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General psychopathology | © Tushnik Ghosh |
DISORDERS OF MEMORY:
Disorder of memory conditionally may be divided in dismnesia and paramnesia.
Dismnesia contains hypermnesia, hypomnesia, and different types of amnesia.
Hypermnesia: it is a nonproductive, some unfairly actualization of past experiences. A
flood of
memory about accidentally occurred situations which had negligible affect on life,
doesn
t improve productivity of thinking, but merely distracts the patient and disturbs him
to obtain new
information. Hypermnesia is seen in mania episodes or sometimes is seen in disorders of
consciousness. It is also observed in case of intake of psychotropic drugs (marijuana,
LSD, opioids,
phenamin etc), or accompanied by epileptic paroxysm.
Hypomnesia: it is general weakening of memory. In this case the patient remembers new
names, dates,
with difficulty and forgets details about events. The patients have to write the
important
information to remember them, with out these notes they cannot remember. During reading '
'
a book, he
has to return at previous pages to remember and connect what he is reading now.
Hypomnesia is often
accompanied by a symptom: anecphoria i.e. when the patient cannot remember names,
words, unless he
is given a clue or hint. Hypomnesia is related to broad spectrum organic diseases of
brain
(basically vascular), sometimes it is seen in functional disorders of psychology eg. in '
'
condition of
fatigue (asthenic syndrome).
Amnesia: it is a row of diseases which is characterized by loss of part of memory.
Retrograde amnesia: it is loss of memory till the beginning of the disease (in most of
the cases it
is connected with acute brain catastrophe with loss of consciousness). A part of memory '
'
of the past
is lost in this case.
Case example: patient, age 42, was born at place A, well settled, married at place B
and lived there
for 15 years with his wife and 2 sons. After divorce went back to place A and worked as '
'
driver.
Married again and had a son from the 2nd marriage. One evening the patient did not
return home from
work. He was found senseless under the bridge on the next morning. He was sent to ICU
for 10 days.
When he was conscious again, couldn
t remember anything about the trauma. After that it was found that he couldn
t remember last few years, he didn
t remember that he divorced his 1st wife, came back to place A to live, didn
t know anything about his 2nd marriage. But clearly remember about his last life at
place A, told
about place A and how he lived there. While his 2nd wife came to visit him, he
recognized her, but
called her by the name of his 1st wife.
In case of brain trauma, the patient practically does not forget his name, age,
memories of
childhood etc. The loss of basic information about the personality of the patient is
related to
psychogenic sources, which is called hysterical amnesia. Hypnosis can cure this
symptom.
Anterograde amnesia: it is loss of memory after the onset of disease (after restoring
consciousness). In this case, the patient is available for contact, he answers the
questions but
cannot remember the fragments of the events occurred just beforehand. The cause of
anterograde
amnesia is obscured consciousness and twilight state. In this case the ability to fix
the events in
memory may be restored with times. But in case of Korsakov
s syndrome (you will read about it later) anterograde amnesia comes as a complete loss
of ability to
fix events in memory.
Fixation amnesia: it is sudden decrease or total loss of ability to store something for '
'
sometimes in
memory. These patients cannot remember anything that they just heard, or saw, or read
(minute
memory). As they remember events till the onset of disease, they may lead professional
lives.
Ability to intellectual actions is also preserved. Along with these the disorder of
memory leads to
very rough disorientation of patient in any new situation, that the patient himself
cannot continue
any labor function. It is seen in chronic vascular disorder of brain (atherosclerotic
dementia) and
in sudden brain catastrophes (intoxication, trauma, asphexia, stroke).
Progressive amnesia: in this case the loss of memory is due to progressive organic
brain disorders.
As a rule, here, at first the ability to memorizing is lost (hypomnesia). Then patient
tends to
forget recent events. Then the long term memory is affected. This includes organized
(learned and
abstract) memory. At last emotional experiences and practical acquired habits are lost
from memory.
Patient may have some fragments of childhood memory left. Progressive amnesia is seen
in case of
diseases like atherosclerosis of vessels in brain (in absence of stroke), Alzheimer
s disease, Pick
s disease, and senile dementia.
Paramnesia is distortion or perversion of contents of memory. It includes mainly
pseudoreminiszenz
and confabulation.
Pseudoreminiszenz: this is filling of gap of memory by real experience but of other
time period from
his past life.
Case example: patient, hospitalized for last 2 months, during conversation with a
medical student
says that on the previous day she make dinner, helped her grandson to do homework.
Confabulation: it is unintentionally or unconsciously filling of gap of memory by
imagined or untrue
experiences that patient believes but has no base in fact.
Case example: patient, age 55, hospitalized for last 6 months, told the inturn on
taking anamnesis
that she on the previous Sunday, president Putin declared war against U.S. she is
afraid because she
saw the war in 1944 and it was a horrible experience for her.
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