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A case of delayed post-traumatic stress disorder with 'organic memories' accompanying therapy.

A case of post-traumatic stress disorder (PTSD) following a road traffic accident in which the onset of symptoms was delayed for 18 months until a widely reported major disaster occurred is described. A severe major depressive episode was precipitated, requiring treatment in its own right. During psychotherapy sessions, extreme emotions, heightened sensations, and 'organic memories' relating to the original accident were experienced.

Accidents, Traffic↗

Diagnosis and management of memory loss and cognitive disorders among elderly persons.

Memory loss and other cognitive dysfunctions, although common in elderly persons, are not universal features of old age. Instead they herald the presence of various neuropsychiatric diseases, which are first recognized as syndromes. The two most common neuropsychiatric syndromes, dementia and delirium, produce global changes in cognition and other capacities. They are differentiated by the patient's level of consciousness, which is impaired in delirium but intact in dementia. Delirium is generally reversible and often indicates serious physical illness. Although dementia is occasionally reversible, the mainstays of its management and treatment are palliative. Comorbid psychiatric symptoms are common in patients with both delirium or dementia, and their recognition and treatment constitute an important task for the geropsychiatrist. The differential diagnosis of primary dementing illness and other psychiatric illnesses such as depression is complex, because symptoms of the two kinds of disorders often coexist and common pathogenetic mechanisms may underlie both syndromes.

Aged↗

Attention-Deficit/Hyperactivity Disorder and working memory: a task switching paradigm.

This study investigated working memory (WM) in children with Attention-Deficit/Hyperactivity Disorder (ADHD) using a task switching paradigm with Stroop color-word stimuli which required participants to switch from color-naming to word-reading. High and low WM load conditions were compared by manipulation of task reminders as a tempo cue. The sample comprised 83 children with ADHD and 29 normal children comparable in age (aged 7 to 13). Within the ADHD group, participants were divided according to the presence or absence of Learning Disability (LD). Results indicated that children with ADHD had slower response times and less accurate responses in general, however, the ADHD groups were not consistently slower in the high WM load condition. Instead, an impairment in adjusting response speed to cope with higher task demands (i.e., high WM load condition) was found. These results do not support the previously documented association between ADHD and a primary deficit in WM for task switching. However, children with ADHD do demonstrate a specific difficulty in slowing down for a demanding task. Present findings suggest that earlier proposals of under-arousal and poor state regulation in ADHD deserve renewed attention.

Analysis of Variance↗

Inter-identity amnesia in dissociative identity disorder: a simulated memory impairment?

BACKGROUND: Although included in the current edition of the DSM, there does not seem to be consensus among mental health professionals regarding the diagnostic status and scientific validity of dissociative identity disorder (DID). This study was aimed at the detection of simulation of inter-identity amnesia in DID. METHOD: A sample of 22 DID patients was included, together with a matched control sample of subjects instructed to simulate inter-identity amnesia, a guessor group that had no knowledge of the stimulus material and a normal control group. A multiple-choice recognition test was included. The rate of incorrect answers was determined. Moreover, the specific simulation strategy used was examined by providing subjects with a range of choices that varied in extent of disagreement with the correct answer and determining whether plausible or implausible answer alternatives were selected. RESULTS: On the recognition test DID patients selected incorrect answers above chance like simulators. Patients thus seem to use their knowledge of the correct answer in determining their given answer. They were not characterized by a well-thought-out simulating behaviour style, as indicated by the differences in selection of specific answer alternatives found between patients and simulators. CONCLUSIONS: DID patients were found not to be characterized by an actual memory retrieval inability, in contrast to their subjective reports. Instead, it is suggested that DID may more accurately be considered a disorder characterized by meta-memory problems, holding incorrect beliefs about their own memory functioning.

Adult↗

Fluoxetine disrupts the integration of anxiety and aversive memories.

Anxiety disorders may result from an overexpression of aversive memories. Evidence suggests that the hippocampal cholinergic system could be the point of convergence of anxiety and memory. We propose that clinically effective anxiolytics may exert their effect by interfering with this integration mechanism. To assess anxiety and aversive memory, we used the shock-probe burying test. A reduction in anxiety in this test is indicated by decreased burying, whereas impaired cognition is reflected by an increased number of probe-contacts and/or reduced retention latency. Both an aversive stimulus and the memory of that stimulus significantly increased hippocampal acetylcholine (ACh) levels (Experiment 1). In fact, the memory of the event seemed to be more important than the event itself since the aversive memory induced a greater increase in hippocampal ACh. Injections (i.p.) of fluoxetine (Prozac) reduced burying behavior, while not affecting probe contacts or retention latency (Experiment 2). Although injections of fluoxetine did not affect basal hippocampal ACh efflux (Experiment 3), fluoxetine abolished the increase in ACh induced by the aversive stimulus and the memory of that stimulus (Experiment 4), emphasizing the significance of aversive memories in anxiety disorders. These actions may be mediated by a decrease in the event-related enhancement in cholinergic neurotransmission through M1 cholinergic receptors (Experiment 5). Therefore, anxiety disorders may stem from an unopposed formation of aversive memories and clinically effective anxiolytics hinder the association between emotional and cognitive processing. This reduces the emotional impact of aversive memories, thereby opposing consequent anxiety.

Acetylcholine↗

Memory bias in patients with hypochondriasis and somatoform pain disorder.

OBJECTIVE: A memory bias enhances memory for disorder congruent information. The experimental evaluation of such biases in somatoform disorders may improve our understanding of these disorders. METHOD: Immediate and delayed free recall as well as recognition for positive, negative, pain, and neutral word stimuli were studied in 28 patients with somatoform disorders (hypochondriasis and/or pain disorder patients) and 14 patients without somatoform disorders. RESULTS: Somatoform patients recalled fewer positive words and their criteria for recognition of negative and pain words were less conservative than in patients without somatoform disorders. In addition, patients with comorbid hypochondriasis and somatoform pain disorder showed an enhanced immediate recall of pain words. CONCLUSION: The memory biases found in this study support cognitive theories of somatoform disorders. They may contribute to the development and maintenance of somatoform disorders.

Adult↗

Neural correlates of enhanced working-memory performance in dissociative disorder: a functional MRI study.

BACKGROUND: Memory functioning has been highlighted as a central issue in pathological dissociation. In non-pathological dissociation, evidence for enhanced working memory has been found, together with greater task-load related activity. So far, no imaging studies have investigated working memory in dissociative patients. METHOD: To assess working memory in dissociative patients functional magnetic resonance imaging was used during performance of a parametric, verbal working-memory task in patients with a dissociative disorder (n=16) and healthy controls (n=16). RESULTS: Imaging data showed that both groups activated brain regions typically involved in working memory, i.e. anterior, dorsolateral and ventrolateral prefrontal cortex (PFC), and parietal cortex. Dissociative patients showed more activation in these areas, particularly in the left anterior PFC, dorsolateral PFC and parietal cortex. In line with these findings, patients made fewer errors with increasing task load compared to controls, despite the fact that they felt more anxious and less concentrated during task performance. CONCLUSIONS: These results extend findings in non-pathological high dissociative individuals, suggesting that trait dissociation is associated with enhanced working-memory capacities. This may distinguish dissociative patients from patients with post-traumatic stress disorder, who are generally characterized by impaired working memory.

Adult↗

Are the neural substrates of memory the final common pathway in posttraumatic stress disorder (PTSD)?

A model for the posttraumatic stress disorder (PTSD) as a disorder of memory is presented drawing both on psychological and neurobiological data. Evidence on intrusive memories and deficits in declarative memory function in PTSD-patients is reviewed in relation to three brain areas that are involved in memory functioning and the stress response: the hippocampus, amygdala, and the prefrontal cortex. Neurobiological studies have shown that the noradrenergic stress-system is involved in enhanced encoding of emotional memories, sensitization, and fear conditioning, by way of its effects on the amygdala. Chronic stress also affects the hippocampus, a brain area involved in declarative memories, suggesting that hippocampal dysfunction may partly account for the deficits in declarative memory in PTSD-patients. Deficits in the medial prefrontal cortex, a structure that normally inhibits the amygdala, may further enhance the effects of the amygdala, thereby increasing the frequency and intensity of the traumatic memories. Thus, by way of its influence on these brain structures, exposure to severe stress may simultaneously result in strong emotional reactions and in difficulties to recall the emotional event. This model is also relevant for understanding the distinction between declarative and non-declarative memory-functions in processing trauma-related information in PTSD. Implications of our model are reviewed.

Amygdala↗

Characteristics of non-verbal memory impairment in bipolar disorder: the role of encoding strategies.

BACKGROUND: There is evidence that individuals with bipolar disorder exhibit neuropsychological impairments not only during episodes of depression or mania but also when they are euthymic. One of the most consistently reported cognitive problems in euthymic individuals with bipolar disorder is impairment in episodic memory. Learning and memory depend on individuals' ability to organize information during learning. A recent study by our group showed that verbal episodic memory impairments in euthymic patients with bipolar I disorder (BP-I) are mediated by difficulties in organizing verbal information appropriately during learning. The purpose of the present study was to determine whether memory impairments in euthymic individuals with BP-I extend to non-verbal memory and whether non-verbal memory impairments are mediated by difficulties in organizing non-verbal information during encoding. METHOD: Study participants were 25 euthymic, remitted individuals with BP-I and 25 age, gender and education matched control participants. Participants completed the Rey-Osterrieth Complex Figure Test (RCFT), a well-established measure of non-verbal memory that enables assessment of organization during learning. RESULTS: Compared to control participants, BP-I participants showed impaired performance on the RCFT immediate recall. They also relied less on organizational strategies during encoding. Multiple regression modeling indicated that group differences between control and BP-I participants in long-delayed free recall did not remain statistically significant when effects of lower organization were partialled out. CONCLUSIONS: Non-verbal memory problems in individuals with bipolar disorder, while euthymic, are mediated by poor use of non-verbal organization strategies during encoding, but do not appear to reflect deficits in retention of information.

Adult↗

Memory creation and the treatment of psychiatric disorders.

False-memory syndrome describes the 'recovery' of memories of traumatic events which did not take place. 'Recovered' memories are created as a result of suggestion or other psychological maneuvers. This means that memories can be implanted. The author suggests that the possibility of use of implantation of 'good' memories for the treatment of certain psychiatric disorders should be explored and that implantation of 'good' memories may be called 'positive memory creation therapy'. The author also suggests that memory creation treatment should be used under strict ethical and legal control.

Humans↗

A model of hippocampal neurogenesis in memory and mood disorders.

The mounting evidence for neurogenesis in the adult hippocampus has fundamentally challenged the traditional view of brain development. The intense search for clues as to the functional significance of the new neurons has uncovered a surprising connection between neurogenesis and depression. In animal models of depression, neurogenesis is reduced, whereas many treatments for depression promote neurogenesis. We speculate on why the hippocampus, traditionally viewed as a memory structure, might be involved in mood disorders, and what specific role the new neurons might have in the pathogenesis of and recovery from depression. The proposed role of neurogenesis in contextual-memory formation predicts a specific pattern of cognitive deficits in depression and has important implications for treatment of this highly prevalent and debilitating disorder.

Animals↗

"Recovered memory" therapy for eating disorders: implications of the Ramona verdict.

"Recovered memory therapy" for eating disorders and other psychiatric conditions seeks to help the patient recover repressed memories of childhood sexual abuse and other traumatic experiences. Through this technique, it is hoped that the patient can work through these experiences to achieve relief from shame, body dissatisfaction, and symptoms of depression and eating disorders. However, this method was questioned in the recent Ramona case, where a father successfully sued two therapists and a hospital for allegedly implanting false memories of childhood sexual abuse in his bulimic daughter. The testimony and verdict in this case recall the principle of primum non nocere: Although it is clearly reasonable to consider an unproven therapeutic technique in an attempt to relieve human suffering, the potential risk of the technique--in this case the possible induction of false incest memories--must be weighed carefully against the technique's expected benefits.

Adult↗

Attention, learning, and memory in posttraumatic stress disorder.

This study compared attention and declarative memory in a sample of combat veterans with posttraumatic stress disorder (PTSD, n = 24) previously reported to have reduced concentrations of the hippocampal neuronal marker N-acetyl aspartate (NAA), but similar hippocampal volume compared to veteran normal comparison participants (n = 23). Healthy, well-educated males with combat-related PTSD without current depression or recent alcohol/drug abuse did not perform differently on tests of attention, learning, and memory compared to normal comparison participants. Further, hippocampal volume, NAA, or NAA/Creatine ratios did not significantly correlate with any of the cognitive measures when adjustments for multiple comparisons were made. In this study, reduced hippocampal NAA did not appear to be associated with impaired declarative memory.

Alcoholism↗

Use of memory tests in differentiating organic disorder from depression.

Although memory tests are commonly used to help differentiate organic conditions from depression, the extent to which depression might influence test performance is unclear. Comparison of the performances of normal, brain-damaged, and depressed subjects on a battery of verbal and visual memory tests revealed that the incidence of impairment amongst the depressed subjects was not significantly greater than amongst normal subjects on the majority of measures, and that within the depressed group, the degree of depression was not related to poor test performance. The brain-damaged group displayed a significant incidence of impairment on all measures, and a significantly greater incidence than the depressed group on the majority of measures. It is concluded that memory tests have a useful role to play in differential diagnosis.

Adolescent↗