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Hidden scars: posttraumatic stress disorder.

Memories of traumatic incidents or experiences can cause deep but invisible scars. Without intervention, the emotional pain associated with the incident can continue unabated. For the most part, painful memories are likely to be suppressed. However, when a memory is "triggered" for some reason, a variety of symptoms may occur which may be termed "posttraumatic stress disorder" (PTSD). A nurse can use an understanding of unhealed psychological scars to gain awareness of unresolved personal stress. In addition to personal reflection, as nurses assess and care for patients, it is important to be alert to indications of unresolved emotional pain.

Adjustment Disorders↗

Disorders of verbal and pictorial memory in right and left brain-damaged patients.

It is still controversial whether verbal and pictorial stimuli are independently processed and stored in memory, as assumed by the dual code hypothesis, or a single code is used both for verbal and for pictorial stimuli, as assumed by the verbal loop hypothesis and by the propositional code hypothesis. According to the first hypothesis, verbal and pictorial memory are independently disrupted by brain damage, whereas according to the second hypothesis a co-occurrence of verbal and pictorial memory disorders are usually observed. To test these contrasting predictions, we constructed a verbal and a pictorial memory task very similar with respect to testing procedures and to material to be memorized and we administered them to 33 left and 27 right brain-damaged patients and to 21 normal controls. The following results were obtained: 1) Disorders of verbal and of pictorial memory were dissociated by brain injury in about one-third of our patients; 2) A consistent relationship was observed between laterality of lesion and type of selective memory impairment, since word recognition was selectively impaired by left and picture recognition by right brain injury; 3) However, only on the test of verbal memory was a significant difference between right and left brain-damaged patients obtained, whereas on the test of pictorial memory only a nonsignificant trend in the opposite direction was observed. These data are in favor of the dual code hypothesis and suggest that the links between left hemisphere and verbal code may be stronger than the relationship between right hemisphere and pictorial code.

Adult↗

Declarative and procedural memory in bipolar disorder.

BACKGROUND: Memory function is an important but under researched area for neuropsychological investigation in persons with bipolar disorder. Previous studies have reported cognitive deficits on tasks of declarative memory in bipolar patients in the euthymic state. METHODS: This study extended these findings by investigating declarative as well as procedural learning and memory in bipolar patients (with and without alcohol abuse) who were examined in the euthymic state. The California Verbal Learning Test, Star Mirror Tracing Task, Pursuit Rotor Task, American National Adult Reading Test, and the Vocabulary Subtest of the WAIS-R, were administered to bipolar patients and control subjects by researchers who were blind to the subject's group. RESULTS: Bipolar patients performed worse than control subjects on a measure of declarative memory (California Verbal Learning Test) but did not differ from the performance of control subjects on either of the two procedural learning tasks (Pursuit Rotor Task and Star Mirror Task). CONCLUSIONS: These results suggest disturbed function of temporal lobe, but not basal ganglia, structures in persons with bipolar disorder.

Adult↗

Early diagnosis of dementia: neuropsychology.

Neuropsychology contributes greatly to the diagnosis of dementia. Cognitive deficits can be detected several years before the clinical diagnosis of dementia. The neuropsychological profile may indicate the underlying neuropathology. Neuropsychological assessment at an early stage of dementia has two goals: (a) to determine a memory disorder, not always associated with a memory complaint, and (b) to characterize the memory disorder in light of the cognitive neuropsychology and to assess other cognitive (and noncognitive) functions toward integrating the memory disorder in a syndrome. We review the global tools, the memory tests that describe the memory profile and indicate the underlying pathology, the assessment of other cognitive functions, and the neuropsychological patterns of typical Alzheimer's disease, frontotemporal dementia, primary progressive aphasia, semantic dementia, Lewy body dementia, subcortical dementia, and vascular dementia. These patterns must be interpreted in the light of the history, rate of progression, imaging results, and nature of existing behavioral disturbances. Moreover, there may be overlap between two or more pathologies, which complicates the diagnostic process. Follow-up of patients is necessary to improve diagnostic accuracy.

Alzheimer Disease↗

[Neuropsychological changes in epilepsy].

OBJECTIVE: The neuropsychological assessment of the epileptic patient is a very important aspect of diagnosis and treatment. It may be used to contribute to localization of the hemisphere involved in the seizures, differentiate situations of anxiety or depression or when planning treatment for rehabilitation. We review the different aspects of neuropsychological changes in patients with epilepsy. DEVELOPMENT: Firstly we review the different tests used in the neuropsychological assessment of epilepsy. Dodrill's neuropsychological battery of tests, in which the patients score less than the controls, is the most commonly used. We then evaluate and study the so-called 'transient cognitive disorder'. We also study memory problems in epilepsy. There may be episodes of seizures with amnesic features ('amnesic epileptic seizures'). Finally, the possibility of neuropsychological dysfunction secondary to antiepileptic drugs should always be considered. CONCLUSIONS: Epileptic patients have lower scores than persons taken as controls for the results of various neuropsychological tests, although there is less difference between the two groups when the patient group is made up of persons with a normal intelligence quotient. Transient cognitive involvement is common in epileptics and may cause underachievement at school or psychological problems. Memory disorders, particularly subjective, are common in epileptics, although neuropsychological tests other than those generally used may be necessary to evaluate this. It is possible that such memory disorders, if occurring as seizures, may be due to amnesic partial crises, which should always be differentiated from the diagnosis of transient global amnesia. Almost all antiepileptic drugs can cause negative neuropsychological effects, especially the benzodiazepines and barbiturates.

Acute Disease↗

Preventing restimulation of memory B cells in hemophilia A: a potential new strategy for the treatment of antibody-dependent immune disorders.

Memory B cells are responsible for the rapidly emerging antibody response after antigen reexposure. The signals required for the restimulation of memory B cells have not been fully explained. We used a murine model of anti-factor VIII (FVIII) antibody responses in hemophilia A to study the requirements for the restimulation of FVIII-specific memory B cells and their differentiation into anti-FVIII antibody-producing cells. We were particularly interested in the significance of activated T cells and costimulatory interactions. Our results indicate that the restimulation of FVIII-specific memory B cells is strictly dependent on interactions with activated T cells. These activated T cells can be specific for either FVIII or third-party antigens. Restimulation by T cells specific for third-party antigens requires the presence of FVIII, indicating that signals induced by B-cell receptor (BCR) triggering and by interactions with activated T cells are important. The blockade of B7-1 or B7-2 as well as the blockade of CD40L inhibits the restimulation and differentiation of FVIII-specific memory B cells in vitro and in vivo. The interference with inducible costimulator-inducible costimulator ligand (ICOS-ICOSL) interactions, however, does not cause any modulation. As expected, the production of anti-FVIII antibodies by plasma cells is not dependent on any of the costimulatory interactions tested.

Animals↗

[Memory disturbances in schizophrenia].

The recent literature on memory disorders in schizophrenic persons is reanalysed. The present interest in memory disorders as a core symptom of cognitive changes in schizophrenia derives from the fact that brain imaging methods have revealed a reduction of substance in the regions surrounding the lateral ventricles. Given this localisation, schizophrenics should suffer from pronounced memory deficits. The paper addresses (1) the role of memory disorders in an overall view of cognitive losses, (2) the pattern of memory losses (verbal vs non-verbal, short-term memory vs long-term memory, implicit vs explicit memory etc.) and (3) recent investigations based on simultaneous use of imaging procedures (fNMR, PET) and cortical activation during memory tasks. A survey of the literature renders it likely that frontal functions play an essential role in the type of memory deficits found among schizophrenics. Thus, a purely temporal localisation is unlikely. The reduced learning efficiency which accounts for most of the schizophrenics' cognitive problems points to a working memory disturbance. On the basis of these results, a model for the memory disorders of schizophrenics is developed. The model covers recent literature on working memory as well as neural network models of schizophrenic disorders. However, a differential psychopathological symptom and syndrome analysis remains a prerequisite for reducing the great variance of the schizophrenics' performance in memory tasks. The importance of cognitive rehabilitation for sociopsychiatric efforts aimed at re-integrating mentally ill persons should not be underestimated.

Humans↗

[Disorders of memory and consciousness in endogenous--depressed patients during antidepressive drug treatment (author's transl)].

Besides the well known somnolent and almost delirious states which always imply different mnestic and gnostic disorders also other drug-induced side-effects and complications can be observed during antidepressive treatment. Mnestic blackouts which clinically are more or less inconspicuous but which are always discovered retrospectively occur more often than they are documented. They are rather related to disturbances of engrammation depending on psychotropic drugs than to a disturbance and narrowing of the state of vigilance and consciousness. In order to exemplify a serious psychopathological complication of the altogether rare amential-amnestical syndrom, a casuistic report is presented of a case of a regulated semiconscious state during two weeks, a case of an amential-amnestical attack, and a case of ictal amnestical episode (Ictus amnesticus). The possible etiology and the observed disorders of memory and consciousness are discussed. The following common pathogenetic factors should be considered though the presented three cases have a different psychopathology and probably a different etiology: (1) The specific pharmacodynamics of the individual antidepressive drug, (2) disease related factors inclusing an alteration of the ability of conceiving and of the process of engrammation, (3) an individual vulnerability of neuronal synaptic systems.

Adult↗

Stress, mood disorders and memory in headache.

Comorbidity between headache and other disorders such as psychological or memory problems is a topic of increasing scientific interest both for us diagnostic and therapeutic implications but also for pathogenetic advances. A central neurogenic mechanism such as a dysregulation of some neurotransmitter system might underlie not only headache but also other coexistent disorders; findings highlight the role of serotonin pathways.

Adolescent↗

The physiological approach: functional architecture of working memory and disordered cognition in schizophrenia.

The method of single-cell recording in awake behaving monkeys as they perform behavioral tasks is perhaps the most powerful approach to understanding the neural basis of behavior. In contrast to cellular analyses in vitro, e.g., in slice preparations, the in vivo approach allows direct correlation of cellular activity and specific processes as they are isolated by behavioral paradigms. As brain mechanisms are studied under natural conditions, inferences about the dynamic basis of information processing are direct. Limitations of this approach include the inability to unequivocally identify the cell under investigation, though location by cytoarchitectonic area and cortical depth is possible. Neurophysiological studies have not only given a dynamic view of neural processing "on line" but have allowed investigators to examine fundamental issues about normal brain function and dementia. Here I illustrate some of these issues and the power of single cell physiology to address them. Before doing so, it should be patently obvious that recording one cell at a time is a technical necessity and in no way should be taken to imply that any behavior is dependent on a single cell. Rather the neuron investigated is a representative of a cohort of cells acting in aggregate.

Animals↗

Memory for the perceptual and semantic attributes of information in pure amnesic and severe closed-head injured patients.

This study investigated the hypothesis that brain damaged patients with memory disorder are poorer at remembering the semantic than the perceptual attributes of information. Eight patients with memory impairment of different etiology and 24 patients with chronic consequences of severe closed-head injury were compared to similarly sized age- and literacy-matched normal control groups on recognition tests for the physical aspect and the semantic identity of words and pictures lists. In order to avoid interpretative problems deriving from different absolute levels of performance, study conditions were manipulated across subjects to obtain comparable accuracy on the perceptual recognition tests in the memory disordered and control groups. The results of the Picture Recognition test were consistent with the hypothesis. Indeed, having more time for the stimulus encoding, the two memory disordered groups performed at the same level as the normal subjects on the perceptual test but significantly lower on the semantic test. Instead, on the Word Recognition test, following study condition manipulation, patients and controls performed similarly on both the perceptual and the semantic tests. These data only partially support the hypothesis of the study; rather they suggest that in memory disordered patients there is a reduction of the advantage, exhibited by normal controls, of retrieving pictures over words (picture superiority effect).

Adolescent↗

The Kluver-Bucy syndrome.

Evolution of psychological disorders following head injury including memory disorders and other cognitive ones are common. The best known are psychiatric disturbances of various kind after lesions of frontal lobes. Cognitive, behavioural and emotional disorders are not usually seen in patients with bilateral temporal lesions. In our Department of Neurotraumatology we observed 4 patients with post-traumatic lesions localized bitemporally. They developed Kluver-Bucy syndrome--rarity in human pathology--with combination of three or more the following syndromes: increased oral activity, hypersexuality, hypermetamorphosis, memory disorders, placidity, loss of people recognition, bulimia. Several symptoms responded dramatically to carbamazepine. We conclude that it may be a useful agent in treatment of this unusual syndrome.

Adult↗

A neuropsychological analysis of memory and amnesia.

Drawing on neuropsychological studies of amnesic patients, cognitive studies of normal individuals, and functional neuroimaging research, this article reviews recent developments in our understanding of the cognitive and neural bases of various forms of memory. This knowledge provides a foundation for a discussion of the clinical analysis of memory disorders. Different etiologies of selective memory impairment commonly seen in neurological practice are reviewed, followed by an overview of the clinical evaluation of memory disorders. In the evaluation of memory deficits, emphasis is placed on the identification of specific processing deficits that can be linked to underlying neuropathology.

Amnesia↗

Post-traumatic stress disorder and memory: prescient medicolegal testimony at the International War Crimes Tribunal?

The nature of remembrance of traumatic events has been particularly controversial during the past decade as vigorous new research has reshaped thinking about trauma and memory. Memory alterations in traumatized individuals have been investigated within both theoretical and biological frameworks. There are different types of memory, and empirical studies have associated post-traumatic stress disorder (PTSD) with a simultaneous weakening and a strengthening of memory. Memory deficiencies in PTSD have been found to be related to problems in new learning (explicit memory), but other specific deficiencies are unvalidated. Recently, accuracy of memory has received particular scrutiny because considerable importance is attached to victims' recollections. In 1998, at the International War Crimes Tribunal in The Hague, The Netherlands, a Bosnian-Croatian soldier was tried for aiding and abetting the rape of a Muslim woman. The defendant's lawyers suggested that the woman's memory was inaccurate, having been adversely affected by her traumatic experiences, and that the defendant whom she identified was not present during her interrogation and abuse. The prosecution disagreed and argued that memories of traumatic experiences in individuals with PTSD are characteristically hyperaccessible. Expert witnesses on both sides were brought in to provide medicolegal testimony about the scientific parameters of stress and its long-term effects on brain regions associated with memory. With the expert witness discussion as background, this article reviews the most recent research about the nature of memory in the aftermath of trauma and the politics of psychological trauma and the law.

Bosnia and Herzegovina↗

[The elimination of chemotherapy side effects in pulmonary tuberculosis patients].

Neurotoxic side-effects of tuberculosis chemotherapy occurred in 14.9% of patients with tuberculosis treated prophylactically with intramuscular pyridoxine infusions. Use of small doses of nootropil (piracetam) allowed to control the side-effects (headache and vertigo, sleep disorders, irritation, memory disorders) and to continue treatment with isoniazide, one of the most potent tuberculostatic agents.

Adult↗

Dissociative identity disorder and memory dysfunction: the current state of experimental research and its future directions.

Memory dysfunction is a central feature of dissociative identity disorder (DID). Following the memorial anomalies outlined by Putnam [Putnam, F. W. (1994). Dissociation and disturbances of self. In: D. Cicchetti & S. L. Toth (Eds.), Disorders and dysfunctions of the self, vol. 5 (pp. 251-265). Rochester, NY: University of Rochester Press; Putnam, F. W. (1995). Development of dissociative disorders. In: D. Chicchetti & D. J. Cohen (Eds.), Developmental psychopathology, vol. 2 (pp. 581-608). New York: Wiley], the experimental research using DID case studies and samples is reviewed. As a whole, research suggests that amnesic barriers between alter personalities are typically impervious to explicit stimuli, as well as conceptually driven implicit stimuli. Autobiographical memory deficits are also experimentally evident in DID. Although no experimental studies have addressed the issue of source amnesia or pseudomemories, there is some evidence that pseudomemories are an infrequent but real phenomenon in DID patients. Finally, potential deficits in working memory are outlined, including those relating to cognitive inhibition. Research directions are discussed throughout to further elucidate the nature of memory dysfunction in DID.

Cognition↗

Disorders of memory in humans.

Memory is composed of dissociable systems that accomplish different forms of learning and that are mediated by distinct neural networks. Knowledge about the psychological nature and neural basis of specific memory systems has come primarily from lesion analysis, but this year functional brain imaging has provided a new source of convergent evidence. Recent findings are reviewed that provide new information about a limbic-diencephalic system critical for learning new declarative information, a temporal lobe system that stores long-term semantic knowledge in a domain-specific fashion, an occipital system that subserves visuoperceptual implicit memory, and a fronto-thalamo-neostriatal system that mediates the executive component of working memory and that plays an important role in some forms of sensorimotor skill learning.

Brain↗