In cases of focal retrograde amnesia ( Kapur, 1993, 2000), psychogenic factors are often suspected ( Kopelman, 2000) but may not initially be obvious. However, many previous descriptions of psychogenic amnesias consisted of case reports, making it difficult to generalize about predisposing factors. Coons and Milstein (1992) also identified previous histories of childhood trauma, sexual abuse, and alcohol/ substance misuse problems. Three factors have been identified as predisposing factors for global psychogenic amnesia ( Kopelman, 1987, 2002 a): (i) a severe precipitating stress, such as marital or emotional crisis, bereavement, a financial crisis or during war time ( Kanzer, 1939 Sargant and Slater, 1941) (ii) a history of depressed mood and suicidal ideas ( Stengel, 1941 Berrington et al., 1956) and (iii) a previous history of a transient, neurological amnesia ( Stengel, 1941 Berrington et al., 1956 Fujiwara et al., 2008 Thomas-Anterion et al., 2008). Situation-specific amnesia refers to a gap in memory for a traumatic incident and can arise in a variety of circumstances: for example, post-traumatic stress disorder (PTSD) ( Brewin et al., 2011) or being the victim of an offence ( Mechanic et al., 1998 Andrews et al., 2000). In ‘focal retrograde amnesia’ (FRA), the memory loss is much more persistent ( Kapur, 1993 Kopelman, 2000 Serra et al., 2007 Hennig-Fast et al., 2008 Tramoni et al., 2009). In psychogenic fugue, there is a loss of sense of personal identity and a period of wandering (psychogenic fugue), which lasts from a few days to about 4 weeks ( Schacter et al., 1982 Kopelman, 2002 a). Global psychogenic amnesia is characterized by a sudden loss of autobiographical memories for the whole of a person’s past. Psychogenic amnesia refers to cases of memory loss presumed to have a psychological, rather than neurological, cause and is either ‘global’ or situation-specific ( Kopelman, 1987, 2002 a). Psychogenic, fugue, retrograde, amnesia, autobiographical memory Introduction 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. In conclusion, the outcome in psychogenic amnesia, particularly those characterized by fugue, is better than generally supposed. By contrast, the two focal retrograde amnesia groups showed less improvement and continued to show a reversed temporal gradient. After 3–6 months, the fugue patients had improved to normal scores for facts and near-normal scores for events. 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. However, clinical depression, family/relationship problems, financial/employment problems, and failure to recognize the family were also statistically more common in that group. As anticipated, loss of the sense of personal identity was confined to the psychogenic group. 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. 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. In particular, we examined the pattern of retrograde amnesia on an assessment of autobiographical memory (the Autobiographical Memory Interview). 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. Consequently, the literature on psychogenic amnesia is somewhat fragmented and offers little prognostic value for individual patients. 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.
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