Psychogenic amnesia: syndromes, outcome, and patterns of retrograde amnesia

Harrison, Neil A, Johnston, Kate, Corno, Federica, Casey, Sarah J, Friedner, Kimberley, Humphreys, Kate, Jaldow, Eli Joseph, Pitkanen, Mervi and Kopelman, Michael D (2017) Psychogenic amnesia: syndromes, outcome, and patterns of retrograde amnesia. Brain, 140 (9). pp. 2498-2510. ISSN 0006-8950

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There are very few case series of patients with acute psychogenic memory loss (also known as dissociative/functional amnesia), and still fewer studies of outcome, or comparisons with neurological memory-disordered patients. Consequently, the literature on psychogenic amnesia is somewhat fragmented and offers little of prognostic value for individual patients. In the present study, we reviewed the case records and neuropsychological findings in 53 psychogenic amnesia cases (3M:1F), in comparison with 21 consecutively recruited neurological memory-disordered patients and 14 healthy controls. In particular, we examined the pattern of retrograde amnesia on an assessment of autobiographical memory (the Autobiographical Memory Interview). We found that our patients with psychogenic memory loss fell into four distinct groups, which we categorised as: (i) fugue state, (ii) fugue-to-focal retrograde amnesia, (iii) psychogenic focal retrograde amnesia following a minor neurological episode, and (iv) patients with gaps in their memories. While neurological cases were characterised by relevant neurological symptoms, a history of a past head injury was actually more common in our psychogenic cases (p=0.012), perhaps reflecting a ‘learning episode’ predisposing to later psychological amnesia. As anticipated, loss of the sense of personal identity was confined to the psychogenic group. However, clinical depression, family/relationship problems, financial/employment problems, and failure to recognise the family were also statistically more common in that group. The pattern of autobiographical memory loss differed between the psychogenic groups: fugue cases showed a severe and uniform loss of memories for both facts and events across all time-periods, whereas the two focal retrograde amnesia groups showed a ‘reversed’ temporal gradient with relative sparing of recent memories. After 3-6 months, the fugue patients had improved to normal scores for facts and near-normal scores for events. By contrast, the two focal retrograde amnesia groups showed a lesser improvement and continued to show a reversed temporal gradient. In conclusion, the outcome in psychogenic amnesia, particularly those characterised by fugue, is better than generally supposed. Findings are interpreted in terms of Markowitsch’s and Kopelman’s models of psychogenic amnesia, and with respect to Anderson’s neuroimaging findings in memory inhibition.

Item Type: Article
Keywords: Psychogenic, fugue, retrograde, amnesia, autobiographical memory
Schools and Departments: Brighton and Sussex Medical School > Neuroscience
Depositing User: Alexei Fisk
Date Deposited: 19 Jul 2017 12:49
Last Modified: 02 Jul 2019 14:51

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