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DISSOCIATIVE AMNESIA

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DISSOCIATIVE AMNESIA Homayoun Amini M.D. Assis. Prof. of Psychiatry Roozbeh Hospital TUMS INTRODUCTION Two main elements of dissociation : 1- they lack evidence of ... – PowerPoint PPT presentation

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Title: DISSOCIATIVE AMNESIA


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 persons 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 persons 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 - korsakoffs 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
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