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Disorders of MEMORY
CHAIRPERSON- DR. TAPAS KUMAR AICH (PROFESSOR AND HEAD)
PRESENTER – DR. ANISHA JOSHI (JR 1)
DEPARTMENT OF PSYCHIATRY
BRD MEDICAL COLLEGE GORAKHPUR
INTRODUCTION
 Memory is a general term for a mental process that allows the individual to store information for
later recall.
MECHANISM OF MEMORY
 Disturbance of memory is described by the length of time for which information has been retained. Memory storage is
organized in three ways :
 1- Sensory Memory
 2- Short Term Memory
 3- Long Term Memory
disorders of memory .pptx disorder of memory
SENSORY MEMORY
 Sensory memory is the initial and early phase of memory.
 It holds large amounts of incoming information briefly. It is a selecting and recording system via which
perceptions enter the memory system.
 Fleeting visual image, iconic memory lasts up to 200 ms, whereas auditory, echoic memory lasts up to
2000 ms.
 The information selected and recorded at this level needs to be further processed as short-term memory,
or it quickly decays and is lost.
 Sensory memory, is registered for each of the senses and its purpose is to facilitate the rapid
processing of incoming stimuli so that comparisons can be made with material already stored in
short- and long-term memory.
 Since there are numerous stimuli bombarding the individual, selective attention allows for the
sifting of relevant material from sensory memory for further processing and storage in short-term
memory.
 As a consequence, most sensory memory fades within a few seconds.
SHORT TERM MEMORY
 Short-term memory, also called working memory, allows for the storage of memories for much longer than
the few seconds available to sensory memory. Short-term memory aids the constant updating of one’s
surroundings.
 Baddeley and Hitch hypothesized a model of working memory comprising a central executive, a
visuospatial scratch pad and a phonological loop.
 In this system, the central executive is the attentional controller assisted by the visuospatial scratch pad
that allows for the temporary storage and manipulation of visual and spatial information.
 The phonological loop holds memory traces of verbal information for a couple of seconds combined with
subvocal rehearsal.
Baddeley and Hitch
(working memory model)
LONG TERM MEMORY
 Long- term memory can be conceptualized into two retrieval systems:
Declarative or Explicit memory
1. Semantic memory
2. Episodic memory
Non declarative or implicit memory
1. Procedural memory
DECLARATIVE/ EXPLICIT
MEMORY
 Deals with facts and events, available to conscious for declaration
 Common examples: 5-minute recalls, asking the patient what they had for breakfast.
 Stored in Hippocampus.
 Person is conscious of what they are remembering.
1. Semantic memory/ memory for abstract facts: What is the capital of India?
2. Episodic memory/ memory for specific events: What did you have for breakfast?
AUTOBIOGRAPHICAL MEMORY
 A type of episodic memory.
 Associated with the active experience of remembering.
 Memories of events and issues that related to oneself.
 Characterized by-
 General recall of event.
 An interpretation of event.
 Recall of few specific details
NON DECLARATIVE/ IMPLICIT
MEMORY
 Performance of tasks such as typing , swimming or cutting a loaf of bread.
 Expressions of prior learning.
 No active awareness that memory is being searched in undertaking particular skill
 Stored in limbic system, amygdala and cerebellum
 Description of the requirements for memory is chiefly referable to long term memory and can be
subdivided phenomenologically into the following five functions :
1. Registration or encoding is the capacity to add new information to the memory store.
2. Retention or storage is the ability to maintain knowledge that can subsequently be returned to
consciousness.
3. Retrieval is the capacity to access stored information from memory by recognition, recall or
implicitly by demonstrating that a relevant task is performed more efficiently as a result of prior
experience.
4. Recall is the effortful retrieval of stored information into consciousness at a chosen moment.
It requires an active, complex search process.
It is influenced by primacy (first item) and recency (last item) effects. The question ‘What is the capital of France?’
requires the recall function.
5. Recognition is the retrieval of stored information that depends on the identification of items previously learned and is
based on either remembering (effortful recollection) or knowing (familiarity-based recollection).
THEORY OF MEMORY
 A THEORY OF GENERAL MEMORY FUNCTION
 According to this theory, Three distinct processes of memory have been identified. These are an encoding process, a
storage process, and a retrieval .
 Encoding is the process of receiving, sensory input and transforming it into a form, or code, which can be stored;
 Storage is the process of process actually putting coded information into memory
 Retrieval is the process of gaining access to stored, coded information when it is needed.
INFORMATION-PROCESSING THEORY :
 the information-processing theory developed by Richard Atkinson and Richard Shriffrin.
 In the Atkinson and Shriffrin theory, memory starts with a sensory input from the environment.
 This input is held for a very brief time – several seconds at most- in a sensory register associated with the
sensory channel.
 Information that is attended to and recognized in the sensory register may be passed on to short term
memory, where it is held for perhaps 20 to 30 seconds.
 Some of the information reaching short term memory is processed by being rehearsed- will link it up with
other information already stored in memory.
 Information that is rehearsed may then be passed along to long term memory; when items of information are
placed in long term memory, they are organized into categories, where they may reside for days, once, years,
or for a lifetime. When you remember something, a representation of the item is withdrawn, or retrieved,
from long term memory.
disorders of memory .pptx disorder of memory
LEVELS OF PROCESSING THEORY:
 According to the levels of processing idea, incoming information can be worked on at different
levels of analysis; the deeper the analysis goes, the better the memory.
 First level is simply perception, which gives us our immediate awareness of the environment. At
a somewhat deeper level, the structural features of input are analyzed; and, finally, at the deepest
level of processing, the meaning of the input is analyzed. Analysis of the deep level of meaning
gives the best memory.
 The idea of elaboration has been added to the levels of processing theory. Elaboration refers to
the degree to which incoming information is processed so that it can be tied to, or integrated
with, existing memories. The greater the degree of elaboration given to item of incoming
information, the more likely it is that it will be remembered.
disorders of memory .pptx disorder of memory
MEMORY IMPAIRMENTS
1. AMNESIA
a) Normal memory decay
b) Psychogenic
c) Organic
2. Paramnesias ( distortion of memory)
a) Distortion of recall
b) Distortion of recognition
3. Hyperamnesia
THE AMNESIAS
Amnesia is defined as partial or total inability to recall past experiences and
events, and its origin may be organic or psychogenic.
PSYCHOGENIC AMNESIA
 Dissociative/ hysterical amnesia
 Dissociative or hysterical amnesia is the sudden amnesia that occurs during periods of extreme
trauma and can last for hours or even days.
 The amnesia will be for personal identity such as name, address and history as well as for personal
events, while at the same time the ability to perform complex behaviour is maintained.
 There is a discrepancy between the marked memory impairment and the preservation of
personality and social skills, so that the person behaves appropriately to their background and
education.
 It is believed to be more common in those with a prior history of head injury..
 Dissociation may be associated with a fugue or wandering state in which the subject travels to
another town or country and is often found wandering and lost.
KATATHYMIC AMNESIA/MOTIVATED
FORGETTING
• Inability to recall specific painful memories.
• Due to defense mechanism of repression.
• More persistent and circumscribed.
• Trigger/ psychotherapeutic intervention makes memory available to consciousness.
• Lasts for many years.
• There is no loss of personal identity
ORGANIC AMNESIAS
• Acute Brain Disease:
• Memory is poor owing to disorders of perception and attention.
• There is failure to encode material in long term memory.
• Acute head injury there is amnesia –retrograde amnesia , which embraces the events just before
the injury
• anterograde amnesia is amnesia occurring after the injury
• Black outs- Anterograde amnesia in alcohol dependent patients.
 Indicate reversible brain damage.
 Delirium- infection, epilepsy
 Subacute Coarse Brain Disease
 Unable to register new memories.
 Antero grade and retrograde amnesia.
 Antero grade amnesia –inability to learn new memories.
 Retrograde amnesia –inability to recall previously learned material.
 Remote memory: intact
 Korsakoff’s syndrome is the amnestic syndrome caused by thiamine deficiency
 Other cause - cerebrovascular disease, multiple sclerosis ,ECT
 Chronic Coarse Brain Disease
 Patients with amnesia or those with Korsakoff’s syndrome usually have a loss of
memory extending back into the recent past for a year or so.
 Patients with a progressive chronic brain disease have an amnesia extending over
many years, though the memory for recent events is lost before that for remote events.
This was pointed out by Ribot and is known as Ribot’s law of memory regression.
 Other Amnesias
 Anxiety amnesia occurs when there is anxious preoccupation or poor concentration in disorders such as
depressive illness or generalized anxiety.
 Initially it may wrongly suggest dissociative amnesia. More severe forms of amnesia in depressive disorders
resemble dementia and are known as depressive pseudodementia.
 Amnesias in anxiety and depressive disorders are generally caused by impaired concentration and resolve
once the underlying disorder is treated.
PARAMNESIA
 Falsification of memory by distortion.
 Occur in
 normal subjects due to process of normal forgetting.
 Emotional problems
 organic states.
 Divided into 2 types:
1. Distortions of recall
2. Distortions of recognition
29
PARAMNESIA
DISTORTIONS OF
RECALL
Retrospective
Falsification.
False Memory
Screen Memory
Confabulation
Pseudologia
Fantastica
Munchausen's
Syndrome
Vorbeireden
Cryptamnesia
Retrospective Delusion
DISTORTIONS OF
RECOGNITION
Déjà vu
Deja entendu.
Jamais Vu.
Deja Pense.
 NORMAL VARIATIONS
SELECTIVE FORGETTING
 In normal forgetting, there is loss of or diminished access to recently acquired and stored information.
 Rates of forgetting are influenced by the personal meaningfulness of the information, the conceptual
style of the individual, the degree of processing and elaboration of the information and age. There are
two forms of interference: proactive and retroactive.
 In proactive interference, newly learned material interferes with the recall of previously learned
material.
 In retroactive interference, previously learned material interferes with the recall of newly learned
material. .
 Forgetting is subject to the influence of affect: which sensations are registered, what is retained and for
how long and what information is available for recall.
 In Freud’s account, traumatic or threatening memories are kept out of conscious awareness by the
mechanism of repression.
 Directed forgetting is the term for the process by which we actively use executive control processes
within the prefrontal cortex to forget items that we do not wish to recall.
 Forgetting is an important and normative process..
 There is some evidence that depression may impair the capacity to forget negative material.
 Selective forgetting including directed forgetting involves unconscious and conscious mechanisms.
RETROSPECTIVE FALSIFICATION
 Retrospective falsification refers to the unintentional distortion of memory that occurs when it is
filtered through a person’s current emotional, experiential and cognitive state.
 It is often found in those with depressive illness who describe all past experiences in negative terms
due to the impact of their current mood. So a depressed person will highlight their failures while
ignoring and/or forgetting about their successes.
 Indeed any psychiatric illness can lead to retrospective falsification .
 Those with hysterical personality, in whom suggestibility is high, can therefore produce a complete
set of distorted memories of the past.
FALSE MEMORY
 False memory is the recollection of an event (or events) that did not occur but which the
individual subsequently strongly believes did take place
 It is not as in normal forgetting, but to the actual construction of memories around events
that never took place.
 This definition was developed specifically in the context of childhood abuse recalled by
the victims in adulthood, it can also be applied in rare situations.
Source amnesia
 Difficulty in remembering the source from which the information was acquired.(from
one's own recall or external source)
SCREEN MEMORY
 A screen memory is a recollection that is partially true and partially false.
 The individual only recalls part of the true memory because the entirety of the true
memory is too painful to recall.
 It is difficult to dissect out precisely which elements of such memories are objectively
true; this may be important in both the therapeutic and legal settings.
 Untangling these relationships may be seen as an opportunity for psychological or psycho
analytic exploration in certain cases.
CONFABULATION
 This is a falsification of memory occurring in clear consciousness in association with an
organically derived amnesia.
 The term is used to describe mild distortions of an actual memory, such as intrusions,
embellishments, elaborations, paraphrasing or high false alarm rates on tests of
anterograde amnesia.
Characteristics of confabulation
• It is a falsely retrieved memory, often containing false details within its own context.
• The patient is unaware that he or she is confabulating and often unaware of the existence of
memory deficit.
• In other words, confabulations are not intentionally produced.
• Patients may act on their confabulation, confirming their belief in the false memory.
• Confabulation is most apparent in autobiographical memory.
 Bonhoeffer observed that confabulation in Korsakov’s syndrome could take two forms:
• Confabulation of embarrassment-fill in gaps of memory as a result of awareness of deficit.
• Fantastic confabulations-lacunae are filled in by details, exceeding the need of memory.
Schnider classified into four subtypes:
(1) Intrusions in memory,
(2) Momentary confabulations,
(3) Fantastic confabulations and
(4) Behaviourally spontaneous confabulations.
PSEUDOLOGICA FANTASTICA
 It is also called pathological lying.
 It occurs in those without organic brain pathology such as personality disorder of antisocial or
hysterical type.
 It seems that the person with pseudologia believes their own stories and there is a blurring of the
boundary between fantasy and reality, when confronted with incontrovertible evidence these
individuals will admit their lying
 Minor varieties of this occur in those who falsify or exaggerate the past in order to impress others.
 An MRI study of a group of persistent liars who did not have personality disorder or any other
psychiatric disorder were found to have over 20 per cent more neural fibres in their prefrontal
cortex.
Munchausen’s syndrome
 Munchausen’s syndrome is a variant of pathological lying in which the individual presents
to hospitals with bogus illnesses, complex medical histories and often multiple surgical
scars.
 A proxy form of this condition has been described in which the individual, usually a
parent, produces a factitious illness in someone else, generally their child.
 This may lead to repeated presentations to hospital over a prolonged period of time and
both diagnosis and management can be very challenging in these cases.
CRYPTAMNESIA
 Cryptamnesia is ‘the experience of not remembering that one is remembering’.
 For example, a person writes a witty passage and does not realise that they are quoting
from some passage they have seen elsewhere rather than writing something original.
 There is no indication as to whether this is a common phenomenon or whether it is
associated with any specific psychiatric disorder.
RETROSPECTIVE DELUSION
 The psychotic patient backdates his delusions in spite of the clear evidence that the illness is of
recent origin
• Person will say that they have always been persecuted or they have always been evil.
• Primary delusional experiences may take the form of memories and these are known as
delusional memories. consisting of sudden delusional ideas and delusional perceptions
• Delusional memories are delusional interpretations of real memories
DISTORTION OF RECOGNITION
 Déjà vu is not strictly a disturbance of memory, but a problem with the familiarity of places and
events. It comprises the feeling of having experienced a current event in the past, although it has no
basis in fact.
 Jamais vu, is the knowledge that an event has been experienced before but is not presently
associated with the appropriate feelings of familiarity.
 Déjà entendu, the feeling of auditory recognition.
 Déjà pensé, a new thought recognised as having previously occurred.
 These can be experience by normal subjects as well as among those with temporal lobe epilepsy.
 Misidentification, and it can occur in organic psychoses and in acute and chronic schizophrenia.
 It may be positive or negative’
1.POSITIVE MISIDENTIFICATION:
 The patient recognises strangers as their friends and relatives.
 seen in confusional states and acute schizophrenia, at most a few people are positively misidentified
2.NEGATIVE MISIDENTIFICATION:
 The patient insists that friends and relatives are not whom they say they are and that they are strangers in disguise.
 CAPGRAS SYNDROME :
Some patients assert that some or all people are doubles of the real people whom they claim to be.
It occurs in schizophrenia and in dementia.
AFFECTIVE DISORDER OF
MEMORY
• Memory is not only disturbed by organic damage to the brain itself, it is also affected by
emotion.
• Depression is linked to self- reported memory problems
• Mood disorder, such as depression, reduces the amount of cognitive processing resources
available for a given task.
• This is manifest as deficits in the elaboration, organization, encoding and retrieval of material
into and out of memory.
GANSER STATE
 Following symptoms shown –
 Vorbeigehen (‘to pass by’), or approximate answers, ‘In the choice of answers the patient appears to
deliberately pass over the indicated correct answer and to select a false one, which any child could
recognize as such’.
 Clouding of consciousness with disorientation.
 ‘Hysterical’ stigmata.
 Recent history of head injury, typhus or severe emotional stress. •
 ‘Hallucinations’, auditory and visual (from his description, they are more like pseudohallucinations).
 Amnesia for the period during which the preceding symptoms were manifest.
 Whit lock considers the distinction between the Ganser state and pseudodementia to lie in disturbed
consciousness, present in the former and not the latter.
HYPERAMNESIA
 In it there is exaggerated registration, retention and recall
.
Flashbulb memories
 These are those memories that are associated with intense emotion.
 They are unusually vivid, detailed and long-lasting.
 For example, many people can recall where and what they were doing when they heard the news of the death of
Diana, Princess of Wales.
Flashbacks
 Flashbacks are sudden intrusive memories that are associated with the cognitive and emotional experiences of a
traumatic event.
 It may lead to acting or feeling that the event is recurring.
 It is one of the characteristic symptoms of post-traumatic stress disorder , substance misuse disorders and
emotional events.
 Flashbacks involving hallucinogenic experiences can occur in association with hallucinogenic drugs and possibly
cannabis use after the short-term effects have worn off
Eidetic images
 It represent visual memories of almost hallucinatory vividness that are found in disorders due to substance
misuse, especially hallucinogenic agents.
THANK YOU.

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disorders of memory .pptx disorder of memory

  • 1. Disorders of MEMORY CHAIRPERSON- DR. TAPAS KUMAR AICH (PROFESSOR AND HEAD) PRESENTER – DR. ANISHA JOSHI (JR 1) DEPARTMENT OF PSYCHIATRY BRD MEDICAL COLLEGE GORAKHPUR
  • 2. INTRODUCTION  Memory is a general term for a mental process that allows the individual to store information for later recall.
  • 3. MECHANISM OF MEMORY  Disturbance of memory is described by the length of time for which information has been retained. Memory storage is organized in three ways :  1- Sensory Memory  2- Short Term Memory  3- Long Term Memory
  • 5. SENSORY MEMORY  Sensory memory is the initial and early phase of memory.  It holds large amounts of incoming information briefly. It is a selecting and recording system via which perceptions enter the memory system.  Fleeting visual image, iconic memory lasts up to 200 ms, whereas auditory, echoic memory lasts up to 2000 ms.  The information selected and recorded at this level needs to be further processed as short-term memory, or it quickly decays and is lost.
  • 6.  Sensory memory, is registered for each of the senses and its purpose is to facilitate the rapid processing of incoming stimuli so that comparisons can be made with material already stored in short- and long-term memory.  Since there are numerous stimuli bombarding the individual, selective attention allows for the sifting of relevant material from sensory memory for further processing and storage in short-term memory.  As a consequence, most sensory memory fades within a few seconds.
  • 7. SHORT TERM MEMORY  Short-term memory, also called working memory, allows for the storage of memories for much longer than the few seconds available to sensory memory. Short-term memory aids the constant updating of one’s surroundings.  Baddeley and Hitch hypothesized a model of working memory comprising a central executive, a visuospatial scratch pad and a phonological loop.  In this system, the central executive is the attentional controller assisted by the visuospatial scratch pad that allows for the temporary storage and manipulation of visual and spatial information.  The phonological loop holds memory traces of verbal information for a couple of seconds combined with subvocal rehearsal.
  • 9. LONG TERM MEMORY  Long- term memory can be conceptualized into two retrieval systems: Declarative or Explicit memory 1. Semantic memory 2. Episodic memory Non declarative or implicit memory 1. Procedural memory
  • 10. DECLARATIVE/ EXPLICIT MEMORY  Deals with facts and events, available to conscious for declaration  Common examples: 5-minute recalls, asking the patient what they had for breakfast.  Stored in Hippocampus.  Person is conscious of what they are remembering. 1. Semantic memory/ memory for abstract facts: What is the capital of India? 2. Episodic memory/ memory for specific events: What did you have for breakfast?
  • 11. AUTOBIOGRAPHICAL MEMORY  A type of episodic memory.  Associated with the active experience of remembering.  Memories of events and issues that related to oneself.  Characterized by-  General recall of event.  An interpretation of event.  Recall of few specific details
  • 12. NON DECLARATIVE/ IMPLICIT MEMORY  Performance of tasks such as typing , swimming or cutting a loaf of bread.  Expressions of prior learning.  No active awareness that memory is being searched in undertaking particular skill  Stored in limbic system, amygdala and cerebellum
  • 13.  Description of the requirements for memory is chiefly referable to long term memory and can be subdivided phenomenologically into the following five functions : 1. Registration or encoding is the capacity to add new information to the memory store. 2. Retention or storage is the ability to maintain knowledge that can subsequently be returned to consciousness. 3. Retrieval is the capacity to access stored information from memory by recognition, recall or implicitly by demonstrating that a relevant task is performed more efficiently as a result of prior experience.
  • 14. 4. Recall is the effortful retrieval of stored information into consciousness at a chosen moment. It requires an active, complex search process. It is influenced by primacy (first item) and recency (last item) effects. The question ‘What is the capital of France?’ requires the recall function. 5. Recognition is the retrieval of stored information that depends on the identification of items previously learned and is based on either remembering (effortful recollection) or knowing (familiarity-based recollection).
  • 15. THEORY OF MEMORY  A THEORY OF GENERAL MEMORY FUNCTION  According to this theory, Three distinct processes of memory have been identified. These are an encoding process, a storage process, and a retrieval .  Encoding is the process of receiving, sensory input and transforming it into a form, or code, which can be stored;  Storage is the process of process actually putting coded information into memory  Retrieval is the process of gaining access to stored, coded information when it is needed.
  • 16. INFORMATION-PROCESSING THEORY :  the information-processing theory developed by Richard Atkinson and Richard Shriffrin.  In the Atkinson and Shriffrin theory, memory starts with a sensory input from the environment.  This input is held for a very brief time – several seconds at most- in a sensory register associated with the sensory channel.  Information that is attended to and recognized in the sensory register may be passed on to short term memory, where it is held for perhaps 20 to 30 seconds.  Some of the information reaching short term memory is processed by being rehearsed- will link it up with other information already stored in memory.  Information that is rehearsed may then be passed along to long term memory; when items of information are placed in long term memory, they are organized into categories, where they may reside for days, once, years, or for a lifetime. When you remember something, a representation of the item is withdrawn, or retrieved, from long term memory.
  • 18. LEVELS OF PROCESSING THEORY:  According to the levels of processing idea, incoming information can be worked on at different levels of analysis; the deeper the analysis goes, the better the memory.  First level is simply perception, which gives us our immediate awareness of the environment. At a somewhat deeper level, the structural features of input are analyzed; and, finally, at the deepest level of processing, the meaning of the input is analyzed. Analysis of the deep level of meaning gives the best memory.  The idea of elaboration has been added to the levels of processing theory. Elaboration refers to the degree to which incoming information is processed so that it can be tied to, or integrated with, existing memories. The greater the degree of elaboration given to item of incoming information, the more likely it is that it will be remembered.
  • 20. MEMORY IMPAIRMENTS 1. AMNESIA a) Normal memory decay b) Psychogenic c) Organic 2. Paramnesias ( distortion of memory) a) Distortion of recall b) Distortion of recognition 3. Hyperamnesia
  • 21. THE AMNESIAS Amnesia is defined as partial or total inability to recall past experiences and events, and its origin may be organic or psychogenic.
  • 22. PSYCHOGENIC AMNESIA  Dissociative/ hysterical amnesia  Dissociative or hysterical amnesia is the sudden amnesia that occurs during periods of extreme trauma and can last for hours or even days.  The amnesia will be for personal identity such as name, address and history as well as for personal events, while at the same time the ability to perform complex behaviour is maintained.  There is a discrepancy between the marked memory impairment and the preservation of personality and social skills, so that the person behaves appropriately to their background and education.  It is believed to be more common in those with a prior history of head injury..  Dissociation may be associated with a fugue or wandering state in which the subject travels to another town or country and is often found wandering and lost.
  • 23. KATATHYMIC AMNESIA/MOTIVATED FORGETTING • Inability to recall specific painful memories. • Due to defense mechanism of repression. • More persistent and circumscribed. • Trigger/ psychotherapeutic intervention makes memory available to consciousness. • Lasts for many years. • There is no loss of personal identity
  • 24. ORGANIC AMNESIAS • Acute Brain Disease: • Memory is poor owing to disorders of perception and attention. • There is failure to encode material in long term memory. • Acute head injury there is amnesia –retrograde amnesia , which embraces the events just before the injury • anterograde amnesia is amnesia occurring after the injury • Black outs- Anterograde amnesia in alcohol dependent patients.  Indicate reversible brain damage.  Delirium- infection, epilepsy
  • 25.  Subacute Coarse Brain Disease  Unable to register new memories.  Antero grade and retrograde amnesia.  Antero grade amnesia –inability to learn new memories.  Retrograde amnesia –inability to recall previously learned material.  Remote memory: intact  Korsakoff’s syndrome is the amnestic syndrome caused by thiamine deficiency  Other cause - cerebrovascular disease, multiple sclerosis ,ECT
  • 26.  Chronic Coarse Brain Disease  Patients with amnesia or those with Korsakoff’s syndrome usually have a loss of memory extending back into the recent past for a year or so.  Patients with a progressive chronic brain disease have an amnesia extending over many years, though the memory for recent events is lost before that for remote events. This was pointed out by Ribot and is known as Ribot’s law of memory regression.
  • 27.  Other Amnesias  Anxiety amnesia occurs when there is anxious preoccupation or poor concentration in disorders such as depressive illness or generalized anxiety.  Initially it may wrongly suggest dissociative amnesia. More severe forms of amnesia in depressive disorders resemble dementia and are known as depressive pseudodementia.  Amnesias in anxiety and depressive disorders are generally caused by impaired concentration and resolve once the underlying disorder is treated.
  • 28. PARAMNESIA  Falsification of memory by distortion.  Occur in  normal subjects due to process of normal forgetting.  Emotional problems  organic states.  Divided into 2 types: 1. Distortions of recall 2. Distortions of recognition
  • 29. 29 PARAMNESIA DISTORTIONS OF RECALL Retrospective Falsification. False Memory Screen Memory Confabulation Pseudologia Fantastica Munchausen's Syndrome Vorbeireden Cryptamnesia Retrospective Delusion DISTORTIONS OF RECOGNITION Déjà vu Deja entendu. Jamais Vu. Deja Pense.
  • 30.  NORMAL VARIATIONS SELECTIVE FORGETTING  In normal forgetting, there is loss of or diminished access to recently acquired and stored information.  Rates of forgetting are influenced by the personal meaningfulness of the information, the conceptual style of the individual, the degree of processing and elaboration of the information and age. There are two forms of interference: proactive and retroactive.  In proactive interference, newly learned material interferes with the recall of previously learned material.  In retroactive interference, previously learned material interferes with the recall of newly learned material. .  Forgetting is subject to the influence of affect: which sensations are registered, what is retained and for how long and what information is available for recall.
  • 31.  In Freud’s account, traumatic or threatening memories are kept out of conscious awareness by the mechanism of repression.  Directed forgetting is the term for the process by which we actively use executive control processes within the prefrontal cortex to forget items that we do not wish to recall.  Forgetting is an important and normative process..  There is some evidence that depression may impair the capacity to forget negative material.  Selective forgetting including directed forgetting involves unconscious and conscious mechanisms.
  • 32. RETROSPECTIVE FALSIFICATION  Retrospective falsification refers to the unintentional distortion of memory that occurs when it is filtered through a person’s current emotional, experiential and cognitive state.  It is often found in those with depressive illness who describe all past experiences in negative terms due to the impact of their current mood. So a depressed person will highlight their failures while ignoring and/or forgetting about their successes.  Indeed any psychiatric illness can lead to retrospective falsification .  Those with hysterical personality, in whom suggestibility is high, can therefore produce a complete set of distorted memories of the past.
  • 33. FALSE MEMORY  False memory is the recollection of an event (or events) that did not occur but which the individual subsequently strongly believes did take place  It is not as in normal forgetting, but to the actual construction of memories around events that never took place.  This definition was developed specifically in the context of childhood abuse recalled by the victims in adulthood, it can also be applied in rare situations. Source amnesia  Difficulty in remembering the source from which the information was acquired.(from one's own recall or external source)
  • 34. SCREEN MEMORY  A screen memory is a recollection that is partially true and partially false.  The individual only recalls part of the true memory because the entirety of the true memory is too painful to recall.  It is difficult to dissect out precisely which elements of such memories are objectively true; this may be important in both the therapeutic and legal settings.  Untangling these relationships may be seen as an opportunity for psychological or psycho analytic exploration in certain cases.
  • 35. CONFABULATION  This is a falsification of memory occurring in clear consciousness in association with an organically derived amnesia.  The term is used to describe mild distortions of an actual memory, such as intrusions, embellishments, elaborations, paraphrasing or high false alarm rates on tests of anterograde amnesia.
  • 36. Characteristics of confabulation • It is a falsely retrieved memory, often containing false details within its own context. • The patient is unaware that he or she is confabulating and often unaware of the existence of memory deficit. • In other words, confabulations are not intentionally produced. • Patients may act on their confabulation, confirming their belief in the false memory. • Confabulation is most apparent in autobiographical memory.
  • 37.  Bonhoeffer observed that confabulation in Korsakov’s syndrome could take two forms: • Confabulation of embarrassment-fill in gaps of memory as a result of awareness of deficit. • Fantastic confabulations-lacunae are filled in by details, exceeding the need of memory. Schnider classified into four subtypes: (1) Intrusions in memory, (2) Momentary confabulations, (3) Fantastic confabulations and (4) Behaviourally spontaneous confabulations.
  • 38. PSEUDOLOGICA FANTASTICA  It is also called pathological lying.  It occurs in those without organic brain pathology such as personality disorder of antisocial or hysterical type.  It seems that the person with pseudologia believes their own stories and there is a blurring of the boundary between fantasy and reality, when confronted with incontrovertible evidence these individuals will admit their lying  Minor varieties of this occur in those who falsify or exaggerate the past in order to impress others.  An MRI study of a group of persistent liars who did not have personality disorder or any other psychiatric disorder were found to have over 20 per cent more neural fibres in their prefrontal cortex.
  • 39. Munchausen’s syndrome  Munchausen’s syndrome is a variant of pathological lying in which the individual presents to hospitals with bogus illnesses, complex medical histories and often multiple surgical scars.  A proxy form of this condition has been described in which the individual, usually a parent, produces a factitious illness in someone else, generally their child.  This may lead to repeated presentations to hospital over a prolonged period of time and both diagnosis and management can be very challenging in these cases.
  • 40. CRYPTAMNESIA  Cryptamnesia is ‘the experience of not remembering that one is remembering’.  For example, a person writes a witty passage and does not realise that they are quoting from some passage they have seen elsewhere rather than writing something original.  There is no indication as to whether this is a common phenomenon or whether it is associated with any specific psychiatric disorder.
  • 41. RETROSPECTIVE DELUSION  The psychotic patient backdates his delusions in spite of the clear evidence that the illness is of recent origin • Person will say that they have always been persecuted or they have always been evil. • Primary delusional experiences may take the form of memories and these are known as delusional memories. consisting of sudden delusional ideas and delusional perceptions • Delusional memories are delusional interpretations of real memories
  • 42. DISTORTION OF RECOGNITION  Déjà vu is not strictly a disturbance of memory, but a problem with the familiarity of places and events. It comprises the feeling of having experienced a current event in the past, although it has no basis in fact.  Jamais vu, is the knowledge that an event has been experienced before but is not presently associated with the appropriate feelings of familiarity.  Déjà entendu, the feeling of auditory recognition.  Déjà pensé, a new thought recognised as having previously occurred.  These can be experience by normal subjects as well as among those with temporal lobe epilepsy.
  • 43.  Misidentification, and it can occur in organic psychoses and in acute and chronic schizophrenia.  It may be positive or negative’ 1.POSITIVE MISIDENTIFICATION:  The patient recognises strangers as their friends and relatives.  seen in confusional states and acute schizophrenia, at most a few people are positively misidentified 2.NEGATIVE MISIDENTIFICATION:  The patient insists that friends and relatives are not whom they say they are and that they are strangers in disguise.  CAPGRAS SYNDROME : Some patients assert that some or all people are doubles of the real people whom they claim to be. It occurs in schizophrenia and in dementia.
  • 44. AFFECTIVE DISORDER OF MEMORY • Memory is not only disturbed by organic damage to the brain itself, it is also affected by emotion. • Depression is linked to self- reported memory problems • Mood disorder, such as depression, reduces the amount of cognitive processing resources available for a given task. • This is manifest as deficits in the elaboration, organization, encoding and retrieval of material into and out of memory.
  • 45. GANSER STATE  Following symptoms shown –  Vorbeigehen (‘to pass by’), or approximate answers, ‘In the choice of answers the patient appears to deliberately pass over the indicated correct answer and to select a false one, which any child could recognize as such’.  Clouding of consciousness with disorientation.  ‘Hysterical’ stigmata.  Recent history of head injury, typhus or severe emotional stress. •  ‘Hallucinations’, auditory and visual (from his description, they are more like pseudohallucinations).  Amnesia for the period during which the preceding symptoms were manifest.  Whit lock considers the distinction between the Ganser state and pseudodementia to lie in disturbed consciousness, present in the former and not the latter.
  • 46. HYPERAMNESIA  In it there is exaggerated registration, retention and recall . Flashbulb memories  These are those memories that are associated with intense emotion.  They are unusually vivid, detailed and long-lasting.  For example, many people can recall where and what they were doing when they heard the news of the death of Diana, Princess of Wales.
  • 47. Flashbacks  Flashbacks are sudden intrusive memories that are associated with the cognitive and emotional experiences of a traumatic event.  It may lead to acting or feeling that the event is recurring.  It is one of the characteristic symptoms of post-traumatic stress disorder , substance misuse disorders and emotional events.  Flashbacks involving hallucinogenic experiences can occur in association with hallucinogenic drugs and possibly cannabis use after the short-term effects have worn off Eidetic images  It represent visual memories of almost hallucinatory vividness that are found in disorders due to substance misuse, especially hallucinogenic agents.