: Cermak LS Handbook of Neuropsychology. Vol. 2. 2nd ed. Amsterdam; Elsevier Science
2000: 409-427
- 18 Loftus EF, Ketcham L The Myth of Repressed Memory. New York; St. Martin's Press
1994
- 19 Pezdek K, Banks WP The Recovered Memory/False Memory Debate. San Diego; Academic
Press 1996
- 20 Halligan P, Bass C, Oakley D A.
Willful deception as illness behavior. In: Halligan P, Bass C, Oakley DA Malingering and Illness Deception. Oxford; Oxford
University Press 2003: 3-28
- 21
Kapur N.
A study of recovery of memory function in a case of witnessed functional retrograde
amnesia.
Cognit Neuropsychiatry.
1996;
1
247-258
- 22
Kopelman M D.
The Autobiographical Memory Interview (AMI) in organic and psychogenic amnesia.
Memory.
1994;
2
211-235
- 23 McHugh PR, Slavney PR The Perspectives of Psychiatry. 2nd ed. Baltimore; The Johns
Hopkins University Press 1998
- 24
Di Renzi E, Lucchelli F, Muggia S, Spinnler H.
Is memory loss without anatomical damage tantamount to a psychogenic deficit? The
case of pure retrograde amnesia.
Neuropsychologia.
1997;
35
781-794
- 25
Stone J, Wojcik W, Durrance D et al..
What should we say to patients with symptoms not explained by disease? The “number
needed to offend”.
BMJ.
2002;
325
1449-1450
- 26
Reuber M, Mitchell A J, Howlett S J, Crimlisk H L, Grünewald R A.
Functional symptoms in neurology: questions and answers.
J Neurol Neurosurg Psychiatry.
2005;
76
307-314
- 27
Kopelman M D.
Focal retrograde amnesia and the attribution of causality: an exceptionally critical
review.
Cogn Neuropsychol.
2000;
17
585-621
- 28
Arrigo J M, Pezdek K.
Lessons from the study of psychogenic amnesia.
Curr Dir Psychol Sci.
1997;
6
148-152
- 29
Draijer N, Langeland W.
Childhood trauma and perceived parental dysfunction in the etiology of dissociative
symptoms in psychiatric inpatients.
Am J Psychiatry.
1999;
156
379-385
- 30
Bernstein E M, Putnam F W.
Development, reliability, and validity of a dissociation scale.
J Nerv Ment Dis.
1986;
174
727-735
- 31
Sargant W, Slater E.
Amnesic syndromes in war.
Proc R Soc Med.
1941;
34
757-764
- 32
Kopelman M D.
Crime and amnesia: a review.
Behav Sci Law.
1987;
5
323-342
- 33 Gudjonsson GH The Psychology of Interrogations, Confessions and Testimony. New
York; Wiley 1992
- 34
Rubinsky E, Brandt J.
Amnesia and criminal law: a clinical overview.
Behav Sci Law.
1986;
4
27-46
- 35
Kaszniak A W, Nussbaum P D, Berren M R, Santiago J.
Amnesia as a consequence of male rape: a case report.
J Abnorm Psychol.
1988;
97
100-104
- 36
Stengel E.
On the aetiology of the fugue states.
J Ment Sci.
1941;
87
572-599
- 37
Gudjonsson G H, Haward L RC.
Case report: hysterical amnesia as an alternative to suicide.
Med Sci Law.
1982;
22
68-72
- 38
Loftus E, Joslyn S, Polage D.
Repression: a mistaken impression?.
Dev Psychopathol.
1998;
10
781-792
- 39
Pope H G, Hudson J, Bodkin J A, Oliva P.
Questionable validity of “dissociative amnesia” in trauma victims: evidence from prospective
studies.
Br J Psychiatry.
1998;
172
210-215
- 40
Brown R J.
The cognitive psychology of dissociative states.
Cognit Neuropsychiatry.
2002;
7
221-235
- 41
Geiselman R E, Bjork R A, Fishman D L.
Disrupted retrieval in directed forgetting: a link with posthypnotic amnesia.
J Exp Psychol Gen.
1983;
112
58-72
- 42
Anderson M C, Green C.
Suppressing unwanted memories by executive control.
Nature.
2001;
410
366-369
- 43
Anderson M C, Ochsner K N, Kuhl B et al..
Neural systems underlying the suppression of unwanted memories.
Science.
2004;
303
232-235
- 44
Broome M R.
A neuroscience of hysteria?.
Curr Opin Psychiatry.
2004;
17
465-469
- 45
Bremner J D, Krystal J H, Charney D S, Southwick S M.
Neural mechanisms in dissociative amnesia for childhood abuse: relevance to the current
controversy surrounding the “false memory syndrome”.
Am J Psychiatry.
1996;
153
71-82
- 46
Markowitsch H J.
Functional retrograde amnesia: mnestic block syndrome.
Cortex.
2002;
38
651-654
- 47
Markowitsch H J.
Psychogenic amnesia.
Neuroimage.
2003;
20
S132-S138
- 48
Lucchelli F, Spinnler H.
The “psychogenic” versus “organic” conundrum of pure retrograde amnesia: is it still
worth pursuing?.
Cortex.
2002;
38
665-669
- 49
Kapur N.
Syndromes of retrograde amnesia: a conceptual and empirical synthesis.
Psychol Bull.
1999;
125
800-825
- 50
Stuss D T, Guzman D A.
Severe remote memory loss with minimal anterograde amnesia: a clinical note.
Brain Cogn.
1988;
8
21-30
- 51
O'Connor M, Butters N, Miliotis P, Eslinger P, Cermak L S.
The dissociation of anterograde and retrograde amnesia in a patient with herpes encephalitis.
J Clin Exp Neuropsychol.
1992;
14
159-178
- 52
Kopelman M D.
Comments on focal retrograde amnesia and the attribution of causality: an exceptionally
benign commentary by Narinder Kapur.
Cogn Neuropsychol.
2000;
17
639-640
- 53
Kapur N.
Focal retrograde amnesia and the attribution of causality: an exceptionally benign
commentary.
Cogn Neuropsychol.
2000;
17
623-637
- 54
Markowitsch H J, Fink G R, Thone A, Kessler A, Heiss W-DA.
PET study of persistent psychogenic amnesia covering the whole life span.
Cognit Neuropsychiatry.
1997;
2
135-158
- 55
Markowitsch H J.
Functional neuroimaging correlates of functional amnesia.
Memory.
1999;
7
561-583
- 56
Yasuno F, Nishikawa T, Nakagawa Y et al..
Functional anatomical study of psychogenic amnesia.
Psychiatry Res.
2000;
99
43-57
- 57
Manes F, Graham K S, Zeman A, Calcagno M, Hodges J R.
Autobiographical amnesia and accelerated forgetting in transient epileptic amnesia.
J Neurol Neurosurg Psychiatry.
2005;
76
1387-1391
- 58 Rogers R, Bagby R M, Dickens S E. Structured Interview of Reported Symptoms: Professional
Manual. Odessa, FL; Psychological Assessment Resources, Inc 1992
- 59
Albert M S, Butters N, Levin J.
Temporal gradients in the retrograde amnesia of patients with alcoholic Korsakoff's
disease.
Arch Neurol.
1979;
36
211-216
- 60
O'Connor M G, Sieggreen M A, Bachna K, Kaplan B, Cermak L S, Ransil B J.
Long-term retention of transient news events.
J Int Neuropsychol Soc.
2000;
6
44-51
- 61
Squire L R, Haist F, Shimamura A P.
The neurology of memory: quantitative assessment of retrograde amnesia in two groups
of amnesic patients.
J Neurosci.
1989;
9
828-839
- 62
Brandt J, Benedict R HB.
The assessment of retrograde amnesia: findings with a new public events procedure.
Neuropsychology.
1993;
7
217-227
- 63
Kopelman M D, Wilson B A, Baddeley A D.
The autobiographical memory interview: a new instrument of autobiographical and personal
semantic memory in amnesia patients.
J Clin Exp Neuropsychol.
1989;
11
724-744
- 64
Crovitz H F, Schiffman H.
Frequency of episodic memories as a function of their age.
Bull Psychon Soc.
1974;
4
517-518
- 65 Butcher J N. Clinical Personality Assessment: Practical Approaches. New York; Oxford
University Press 2002
- 66 Morey L C. An Interpretive Guide to the Personality Assessment Inventory (PAI). Odessa,
FL; Psychological Assessment Resources, Inc 1996
- 67 Tombaugh T N. Test of Memory Malingering (TOMM). Toronto, Ontario; Multi-Health
Systems 1996
- 68
Green P, Iverson G, Allen L.
Detecting malingering in head injury litigation with the Word Memory Test.
Brain Inj.
1999;
13
813-819
- 69 Frederick R I. Validity Indicator Profile Manual. Minneapolis; National Computer
Systems 1997
- 70
Green P, Iverson G L.
Validation of the computerized assessment of response bias in litigating patients
with head injuries.
Clin Neuropsychol.
2001;
15
492-497
- 71
Rosen H, Myers H.
Abreaction in the military setting.
Arch Neurol Psychiatry.
1947;
557
162-172
- 72
Perry J C, Jacobs D.
Overview: clinical applications of the Amytal interview in psychiatric emergency settings.
Am J Psychiatry.
1982;
139
552-559
- 73
Kavirajan H.
The amobarbital interview revisited: a review of the literature since 1966.
Harv Rev Psychiatry.
1999;
7
153-165
- 74
MacHovec F J.
Hypnosis to facilitate recall in psychogenic amnesia and fugue states: treatment variables.
Am J Clin Hypn.
1981;
24
7-13
- 75
Squire L R, Wetzel C D, Slater P C.
Memory complaint after electroconvulsive therapy: assessment with a new self-rating
instrument.
Biol Psychiatry.
1979;
14
791-801
- 76
Sellal F, Manning L, Seegmuller C, Scheiber C, Schoenfelder F.
Pure retrograde amnesia following a mild head trauma: a neuropsychological and metabolic
study.
Cortex.
2002;
38
499-509
1 All initials are fictitious to preserve patients' anonymity.
Jason BrandtPh.D.
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Hospital
600 N. Wolfe Street, Meyer 218, Baltimore, MD 21287-7218