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

Research output: Contribution to journalArticle

Neil A. Harrison, Kate Johnston, Federica Corno, Sarah Casey, Kimberley Friedner, Kate Humphreys, Eli J Jaldow, Mervi Pitkänen, Michael David Kopelman

Original languageEnglish
Pages (from-to)2498-2510
Number of pages12
JournalBrain : a journal of neurology
Volume140
DOIs
Publication statusPublished - 2017

King's Authors

Abstract

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 prognostic value for individual patients. In the present study, we
reviewed the case records and neuropsychological findings in 53 psychogenic amnesia cases (ratio of 3:1, males:females), in
comparison with 21 consecutively recruited neurological memory-disordered patients and 14 healthy control subjects. 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 categorized 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 characterized 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 recognize 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 less improvement and continued to show a reversed temporal
gradient. In conclusion, the outcome in psychogenic amnesia, particularly those characterized 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.

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