Unit 4. Psychopathology of Memory

Key Aspects of Memory

·       Encoding: The process of gathering and interpreting information based on prior knowledge and context.

·       Storage: Maintaining encoded information for varying durations.

·       Retrieval: Accessing stored information when required.

·       Memory involves various interconnected systems differing by:

o   Duration: From milliseconds (short-term memory) to a lifetime (long-term memory).

o   Capacity: From limited chunks (e.g., working memory) to vast networks of detailed information.

·       Identity and Memory:

o   Memory forms the backbone of personal identity.

o   Loss of memory (e.g., amnesia) often disrupts a person’s sense of self.

o   Disorders like dissociative amnesia highlight the decoupling of memory and identity, where traumatic memories may be "forgotten" as a psychological defense mechanism.

Types of Memory Disorders

1. Quantitative Disorders These involve changes in the capacity to store or recall information. Examples include:

o   Hyperamnesia: Excessive memory recall.

§  Can be permanent (e.g., individuals with savant syndrome or exceptional intellectual abilities) or transitory:

§  In heightened emotional states like hypomania, near-death experiences, or hypnosis.

§  E.g., some people recall entire sequences of events in detail during flashbulb memories (e.g., catastrophic events).

o   Hypoamnesia: Reduced memory capacity.

§  Example: The “tip-of-the-tongue” phenomenon.

§  Often of little clinical concern but could signal early cognitive decline or diseases like Alzheimer’s.

o   Amnesia: Severe loss of memory:

§  Anterograde Amnesia:

§  Inability to retain new information post-injury or event.

§  Example: Korsakoff syndrome (common in chronic alcohol use leading to vitamin B deficiency).

§  Retrograde Amnesia:

§  Inability to recall past memories.

§  Triggered by intense physical or mental trauma (e.g., accidents, psychological shock).

§  Global Amnesia:

§  A combination of both anterograde and retrograde amnesia, often due to organic trauma like encephalitis.

§  Transient Global Amnesia:

§  Sudden, temporary memory loss.

§  Symptoms:

§  Loss of recent episodic memories (retrograde).

§  Inability to form new memories (anterograde).

§  Typically resolves in 24 hours.

§  Risk factors: Stress, migraines, and conditions like vascular diseases.

2. Qualitative Disorders (Paramnesias) These distort memory accuracy, creating false or altered recollections. Examples include:

o   Retrospective Falsification:

§  Memory distortion influenced by the individual’s current emotional state or beliefs.

§  Common in psychiatric illnesses like schizophrenia, depression, and mania.

§  Patients may genuinely believe their distorted memories, e.g., remembering delusions (a transmitter implanted in their brain).

o   Screen Memory:

§  Partial recollection of a painful or significant event, often masking deeper trauma.

§  Example: Childhood abuse remembered inaccurately as being perpetrated by a stranger rather than a family member.

o   Confabulation:

§  Filling gaps in memory with fabricated yet unintended information.

§  Common in Korsakoff syndrome, Anton’s syndrome, and traumatic brain injuries.

§  Patients create stories to cope with memory gaps, often unaware they are false.

o   Fantastic Confabulation:

§  Creation of elaborate, implausible tales, often tied to delirium or psychosis.

§  Example: Claims of traveling to outer space or supernatural experiences.

o   Pseudologia Fantastica:

§  Elaborate pathological lying.

§  Lies are intentionally told, often to boost ego or gain attention.

§  Example: False accusations or creating grandiose self-narratives for admiration.

Dissociative Memory Disorders

These disorders are typically psychological in origin, stemming from trauma or stress:

·       Dissociative Amnesia:

o   Memory loss specific to personal information or events.

o   Often triggered by psychological trauma and distinguished by:

§  Localized Amnesia: Inability to recall events during a specific period (e.g., after an accident).

§  Selective Amnesia: Partial recall of traumatic events (e.g., abuse survivors recalling fragments).

§  Generalized Amnesia: Loss of all personal identity and life history, often sudden in onset.

§  Systematized Amnesia: Forgetting specific categories of information (e.g., related to one person or family).

§  Continuous Amnesia: New events are forgotten as they occur (similar to the movie "50 First Dates").

o   Subtype: Dissociative Fugue:

§  Individuals wander to new places with no memory of why they are there, sometimes creating new identities.

Deja Vu and Related Phenomena

·       Deja Vu: A false sense of familiarity with a new situation.

·       Jamais Vu: Lack of recognition for previously familiar places or people.

·       Deja Phenomena:

o   Deja Entendu: False auditory recognition.

o   Deja Pense: Belief that a thought is a repetition of a previous thought.

o   Deja Vecu: Recollection of an entire sequence of experiences as though relived.

State-Dependent Memory

·       Memory recall is influenced by the emotional or physiological state during encoding.

·       Examples:

o   Psychotic patients may recall traumatic memories only when in similar psychotic episodes.

Differential Diagnosis

·       Memory disorders must be distinguished between:

o   Organic Causes: Diseases (e.g., dementia, stroke) or drugs.

o   Functional Causes: Stress, trauma, or dissociation.

o   Clear differentiation is critical, especially with dissociative amnesia, to rule out medical conditions.

Important Considerations

• Memory is reconstructive; every recollection alters the original memory.

• In therapeutic contexts, building narratives around trauma helps integrate memories into the past, reducing recurring flashbacks or panic attacks.

• Non-pathological memory lapses (e.g., forgetting parts of a routine drive) can occur due to distractions or preoccupations.