1 / 24

DISSOCIATIVE AMNESIA

DISSOCIATIVE AMNESIA. Homayoun Amini M.D. Assis. Prof. of Psychiatry Roozbeh Hospital TUMS. INTRODUCTION.

imaran
Download Presentation

DISSOCIATIVE AMNESIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DISSOCIATIVE AMNESIA Homayoun Amini M.D. Assis. Prof. of Psychiatry Roozbeh Hospital TUMS

  2. INTRODUCTION • Two main elements of dissociation : 1- they lack evidence of proximate organic illness or pathophysiological disturbance; 2 – the symptoms correspond to ideas of the patient about how parts of the body or mind malfunction or fail to function;

  3. DEFINITION • Dissociative phenomena are limited to amnesia • Key symptoms is the inability to recall information, usually about stressfull or traumatic events in person’s lives • There may be a loss of knowledge of personal identity with preservation of other information, often including complex learned information or skills

  4. DEFINITION • It cannot be explained by ordinary forgetfulness • There is no evidence of an underlying brain disorder • Persons retain the capacity to learn new information

  5. SUBTYPES • Localized: a circumscribed period of time • Selective: some, but not all, of the events during a circumscribed period of time • Generalized: the person’s entire life • Continuous: events subsequent to a specific time up to and including present • Systematized: certain categories of information

  6. EPIDEMIOLOGY • Amnesia is the most common dissociative symptoms • More often in women than in men • More often in young adults than in older adults • Incidence increases during times of war & natural disasters

  7. EPIDEMIOLOGY • In civilian cases, a history of head trauma or brain damage is often present • The condition may be more frequent amongst criminals or soldiers in distress • Tends to present to accident & emergency departments and then to neurologists, but is only seen secondarily in psychiatric departments

  8. ETIOLOGY • Psychoanalytic approach: emotional conflict, primary & secondary gain • Hx of child abuse ?? • Amnesia seems to be related to immediate adult adjustment problems, rather than the consequences of early child abuse • The theory of state-dependent learning

  9. DIAGNOSIS(DSM-IV-TR) • A. The predominant disturbance is one or more episode of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. • B. The disturbance does not occur exclusively during the course of dissociative identity disorder, dissociative fugue, PTSD, ASD, or somatization disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other GMC (e.g., amnestic disorder due to head trauma). • C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  10. DIAGNOSIS(ICD-10) • G1. There must be no evidence of a physical disorder that can explain the characteristic symptoms of this disorder (although physical disorders may be present that give rise to other symptoms). • G2. There are convincing associations in time between the onset of symptoms of the disorder and stressful events, problems, or needs. • G3. There must be amnesia, either partial or complete, for recent events or problems that were or still are traumatic or stressful. • G4. The amnesia is too extensive and persistent to be explained by ordinary forgetfulness (although its depth and extent may vary from one assessment to the next) or by intentional simulation.

  11. CLINICAL FEATURES • Onset is often abrupt • Patients are usually aware that they have lost their memories • Some patients are upset but others appear to be unconcerned • Amnestic patients are usually alert before and after the amnesia occurs • Depression and anxiety are common predisposing factors • Distortions in time perception

  12. DIFFERENTIAL DIAGNOSIS • Clinicians should conduct: - a medical history - a physical examination - a psychiatric history - a MSE - a laboratory workup

  13. DIFFERENTIAL DIAGNOSIS… • Is the amnesia a result of an organic disease? a psychiatric disorder? a dissociative disorder?

  14. DIFFERENTIAL DIAGNOSIS… • Amnestic disorders: - epileptic seizures: short duration, less identity confusion, stereotypic -head injury: brief retrograde amnesia + longer anterograde amnes - korsakoff’s syndrome: significant anterograde amnesia + variable rerograde amnesia, intact other cognitive functions

  15. DIFFERENTIAL DIAGNOSIS… • Transient Global Amnesia: - Acute - Transient(prompt return of memory) - Recent memory is often impaired - Highly complex mental & physical acts are preserved

  16. DIFFERENTIAL DIAGNOSIS… • TGA can be differentiated from dissociative amnesia: - anterograde amnesia - more upset and concerned - personal identity is retained - more generalized - most common in 60s & 70s

  17. DIFFERENTIAL DIAGNOSIS… • Dementia: multiple cognitive deficits, • Delirium: altered consciousness, impaired attention, fluctuation, • Cerebral infections & neoplasms • Metabolic disorders • ….

  18. DIFFERENTIAL DIAGNOSIS… • Organic amnesias have several distinguishing features: - no recurrent identity alteration - not selectively limited to personal information - do not focus on or result from an emotionallt traumatic event - more often anterograde than retrograde

  19. DIFFERENTIAL DIAGNOSIS… • Organic amnesias have several distinguishing features…. - usually permanent (excluding substance abuse, TGA, metabolic, delirium,…) - the erasure or destruction of memory or not registration

  20. DIFFERENTIAL DIAGNOSIS… • Substance use disorders: - alcohol - sedative hypnotics - anticholinergics - steroids - lithium carbonate - beta blockers - hypoglycemic agents - marijuana - hallucinogens - pentazocine - phencyclidine

  21. DIFFERENTIAL DIAGNOSIS… • Psychiatric disorders: - depression - PTSD - acute stress disorder - somatoform disorders - sleep disorders - factitious disorder - malingering • Other dissociative disorders: - fugue - identity

  22. COURSE & PROGNOSIS • Recovery is usually complete and termination may be rapid in localized or selective subtypes • Recovery is usually gradual in generalized subtype • Functional impairment varies from mild to severe, depending on the extent of the amnesia • The more acute & the more recent the instance of dissociative amnesia, the more likely & the more quickly it is to be resolved

  23. TREATMENT • Intrusive attempts to retrieve memories can result in retraumatization if the patient is not properly prepared • This risk is especially great for longstanding or childhood-onset amnesias • The clinician should control the pace of suggested recollection, usually within the framework of a broader psychotherapy • In extreme cases, hospitalization may be necessary

  24. TREATMENT… • Group psychotherapy: especially successful in helping combat veterans and survivors of childhood abuse • Hypnosis • Drug-assisted interview

More Related