Memory and Mental Health

Hello, my name is Dr. Dorothy Buckley and it's my pleasure to welcome you to this video where we'll be talking about memory and mental health or how memory is disrupted in a variety of psychological disorders. So I'm going to start out this lecture by sharing a very famous case study with you that was published by Daniel Sachet in 1996. Okay, so So this case details the experience of a man named Lumberjack. So Lumberjack was admitted to a hospital in Toronto, Canada in 1980. He had been discovered by police officers roaming the streets of Toronto in midwinter. Lumberjack was not wearing a coat and looked freezing. So the police officer questioned him. When the officer was unable to obtain information from him, Lumberjack was brought to the hospital for testing. Lumberjack was suffering from a dense and complete psychogenic amnesia, including what is known as a fugue state, which means he did not know who he was. His amnesia was so dense that he did not know his own name or where he lived. Indeed, Lumberjack could remember nothing from his personal past. except for the events just prior and subsequent to his interaction with the police officer local newspapers printed his photograph in a vain effort to locate relatives who could identify him during the next few days lumberjack remained in a dense amnesic state then a few days later while watching television in the hospital some images from a movie he was watching triggered his memory and his identity and memory of his life returned the specific image that triggered his memory was the depiction of a funeral in the miniseries this caused him to remember the funeral of his own grandfather which was the traumatic event that had triggered the amnesiac episode within a matter of hours he had recalled not just his own name and home address but complete autobiographical memory returned as well because the doctors in the hospital had called in researchers to document his memory loss his profound memory loss and the subsequent return of his memories were documented in the scientific literature in psychogenic amnesia we occasionally see a loss of personal identity which is almost never seen in neurological based amnesia except perhaps in the terminal stages of alzheimer's disease in psychogenic amnesia the loss of personal identity means that although patients are verbal responsive to surroundings and socially aware they do not have an identity and may not know their name or very much about themselves including who their close family members may be in addition patients with a loss of personal identity may be unable to recall any events from their life interestingly the loss of identity may occur without anterograde amnesia meaning as often portrayed in the movies they can start reconstructing their own life in the absence of what occurred before the onset of the loss of personal identity. The patient may be learning new information, including autobiographical information, starting from the time of the onset of the amnesia. So psychogenic amnesia is a broad term that covers all forms of amnesia that are not directly linked to disruption or injury of the brain. In some cases, injury to the brain may be related to psychogenic amnesia, but the cause of psychogenic amnesia is not the brain damage itself. Caused by psychiatric disorders or psychological trauma rather than physical insult to the brain. So psychogenic amnesia is caused by... either psychiatric disorders or trauma rather than neurological amnesia, which is caused by brain tumors, destruction of the hippocampus, etc. So, Arrigo and Pesdak in 1997 list a number of common precursors to psychogenic amnesia. These incur disasters, combat, attempted suicide, witness or participating in criminal acts, as well as sexual assault. In one documented case of psychogenic amnesia without the loss of personal identity, the patient J.H. spent six years of his life in a state of psychogenic amnesia, in which he could remember nothing of the first 53 years of his life. J.H. was brought to the hospital in 2005 after initially being reported missing by his family. Unlike Lumberjack, J.H. never lost his personal identity. He displayed strong anterograde and retrograde amnesia, but showed no brain abnormalities. During the ensuing years, he did his best to cope with his intense retrograde amnesia and persistent anterograde amnesia. Despite the psychogenic amnesia, he was able to return to his family and to his job. However, at the age of 60, a variety of psychotherapy approaches allowed J.H. to regain the missing past and his bout with psychogenic amnesia appeared to be over. Because of the extended period of J.H.'s psychogenic amnesia, he was also extensively tested. Rothborn documented severe deficits in his self-knowledge. as well as an inability to plan for the future. These symptoms returned to normal once the psychogenic amnesia finally wore off. That such a profound amnesia could be treated with psychotherapy is very fortunate. So, um, so J.H. developed psychogenic amnesia, right? He had profound retrograde and enterograde amnesia, but he was able to return to his family and his job. And at the age of 60, almost seven years after he initially developed psychogenic amnesia, he was able to regain his memory with intensive psychotherapy. Another reported case of psychogenic amnesia was documented by Stanilou and colleagues in 2018, and they described patient C. Patient C was in an auto accident in which he overturned the truck that he was driving. Patient C received only minor injuries in the crash, and it was not clear whether he suffered a concussion or not. There did not. appear to be any lasting damage to his brain. In terms of memory, however, patient C did not lose identity after the crash but suffered extreme retrograde amnesia, which lasted at least until publication of the paper. The researchers point out that patient C, like many patients with psychogenic amnesia, suffered from what they called la belle indifférence. meaning that the patients were not concerned at all about their condition in this case the extreme loss of autobiographical memory la belle indifference is another name for agnosinosia by neuropsychologists so la belle indifference or agnosinosia is basically being aware of a significant disruption in function but being indifferent to it or not seeing it as a problem. So indifference to amnesia is problematic because it prevents the person from implementing the proper steps to deal with the effects of their amnesia. So to summarize, psychogenic amnesia is caused by psychological problems rather than neurological problems. in most cases a traumatic event of one kind or another causes a strong block preventing access to episodic and autobiographical memories and in some cases even facets of self-identity In the case of Lumberjack, the funeral of his grandfather triggered his psychogenic amnesia because his grandfather raised him and was his only committed relative. The shock of his grandfather's sudden death apparently was sufficiently traumatic to induce amnesia. In J.H., personal financial difficulties may have contributed to the development of his amnesia and in patient C, the trauma of the trup. The truck accident may have contributed to his amnesia. Some argue that amnesia is one way in which the person copes with trauma. Although psychogenic amnesias have a psychological cause, Sachet pointed out that a large proportion of documented cases of psychogenic amnesia are in people who have a history of brain injury, as was the case with Lumberjack. The case studies of Stanilou, Liu, and colleagues 2018 also support this view, but because of the rareness of this state, at present, little empirical data exists on the origins and causes of psychogenic amnesia. So, what are some of the factors that lead to the onset of psychogenic amnesia? Harrison and colleagues 2017 lay out three features that appear to be consistent across published cases of psychogenic amnesia. The first is severe stress. The stress can vary from combat experience, being the victim of a violent crime, being the perpetrator of a violent crime, or to more ordinary everyday stressors. such as the death of a family member or the loss of a job. The stressful event usually serves as the trigger for the onset of psychogenic amnesia, but other conditions must also be met for psychogenic amnesia to occur. Thus, stress is thought of broadly here, but consistent across the conditions that a person has to deal with, with both trauma and distress. The second feature is depression or suicidal tendencies. In both cases documented by Harrison and colleagues, in Stanilou and colleagues, depression tends to be a precursor for the onset of psychogenic amnesia. The depression may not develop until after the stressful event, but people who do not experience clinical depression do not typically suffer from psychogenic amnesia. The third feature is a previous history of neurological trauma. That is, psychogenic amnesia tends to more likely develop in people who at some point in their life suffered from either a concussion or another form of brain trauma, such as brain surgery or epilepsy. In some cases, the presence of neurological damage can be a cause of brain damage. may make it difficult to separate psychogenic amnesia from neurologically based amnesia, but in some cases, the neurological damage was many years prior to the onset of amnesic symptoms, and therefore it may be possible to assign amnesia to the psychogenic variety. So what are treatment options available for those suffering from psychogenic amnesia? Given the complexity of psychogenic amnesia, the treatment will vary greatly from case to case, but we can review some of the trends in treatment. The first step is to address the depression that invariably accompanies psychogenic amnesia. This may involve pharmaceuticals that help reduce depression. the second step is to address how the psychogenic amnesia has affected relationships with family members from spouses to children to parents if the person has lost memory of some or all of those people addressing such relationships is an important part of coping for the person with psychogenic amnesia one can only imagine what it must be like to be told a person is a spouse or child and not be able to recognize them. Third, if retrograde amnesia is not subsiding on its own, psychiatrists and psychologists will engage in a number of procedures to reinstate lost memories, such as structured interviews that attempt to find the right retrieval cues to trigger lost memory, just as watching the movie triggered recovery from lumberjack. If ultimately the lost memories do not return, Counseling can be offered to help people with psychogenic amnesia manage their symptoms. Dissociative amnesia is a condition in which only the traumatic event or events closely related to the trauma are remembered. Dissociative identity occurs not because of neurological ailments such as a concussion, but because of psychological trauma. For example, a veteran may have selective amnesia for the event in which she lost a limb during combat. Dissociative amnesia is retrograde amnesia as it refers to the inability to remember a specific past event or events. Most patients suffering from dissociative amnesia have equivalent semantic knowledge of the traumatic event but have lost amnesia. episodic access to the trauma. This distinguishes dissociative amnesia from repression, in which both episodic and semantic access are lost. Because dissociative amnesia is a psychological amnesia, there can be a great deal of variation from patient to patient. Some will experience amnesia only for the event, whereas others will also be amnesic for events that surround the trauma in time. or are related to the trauma in meaning or content. For example, Patient E had trained to be a police officer following the childhood in which becoming a police officer was her dream. Shortly after successfully completing police officer training, she was a passenger in an accident in which she was badly injured and had multiple physical injuries that prevented her from beginning her career as a police officer. Although she did not suffer any direct damage to the head or brain, she developed a case of dissociative amnesia with severe andrograin amnesia for autobiographical events both surrounding the accidents as well as extending back in time. Thus, because her injuries were extensive but not focused on the brain, her amnesia was considered dissociative amnesia and not neurologically based. Indeed, her retrograde amnesia was accompanied by depression and loss of interest in activities that had previously interested her. At the time that Stanalu and colleagues wrote their report, patient E had been suffering from dissociative amnesia for years. Dissociative fugue is the psychogenic amnesia in which the patient forgets their personal identity in addition to their autobiographical past thus the term fugue is reserved for the loss of personal identity which will also be accompanied by extensive retrograde amnesia for example the case of lumberjack involved a dissociative fugue state characteristic of dissociative fugue is forgetting one's name occupation place and date of birth and where one currently lives for the patient it can be very confusing but in some cases the patient seems unconcerned about their own lack of identity in most documented cases of dissociative fugue the fugue state wears off in a matter of days and the person regains their original identity but there are some reports of dissociative fugue lasting years stanallew and colleagues describe the case of patient ZB, who was brought to a psychiatric hospital after he could not identify himself to German police. When patient ZB was found by the police, he was around 50 years old and was carrying books about history, though he could not explain why he had those books. Patient ZB spoke with a German accent associated with a part of Germany far from where he was found suggesting that he had traveled some distance before help intervened there was no evidence of brain damage when doctors performed an mri on him when tested during his fuguesate patient z b scored well on many tests of cognition including those of working and visual memory However, ZB did not know his identity and could not remember any autobiographical fact prior to the onset of dissociative fugue. Amazingly, patient ZB's fugue state has remained, at least when Stanilou and colleagues published their paper. Moreover, the police were never able to determine his objective identity. Several other patients described by Stanilou and colleagues also were found fugue-free. far from where they live. Apparently, dissociative fugue states bring on the need to travel. Harrison et al. also examined a case of dissociative fugue. Patient 1 was a young man found by police wandering around London without knowing who he was or how he had gotten where he was. Luckily, case 1 had identification in his possession, which allowed police to match him and his family. to a missing person's report. However, when the police brought him to his address, Case 1 could not identify his family members. Because of this, Case 1 was brought to the hospital. His autobiographical memory returned in full six days later. Because his memory returned and his identity was known, Harrison et al. were able to link his fugue state to stress and depression related to financial troubles. However, in case one, there was no history of neurological trauma, despite the general trend relating to dissociative fugue and a history of neurobiological trauma. In dissociative fugue, in some cases, something, often a word or image, serves as a cue or trigger for the person in the fugue to remember his or her past. With that one cue, the person's entire past is seems to return in a flood of memories however in one documented case much anterograde amnesia remained even after the fugue state had worn off and the patient regained his identity thus not all dissociative fugue states end in a flood of memories from the past in some cases the fugue state does not wear off at all future research will be required to determine whether these two types of recovery from dissociative puke differ as a function of psychological and neurological origins of the amnesic state. Puke states are extremely rare and seem to be highly idiosyncratic. Therefore, devising treatment plans is challenging at best. As we have seen with other dissociative amnesias, Treatment is often explicitly individualized. Indeed, given that the process of how people enter their fugue states and the circumstances which cause people to persist in a fugue state are poorly understood, so treatment is often a guessing game. There are two separate tracks, however, to addressing someone in a fugue state. First is an attempt to restore them to their pre-fugue identities. This involves exposing them to powerful cues to remind them of their identity. This typically means putting them in contact with people, places, or objects from their pre-fugue lives. If this fails to jog the memory of their former selves, psychiatrists might try sedating the patient in the hopes that if they were less stressed, their former selves might return. following sedation another interview might jog their memory however despite its ineffectiveness in general respect to memory some treatment plans will include hypnosis however as we saw with the case of patient zb in some cases the fugue state does not wear off if so then the treatment shifts from beginning the patient back to their former identity to have them cope with the present amnesia and present life situation this may vary widely given the person's cognitive emotional and medical situation nonetheless in these situations the treatment changes from memory to life adjustment and patients may focus on supportive therapy which is effective in adjusting to stressors and developing coping strategies even after recovering memory Jha and Sharma found that supportive therapy and mindfulness training were helpful in patients who had recovered from fugue states, which makes sense especially if we consider that depression and suicidal ideation and neurological trauma are often accompanying conditions and these treatments can be helpful for those conditions as well. Post Traumatic Stress Disorder or PTSD is a psychological disorder that is caused by exposure to an extremely disturbing experience. One of the chief symptoms of PTSD is an inability to stop the retrieval of memories that are related to the traumatic event. Memory deficits in Post Traumatic Stress Disorder differ greatly from memory deficits in other neurological and psychological disorders. This is mainly because the deficit in PTSD doesn't have anything to do with amnesia, but rather reflects an inability to inhibit the retrieval of unwanted memories. In PTSD, harmless events can cue retrieval of traumatic events, such as being a victim of a violent crime or a war-related tragedy. A traumatic event or events may vary. and may not even seem traumatic to everyone. In other cases, some people do not get PTSD even after being exposed to horrible trauma. But it is trauma that precipitates PTSD. For example, a veteran may be reminded of a violent explosion on the battlefield when his or her shopping cart accidentally bumps into the cart of another shopper. A victim of Sexual assault may be reminded of the crime and trauma when she sees someone who resembles the assailant. A survivor of a school shooting may be reminded of the school shooting whenever they pass a school on the road. Whereas someone without PTSD may also be occasionally reminded of the traumatic event and retrieve it, people with PTSD are reminded of the event by many different stimuli. Moreover, the retrieval is frequently accompanied by debilitating negative emotions. PTSD is a psychological disorder that includes the inability to inhibit unwanted memories because of exposure to extremely dangerous or stressful situations. PTSD may last anywhere from a few days to many years, and symptoms are quite varied but include nightmares, avoiding situations that invoke the trauma, anxiety, and depression. That is, the psychological problems stem directly from episodic memory and unwanted retrieval of these memories. Indeed, one of the most successful treatments for PTSD is to render traumatic memories less accessible and also less emotional. Treatment usually involves trying to desensitize cues and that prompt these memories. Most relevant in the current discussion is the invasiveness of intrusive memories. Intrusive memories are environmentally cued unwanted retrievals of events related to the PTSD trauma event. They typically involve retrieval of sensory details. such as visual imagery of the traumatic event but may also be accompanied by other details such as remembering the sounds and smells accompanying the traumatic event in addition emotional content is remembered during intrusive memories for example a veteran of combat may have intrusive memories not just of the sights and sounds of war but also the whizzing of bullets Intrusive memories are likely to occur for anyone who has undergone a traumatic event, from being in a car accident to watching a family member die. For most of us, intrusive memories subside over time, and they may occur in people who clearly do not have a PTSD diagnosis. Indeed, in a study of people who have been in car crashes, more than 75% of people have reported intrusive memories in the first few weeks after being in the crash. That number was reduced to under 25% a year after the accident. However, in patients with PTSD, the intrusive memories persist long after the initial traumatic event, sometimes for many years. Nonetheless, for many people, intrusive memories may lie below the threshold of a PTSD diagnosis. Because we know that most people who experience trauma will also experience intrusive memories, but not all people who experience intrusive memories will develop PTSD, it's instructive to ask if individual differences in memory encoding affect PTSD To simplify, do characteristics of encoding affect the onset of PTSD? Consider two victims of trauma, one with a vivid visual imagery system and the other with a less vivid imagery system. Which people is more likely to use semantic or contextual based encoding? Given that intrusive memories and PTSD are characterized by vivid visual retrieval, people with more or better visual imagery may be at more risk of developing PTSD. This turns out to be the case. There is a positive correlation between better visual imagery systems and the development of PTSD after trauma. One of the goals for treatment of PTSD is to reduce or eliminate the intrusive memories that occur. The idea here is that if there are fewer intrusive memories, people with PTSD will be able to focus on the issues rather than the traumatic event or events. Various strategies have been used to reduce intrusive memories including drug treatment, sleep deprivation, and cognitive interference. Treatment focused on cognitive interference is the idea that working memory has a limited capacity and distracting information interferes with retrieval. Whereas in most contexts, these limitations are problems, they can be put to good use in the case of intrusive memories and PTSD. In one study playing the attention-grabbing game Tetris, after being exposed to disturbing images interfered with the intrusive memories of those images in both the near term and at longer retention intervals but with people not diagnosed with ptsd another study found that counting back from ten interfered with the retrieval of intrusive auditory memories Linder, I and colleagues in 2019 tested the idea about interference directly with patients who had been in severe automobile accidents. Hospitalized patients were randomized into an interference condition, playing Tetris after recalling the accident, and an attention-demanding control condition, filling out an activity lab. One week later, the people in the interference condition showed a marked reduction in intrusive memories relative to those patients in the control condition. This suggests that engaging in memory interfering activities can reduce intrusive memories. However, the authors point out that both patient groups showed equivalent anxiety and depression symptoms. Thus, it is not clear if focusing on the reduction of intrusive memories is enough to really impact the severity of PTSD. There is also evidence that suggests that people with PTSD have mild amnesiac problems for everyday memories. We know that PTSD is characterized by intrusive memories, but because people with PTSD deal with the repeated retrieval of memories that they would prefer not to, it is also possible to consider that people with PTSD may be impaired with respect to the retrieval of normal memories. That is, we might expect to see general memory deficits in patients with PTSD. In the case of patients with PTSD, the constant retrieval of traumatic events may interfere with the retrieval of related memories of a non-traumatic nature. Thus, it is consistent with memory theory. of interference and related dynamics that this might occur. A number of studies illustrate this impairment. For example, Chow 2017 found that self-reported memory deficits correlated with actual memory deficits in military veterans with PTSD. Sachet and colleagues in 2018 also found both memory and mental health issues associated and metamemory deficits in patients with PTSD relative to a control sample. For example, the authors compared patients with PTSD to a control sample on a cue target learning task. So, for example, they had to learn word pairs like bear and wolf. Later, participants tried to recall the second word in response to the first. They also made feeling of knowing judgments. Sachet and colleagues found that patients with PTSD recalled fewer target words and showed lower feeling of knowing judgment accuracy than control patients. Thus, there is evidence to support the idea that patients with PTSD have mild memory deficits relative to controls. Thus, people with PTSD have problems with both too much remembering of traumatic events, as well as memory deficits for non-trauma related material. So just to give an interim summary, psychogenic amnesia is a term that covers all forms of amnesia that are not directly linked to disruption or injury to the brain. Psychogenic amnesias are caused by psychiatric disorders or psychological trauma. rather than physical injury to the brain. In psychogenic amnesia, we occasionally see a loss of personal identity. However, in most cases of psychogenic amnesia, there may be substantial retrograde amnesia, but no loss of identity. In order to treat psychogenic amnesia, one must first treat the underlying depression before engaging in memory therapy to retrieve memories of the past dissociative amnesia is a condition in which only the traumatic event or events closely related to the trauma are not remembered dissociative fugue is the psychogenic amnesia in which in which the patient forgets their personal identity in addition to access to his or her autobiographical past treatments for fugue involve reducing the levels of stress experienced and then presenting the person with various cues in order to help the person retrieve their past and their identity. Post-traumatic stress disorder is a psychological trauma that is caused by exposure to a traumatic stressor. One of the chief symptoms of PTSD is an inability to stop the retrieval of memories that are related to the traumatic event. People with PTSD may also have deficits in other areas of memory retrieval. Intrusive memories are a major symptom of PTSD, but they may also occur in people without PTSD. Engaging in memory-interfering activities that tax working memory can reduce intrusive memories and may help people with PTSD. To begin our discussion of schizophrenia and memory deficits in schizophrenia specifically, once again I'm going to start with an illustrative case study. So James is a mild-mannered zookeeper. He works at a small zoo and tends to the tropical birds. He knows the scientific and common names of the kind of birds in his care, as well as their diets and temperaments he is very gentle and kind with the birds and seems to have a way of calming down even the most agitated bird once an injured wild heron landed in the baboon enclosure james entered the enclosure stared off the angry baboons and gently picked up the equally agitated heron and brought it to the veterinarian James lives in a small trailer just adjacent to the zoo and attends a church nearby that he can walk to. Every so often, James forgets to take his medications for schizophrenia. When he does so, he believes that the CIA has bugged his trailer, that the KGB has implanted electrodes in him which control him, and that the only thing preventing one or the other of these organizations from assassinating him, is the actual presence of Jesus on the zoo grounds. When he experiences these beliefs, he excuses himself, returns to his trailer, and takes his medications immediately. Once back on his medications, these delusions dissipate, and James returns to being a kind-hearted zookeeper. Schizophrenia is a relatively rare... rare but well-publicized psychiatric condition. People with schizophrenia have a chronic and severe psychiatric disorder, which mainly affects how a person thinks, and this in turn affects how they feel and behave. In some cases, people with schizophrenia appear to no longer be focused on an external reality, but rather some internal mental construction. We distinguish here between the reality of schizophrenia and how it is portrayed in popular media. In movies, people with schizophrenia are often violent and terrifying, whereas in reality people with schizophrenia are no more or less violent than typical people. In the movies, people with schizophrenia hear voices and see hallucinations all the time. But in reality this is rare. although a distorted sense of consciousness and lack of awareness are hallmarks of schizophrenia even when treated however people with schizophrenia have a host of cognitive problems including issues with memory and metamemory as with the other psychiatric conditions reviewed in this lecture our concerns are less with what causes schizophrenia and how to treat it but rather the nature of memory deficits seen in people with schizophrenia. We do not have space to consider the substantial data of what happens in the brains of people with schizophrenia. Suffice to say that abnormal functioning is seen in the dorsolateral prefrontal cortex, which is an area associated with attentional control and memory, the parietal lobe, and an assortment of subcortical structures. Memory problems in people with schizophrenia emerge in two main areas. People with schizophrenia have deficits in working memory and episodic memory. The working memory deficits appear to be related to attentional or central executive functioning, which can then lead to performance declines in many ways. Remember that the central executive is defined as the attentional mechanism of working memory. Working tasks get complicated, this aspect of cognition must guide the person toward allocating attention in appropriate ways. If the neural mechanisms underlying the central executive are affected from schizophrenia, performance in many areas may suffer. Moreover, research indicates that people with schizophrenia show deficits in all aspects of working memory, including the visual-spatial sketchpad, and the phonological loop, as well as the central executive. Again, to be clear, the concerns of this lecture are to explore memory issues in schizophrenia and not to review what we know about schizophrenia in general. To illustrate the deficit in working memory in people with schizophrenia, Van Snelberg and colleagues in 2016 Compared working memory performance among a sample of medicated people with schizophrenia, a sample of unmedicated people with schizophrenia, and a control group, Van Snelberg and colleagues used an interesting task to assess working memory. Patient were presented with images of eight odd objects designed to be difficult to verbalize. These objects were presented simultaneously on a computer screen. and were allowed to remain there participants were simply asked to touch the image of each of the eight objects but only once each if you retouched an object that had previously been touched that was considered an error the goal was to touch all of the objects with eight touches thus the task called upon working memory as a person needs to remember which objects have already been touched in order to avoid retouching them. Van Snelberg and colleagues then were able to use this task as a means to determine if people with schizophrenia had deficits in working memory, which indeed they did. Van Snelberg and colleagues found that control patients made fewer errors and responded faster than both patient groups. The medicated people with schizophrenia did better on the task. than the unmedicated people with schizophrenia, although they did not do it faster. This result suggests that the medication people take for schizophrenia allows them to better allocate their attentional resources and therefore show higher performance in tasks, though still not at levels seen in comparison people. People with schizophrenia also show deficits in encoding with episodic memory relative to control populations. For example, Bacon and colleagues showed that people with schizophrenia and control participants So, for example, Bacon and colleagues showed people with schizophrenia and control participants line drawings of fictional animals. The participants were instructed to learn the names of the animals and recall the name when shown the picture again later. Thus, the participant may see a picture of an odd flightless bird and be told that it is called the Yelky. bacon and colleagues also asked participants to report feeling of knowing judgments for the picture named pears in anticipation of a future recognition test although the accuracy of the feeling of knowing judgments did not differ for the people with schizophrenia and the healthy controls there were significant differences in the amount recalled people with schizophrenia recalled fewer of the fictional animal names then did controls when presented with the picture, thereby demonstrating a deficit in episodic memory. Sahakian and Quapel in 2018 looked at people with non-clinical schizophrenia, often referred to as schizotypy. These are individuals with the characteristics of schizophrenia. but not serious enough to require psychiatric care. Like people with schizophrenia, those with schizotypy show deficits in free recall from episodic memory and deficits in strategies used to initiate recall. The next question concerns the cognitive and neurological reasons for why people with schizophrenia show deficits in memory. Gammond and colleagues in 2017 were interested in potential encoding deficits in people with schizophrenia, although they focused on encoding into semantic memory rather than episodic memory. In their study, people with schizophrenia and control participants studied visual image pairs in the context of different semantic memory strategies. In one condition, the participants were asked to determine if the visual image pairs were in the same category as each other, and in a second condition, if the objects by the visual image pairs were different sizes in real life. If the participants saw a picture of an apple and a picture of a strawberry, the answer to both questions would be yes. Both an apple and a fruit belong to the category fruit and the strawberry is smaller than the apple. If participants saw a picture of a pair of pants and a ladybug, the answer to the first question would be no, but the answer to the second question would be yes. A pants and ladybug don't belong to the same category. However, a ladybug is considerably smaller than a pair of pants. Gammond and colleagues allowed some participants to use their own study strategies, but they encouraged others to use semantic processing by looking for potential relationships between the objects. Later, a recognition test occurred, and Gammond and colleagues did the study while participants were being monitored in an fMRI so they could examine both behavioral results and the and neuroimaging results. The behavioral results showed that people with schizophrenia had considerable deficits in recognition memory relative to controls when left to their own study methods. However, the people with schizophrenia improved and were comparable to the control group when prompted to use good study strategies. Thus, Gammond and colleagues conclude that memory deficits seen in people with schizophrenia may be more about strategic use of memory rather than raw encoding ability. Now we'll talk about ADHD and the associated memory deficits with this disorder. So attention deficit disorders are commonly prescribed developmental disorders. seen in children and adults. It is commonly abbreviated as ADHD for attention deficit hyperactivity disorder. Although ADHD does not go away in adulthood, the vast majority of research on ADHD focuses on how it affects children, particularly of elementary school age. According to the National Institute of Mental Health, attention deficit hyperactivity disorder is a neurologically based disorder characterized by deficits in attention and often accompanied by hyperactivity or impulsivity. all of which interfere with normal development and normal functioning in children with ADHD. ADHD is diagnosed in children as young as preschool age when it typically reveals itself in hyperactivity. However, there are forms of ADHD that do not include the hyperactivity component. More common in males than females, ADHD has been the subject of a tremendous volume of research in recent years. It is estimated that approximately 5% of the population can be diagnosed with ADHD. ADHD can cause many problems for people, both in terms of the development of self-esteem and underachievement relative to peers without ADHD. Our focus here is on memory deficits seen in ADHD, most of which center around working memory. Attention Deficit Hyperactivity Disorder, or ADHD, is a neurologically based disorder characterized by deficits in attention, which may include hyperactivity and impulsivity. The prevalence and demographics associated with ADHD is that most research focuses on children either of school age or preschool age, and it's more prevalent in males and females. and 5% of the population is estimated to have ADHD. The impact of ADHD is that it can lead to issues with self-esteem and also underachievement compared to peers without ADHD, impacting both academic performance and personal development. And there are memory deficits, right? So this is going to be our focus. And most of the deficits related to ADHD are concerned with working memory. So, one of the major deficits in ADHD occurs in the domain of working memory. Indeed, studies show that people with ADHD have deficits across all components of working memory, from the phonological loop, to the cognitive loop, to the cognitive loop, to to the visual spatial sketchpad to executive functioning. Working memory tasks have shown that deficits in people with ADHD include both the forward and backward digit span, visual working memory tasks, and a host of other working memory deficits. Working memory deficits in ADHD are also associated with many other issues in ADHD. that cause lifelong problems, including the link between deficits in working memory and reading disorders. Luckily, there do not appear to be deficits in episodic memory in people with ADHD. So unlike working memory, episodic memory remains relatively intact in individuals with ADHD, showing no significant deficits. So given the host of issues with ADHD and working memory, an important research question is whether or not working memory training can improve working memory in people with ADHD and therefore potentially alleviate some of the other symptoms. The thinking here is that if working memory can be improved in people with ADHD, then it is likely that cognitive deficits that spring from problems with working memory can may also be reduced. Ackerman and colleagues in 2018 conducted a study that directly addressed this question. In the study, medicated and unmedicated adolescents with ADHD ages 11 through 15 were given working memory training and compared with age-matched controls without ADHD. Working memory training is a practice first introduced in the early 2000s and is now quite standardized. The study was conducted in the United States in the United States of America in the United In the Ackerman and Colleagues study, participants with ADHD were trained on tasks such as the digit span, the backward digit span, and a visual-spatial task known as the Corsi task, in which the participant has to tap pictures of blocks in the same pattern as demonstrated by a computer or the experimenter. A number of other working memory-related tasks were used as well. In all tasks, the control participants scored higher than patients with ADHD. However, like the control participants, The participants with ADHD improved from pre-training to post-training on all of the tasks. However, for patients with ADHD, improvement was only measured if the participants were medicated. Unmedicated participants did not show across-the-board improvement. Thus, this study replicated a number of consistent findings concerning people with ADHD and working memory. There is a deficit in working memory with ADHD. Second, working memory can improve performance for both people with and without ADHD. However, in order for the training to be successful, people with ADHD must be on their medications. Ackerman and colleagues showed that improvements in working memory were reliably correlated with the reduction of other symptoms, such as impulsivity and hyperactivity. Thus, working memory training has additional benefits. In some, people with ADHD have a primary deficit in attentional control as well as hyperactivity and impulsivity. Because of the deficit in attentional control, they have deficits in working memory, although no comparable deficits in long-term memory processes, such as episodic memory. Direct training of working memory skills can be of use to people with ADHD. Okay, so the final neuropsychological disorder that we're going to discuss in today's lecture is autism. So autism is a range or spectrum of disorders that develop in young childhood and persist throughout life. which center on deficits in social communication and social interaction including deficits in language emotion perception theory of mind and often repetitive or restrictive behaviors that covers a lot of ground but there is still much debate as to what exactly is autism at its core in severe cases autistic children may be extremely slow to learn language and unresponsive to social cues. In these extreme cases, some autistic adults may also have a limited ability to use language. In a less severe form of autism known as Asperger's syndrome, intelligence is normal or above normal but people with Asperger's have difficulties with social communication and interaction. Memory problems are not considered a diagnostic characteristic of autism. Indeed, some people with Asperger's syndrome may have memory abilities in some domains such as encoding into semantic memory that greatly exceed those of typically developing individuals. So, like I said, memory problems are not a core diagnostic feature of autism. Some individuals with Asperger's syndrome in particular may excel. in encoding information into semantic memory in particular. Thus, there is ongoing discussion about the precise nature of autism and its four characteristics, reflecting the complexity and variability within the autism spectrum. Savant syndrome is a condition in which a person with autism demonstrates extraordinary cognitive abilities, usually in the domain of visual-based semantic memory. For example, Temple Grandin, a professor of animal science at Colorado State University, has been a spokesperson for people with autism for some time. Dr. Grandin claims to have extraordinary visual memory and is a professor of animal being able to remember knowledge and events and replaying them like a movie indeed she characterizes her memory retrieval as being like an internet search syndrome only looking for photographs and not texts Note, of course, that Grandin's self-description is not scientific data, as it is not generated through an experiment. Other autistic memory savants excel in domains like math and music. One such person is Rex Lewis Clark, a young American piano player. Despite being blind and autistic, Lewis Clark has won numerous awards for his piano playing. Because he is blind, he must memorize all of the music that he plays. Hoppe, 2018, argues that these savant symptoms are more common in people with autism than the general population because people with autism tend to focus on specific details, more than general patterns of meaning or meaning-based processing. Therefore, autistic savants, develop great encoding skills for specific details such as notes being played in a concerto or the specific details in a visual scene which can then be drawn upon if the individual has developed drawing or painting skills because individuals with autism may have deficits in planning and executive function they focus on details that they are good at There are two common memory deficits observed in people with autism. These deficits seem to cluster into two categories. The first set of deficits has to do with attentional control, with some people with autism showing poor attention to certain details that people without autism would process and then later recall. The second has to do with relational processing. Both of these may stem from characteristics that drive people away from the normal way from attending to the social aspects of the environment or paying close attention to the meaning of information. Consistent with the idea of intentional control being impacted in people with autism, metamemory accuracy is also lower in people with autism than in comparison samples, at least for episodic memory materials. Other research suggests that people with autism show deficits in relational processing. which can lead to deficits in encoding for meaning-based information. This view is consistent with the experience of Temple Grandin, who describes her visual-based memory, which can be thought of as more similar to item-specific encoding. The strategies of relational processing, which typically lead to good encoding of episodic information, appear to be compromised in people with autism, leading to poor memory relative to comparison individuals in at least some situations gage and bowler also point out the implications for this when considering people with autism as witnesses because the encoding of people with autism is more item specific than relational more accurate testimony will result from giving them specific cues that capitalize on item specific coding encoding rather than typical free recall instructions. To test the idea that relational processing is damaged in people with autism, Ring and colleagues in 2016 compared people with autism with people that don't have autism. In the study, participants were asked to study a set of three odd shapes placed in juxtaposition together. The task was to find the most suitable shape for the person. was to be able to remember the shapes later, either in combination or by themselves. The task was set to equalize people with autism with the control condition, as the test used visual stimuli rather than written words, for which the comparisons the control group would have an advantage. Moreover, the nature of the task allowed Ring and colleagues to to compare a test that focuses on relational processing, namely recognizing the combination of shapes, and a test that focuses on item-specific processing, namely recognizing the individual shapes. In keeping with the hypothesis that people with autism have deficits in relational processing, they scored lower on the test that looked at the order of combinations of shapes. Interestingly, people with autism scored lower on individual object recognition as well, suggesting that relational processing improves performance on that task as well as on that task as well, or that the deficits in memory in autism also sometimes generalize to item-specific processing. Although these data are equivocal in pinpointing relational processes as the problem in encoding for people with autism, they do demonstrate the overall problem with encoding seen in people with autism. In summary, there is a general pattern of impaired memory performance in people with autism based on poor attention to social factors, deficits in attentional control, and in relational processing. In some people with autism, this is offset by extraordinary memory for item-specific visual information. So, just to summarize, the impact on test performance. was that research such as that conducted by Ring and colleagues in 2016 shows that people with autism perform worse on tasks requiring relational processing, as well as recognizing combinations of shapes. They also sometimes perform poorly on item-specific tasks, which suggests they may have a general problem with encoding. So, as far as practical implications, for individuals with autism, item-specific memory may be stronger in some contexts, and providing specific cues can enhance accuracy in contexts like eyewitness testimony. However, overall, memory performance in autism tends to be impaired due to deficits in attentional control and relational processing. So just to summarize what we've talked about thus far, memory deficits in schizophrenia primarily involve working memory and episodic memory, as individuals with schizophrenia often struggle with attentional control and central executive functions affecting their overall memory performance. ADHD is characterized by by significant deficits in working memory affecting all components, including the phonological loop, the visual-spatial sketchpad, and the central executive. And working memory issues in ADHD are linked to broader developmental and functional challenges that fortunately respond well to working memory training. People with autism show common memory deficits, in attentional control and relational processing. While some may have extraordinary memory abilities in specific domains, overall memory performance can be impaired, particularly when processing relational information.

Lumberjack was not wearing a coat and looked freezing. So the police officer questioned him. When the officer was unable to obtain information from him, Lumberjack was brought to the hospital for testing. Lumberjack was suffering from a dense and complete psychogenic amnesia, including what is known as a fugue state, which means he did not know who he was.

His amnesia was so dense that he did not know his own name or where he lived. Indeed, Lumberjack could remember nothing from his personal past. except for the events just prior and subsequent to his interaction with the police officer local newspapers printed his photograph in a vain effort to locate relatives who could identify him during the next few days lumberjack remained in a dense amnesic state then a few days later while watching television in the hospital some images from a movie he was watching triggered his memory and his identity and memory of his life returned the specific image that triggered his memory was the depiction of a funeral in the miniseries this caused him to remember the funeral of his own grandfather which was the traumatic event that had triggered the amnesiac episode within a matter of hours he had recalled not just his own name and home address but complete autobiographical memory returned as well because the doctors in the hospital had called in researchers to document his memory loss his profound memory loss and the subsequent return of his memories were documented in the scientific literature in psychogenic amnesia we occasionally see a loss of personal identity which is almost never seen in neurological based amnesia except perhaps in the terminal stages of alzheimer's disease in psychogenic amnesia the loss of personal identity means that although patients are verbal responsive to surroundings and socially aware they do not have an identity and may not know their name or very much about themselves including who their close family members may be in addition patients with a loss of personal identity may be unable to recall any events from their life interestingly the loss of identity may occur without anterograde amnesia meaning as often portrayed in the movies they can start reconstructing their own life in the absence of what occurred before the onset of the loss of personal identity.

The patient may be learning new information, including autobiographical information, starting from the time of the onset of the amnesia. So psychogenic amnesia is a broad term that covers all forms of amnesia that are not directly linked to disruption or injury of the brain. In some cases, injury to the brain may be related to psychogenic amnesia, but the cause of psychogenic amnesia is not the brain damage itself.

Caused by psychiatric disorders or psychological trauma rather than physical insult to the brain. So psychogenic amnesia is caused by... either psychiatric disorders or trauma rather than neurological amnesia, which is caused by brain tumors, destruction of the hippocampus, etc.

So, Arrigo and Pesdak in 1997 list a number of common precursors to psychogenic amnesia. These incur disasters, combat, attempted suicide, witness or participating in criminal acts, as well as sexual assault. In one documented case of psychogenic amnesia without the loss of personal identity, the patient J.H. spent six years of his life in a state of psychogenic amnesia, in which he could remember nothing of the first 53 years of his life.

J.H. was brought to the hospital in 2005 after initially being reported missing by his family. Unlike Lumberjack, J.H.

never lost his personal identity. He displayed strong anterograde and retrograde amnesia, but showed no brain abnormalities. During the ensuing years, he did his best to cope with his intense retrograde amnesia and persistent anterograde amnesia. Despite the psychogenic amnesia, he was able to return to his family and to his job.

However, at the age of 60, a variety of psychotherapy approaches allowed J.H. to regain the missing past and his bout with psychogenic amnesia appeared to be over. Because of the extended period of J.H.'s psychogenic amnesia, he was also extensively tested. Rothborn documented severe deficits in his self-knowledge. as well as an inability to plan for the future.

These symptoms returned to normal once the psychogenic amnesia finally wore off. That such a profound amnesia could be treated with psychotherapy is very fortunate. So, um, so J.H. developed psychogenic amnesia, right? He had profound retrograde and enterograde amnesia, but he was able to return to his family and his job.

And at the age of 60, almost seven years after he initially developed psychogenic amnesia, he was able to regain his memory with intensive psychotherapy. Another reported case of psychogenic amnesia was documented by Stanilou and colleagues in 2018, and they described patient C. Patient C was in an auto accident in which he overturned the truck that he was driving. Patient C received only minor injuries in the crash, and it was not clear whether he suffered a concussion or not. There did not.

appear to be any lasting damage to his brain. In terms of memory, however, patient C did not lose identity after the crash but suffered extreme retrograde amnesia, which lasted at least until publication of the paper. The researchers point out that patient C, like many patients with psychogenic amnesia, suffered from what they called la belle indifférence. meaning that the patients were not concerned at all about their condition in this case the extreme loss of autobiographical memory la belle indifference is another name for agnosinosia by neuropsychologists so la belle indifference or agnosinosia is basically being aware of a significant disruption in function but being indifferent to it or not seeing it as a problem.

So indifference to amnesia is problematic because it prevents the person from implementing the proper steps to deal with the effects of their amnesia. So to summarize, psychogenic amnesia is caused by psychological problems rather than neurological problems. in most cases a traumatic event of one kind or another causes a strong block preventing access to episodic and autobiographical memories and in some cases even facets of self-identity In the case of Lumberjack, the funeral of his grandfather triggered his psychogenic amnesia because his grandfather raised him and was his only committed relative. The shock of his grandfather's sudden death apparently was sufficiently traumatic to induce amnesia.

In J.H., personal financial difficulties may have contributed to the development of his amnesia and in patient C, the trauma of the trup. The truck accident may have contributed to his amnesia. Some argue that amnesia is one way in which the person copes with trauma.

Although psychogenic amnesias have a psychological cause, Sachet pointed out that a large proportion of documented cases of psychogenic amnesia are in people who have a history of brain injury, as was the case with Lumberjack. The case studies of Stanilou, Liu, and colleagues 2018 also support this view, but because of the rareness of this state, at present, little empirical data exists on the origins and causes of psychogenic amnesia. So, what are some of the factors that lead to the onset of psychogenic amnesia?

Harrison and colleagues 2017 lay out three features that appear to be consistent across published cases of psychogenic amnesia. The first is severe stress. The stress can vary from combat experience, being the victim of a violent crime, being the perpetrator of a violent crime, or to more ordinary everyday stressors.

such as the death of a family member or the loss of a job. The stressful event usually serves as the trigger for the onset of psychogenic amnesia, but other conditions must also be met for psychogenic amnesia to occur. Thus, stress is thought of broadly here, but consistent across the conditions that a person has to deal with, with both trauma and distress. The second feature is depression or suicidal tendencies. In both cases documented by Harrison and colleagues, in Stanilou and colleagues, depression tends to be a precursor for the onset of psychogenic amnesia.

The depression may not develop until after the stressful event, but people who do not experience clinical depression do not typically suffer from psychogenic amnesia. The third feature is a previous history of neurological trauma. That is, psychogenic amnesia tends to more likely develop in people who at some point in their life suffered from either a concussion or another form of brain trauma, such as brain surgery or epilepsy. In some cases, the presence of neurological damage can be a cause of brain damage.

may make it difficult to separate psychogenic amnesia from neurologically based amnesia, but in some cases, the neurological damage was many years prior to the onset of amnesic symptoms, and therefore it may be possible to assign amnesia to the psychogenic variety. So what are treatment options available for those suffering from psychogenic amnesia? Given the complexity of psychogenic amnesia, the treatment will vary greatly from case to case, but we can review some of the trends in treatment. The first step is to address the depression that invariably accompanies psychogenic amnesia. This may involve pharmaceuticals that help reduce depression.

the second step is to address how the psychogenic amnesia has affected relationships with family members from spouses to children to parents if the person has lost memory of some or all of those people addressing such relationships is an important part of coping for the person with psychogenic amnesia one can only imagine what it must be like to be told a person is a spouse or child and not be able to recognize them. Third, if retrograde amnesia is not subsiding on its own, psychiatrists and psychologists will engage in a number of procedures to reinstate lost memories, such as structured interviews that attempt to find the right retrieval cues to trigger lost memory, just as watching the movie triggered recovery from lumberjack. If ultimately the lost memories do not return, Counseling can be offered to help people with psychogenic amnesia manage their symptoms. Dissociative amnesia is a condition in which only the traumatic event or events closely related to the trauma are remembered.

Dissociative identity occurs not because of neurological ailments such as a concussion, but because of psychological trauma. For example, a veteran may have selective amnesia for the event in which she lost a limb during combat. Dissociative amnesia is retrograde amnesia as it refers to the inability to remember a specific past event or events. Most patients suffering from dissociative amnesia have equivalent semantic knowledge of the traumatic event but have lost amnesia.

episodic access to the trauma. This distinguishes dissociative amnesia from repression, in which both episodic and semantic access are lost. Because dissociative amnesia is a psychological amnesia, there can be a great deal of variation from patient to patient. Some will experience amnesia only for the event, whereas others will also be amnesic for events that surround the trauma in time. or are related to the trauma in meaning or content.

For example, Patient E had trained to be a police officer following the childhood in which becoming a police officer was her dream. Shortly after successfully completing police officer training, she was a passenger in an accident in which she was badly injured and had multiple physical injuries that prevented her from beginning her career as a police officer. Although she did not suffer any direct damage to the head or brain, she developed a case of dissociative amnesia with severe andrograin amnesia for autobiographical events both surrounding the accidents as well as extending back in time. Thus, because her injuries were extensive but not focused on the brain, her amnesia was considered dissociative amnesia and not neurologically based. Indeed, her retrograde amnesia was accompanied by depression and loss of interest in activities that had previously interested her.

At the time that Stanalu and colleagues wrote their report, patient E had been suffering from dissociative amnesia for years. Dissociative fugue is the psychogenic amnesia in which the patient forgets their personal identity in addition to their autobiographical past thus the term fugue is reserved for the loss of personal identity which will also be accompanied by extensive retrograde amnesia for example the case of lumberjack involved a dissociative fugue state characteristic of dissociative fugue is forgetting one's name occupation place and date of birth and where one currently lives for the patient it can be very confusing but in some cases the patient seems unconcerned about their own lack of identity in most documented cases of dissociative fugue the fugue state wears off in a matter of days and the person regains their original identity but there are some reports of dissociative fugue lasting years stanallew and colleagues describe the case of patient ZB, who was brought to a psychiatric hospital after he could not identify himself to German police. When patient ZB was found by the police, he was around 50 years old and was carrying books about history, though he could not explain why he had those books. Patient ZB spoke with a German accent associated with a part of Germany far from where he was found suggesting that he had traveled some distance before help intervened there was no evidence of brain damage when doctors performed an mri on him when tested during his fuguesate patient z b scored well on many tests of cognition including those of working and visual memory However, ZB did not know his identity and could not remember any autobiographical fact prior to the onset of dissociative fugue.

Amazingly, patient ZB's fugue state has remained, at least when Stanilou and colleagues published their paper. Moreover, the police were never able to determine his objective identity. Several other patients described by Stanilou and colleagues also were found fugue-free.

far from where they live. Apparently, dissociative fugue states bring on the need to travel. Harrison et al. also examined a case of dissociative fugue. Patient 1 was a young man found by police wandering around London without knowing who he was or how he had gotten where he was.

Luckily, case 1 had identification in his possession, which allowed police to match him and his family. to a missing person's report. However, when the police brought him to his address, Case 1 could not identify his family members.

Because of this, Case 1 was brought to the hospital. His autobiographical memory returned in full six days later. Because his memory returned and his identity was known, Harrison et al. were able to link his fugue state to stress and depression related to financial troubles. However, in case one, there was no history of neurological trauma, despite the general trend relating to dissociative fugue and a history of neurobiological trauma.

In dissociative fugue, in some cases, something, often a word or image, serves as a cue or trigger for the person in the fugue to remember his or her past. With that one cue, the person's entire past is seems to return in a flood of memories however in one documented case much anterograde amnesia remained even after the fugue state had worn off and the patient regained his identity thus not all dissociative fugue states end in a flood of memories from the past in some cases the fugue state does not wear off at all future research will be required to determine whether these two types of recovery from dissociative puke differ as a function of psychological and neurological origins of the amnesic state. Puke states are extremely rare and seem to be highly idiosyncratic. Therefore, devising treatment plans is challenging at best.

As we have seen with other dissociative amnesias, Treatment is often explicitly individualized. Indeed, given that the process of how people enter their fugue states and the circumstances which cause people to persist in a fugue state are poorly understood, so treatment is often a guessing game. There are two separate tracks, however, to addressing someone in a fugue state. First is an attempt to restore them to their pre-fugue identities. This involves exposing them to powerful cues to remind them of their identity.

This typically means putting them in contact with people, places, or objects from their pre-fugue lives. If this fails to jog the memory of their former selves, psychiatrists might try sedating the patient in the hopes that if they were less stressed, their former selves might return. following sedation another interview might jog their memory however despite its ineffectiveness in general respect to memory some treatment plans will include hypnosis however as we saw with the case of patient zb in some cases the fugue state does not wear off if so then the treatment shifts from beginning the patient back to their former identity to have them cope with the present amnesia and present life situation this may vary widely given the person's cognitive emotional and medical situation nonetheless in these situations the treatment changes from memory to life adjustment and patients may focus on supportive therapy which is effective in adjusting to stressors and developing coping strategies even after recovering memory Jha and Sharma found that supportive therapy and mindfulness training were helpful in patients who had recovered from fugue states, which makes sense especially if we consider that depression and suicidal ideation and neurological trauma are often accompanying conditions and these treatments can be helpful for those conditions as well. Post Traumatic Stress Disorder or PTSD is a psychological disorder that is caused by exposure to an extremely disturbing experience. One of the chief symptoms of PTSD is an inability to stop the retrieval of memories that are related to the traumatic event.

Memory deficits in Post Traumatic Stress Disorder differ greatly from memory deficits in other neurological and psychological disorders. This is mainly because the deficit in PTSD doesn't have anything to do with amnesia, but rather reflects an inability to inhibit the retrieval of unwanted memories. In PTSD, harmless events can cue retrieval of traumatic events, such as being a victim of a violent crime or a war-related tragedy. A traumatic event or events may vary. and may not even seem traumatic to everyone.

In other cases, some people do not get PTSD even after being exposed to horrible trauma. But it is trauma that precipitates PTSD. For example, a veteran may be reminded of a violent explosion on the battlefield when his or her shopping cart accidentally bumps into the cart of another shopper.

A victim of Sexual assault may be reminded of the crime and trauma when she sees someone who resembles the assailant. A survivor of a school shooting may be reminded of the school shooting whenever they pass a school on the road. Whereas someone without PTSD may also be occasionally reminded of the traumatic event and retrieve it, people with PTSD are reminded of the event by many different stimuli. Moreover, the retrieval is frequently accompanied by debilitating negative emotions. PTSD is a psychological disorder that includes the inability to inhibit unwanted memories because of exposure to extremely dangerous or stressful situations.

PTSD may last anywhere from a few days to many years, and symptoms are quite varied but include nightmares, avoiding situations that invoke the trauma, anxiety, and depression. That is, the psychological problems stem directly from episodic memory and unwanted retrieval of these memories. Indeed, one of the most successful treatments for PTSD is to render traumatic memories less accessible and also less emotional. Treatment usually involves trying to desensitize cues and that prompt these memories. Most relevant in the current discussion is the invasiveness of intrusive memories.

Intrusive memories are environmentally cued unwanted retrievals of events related to the PTSD trauma event. They typically involve retrieval of sensory details. such as visual imagery of the traumatic event but may also be accompanied by other details such as remembering the sounds and smells accompanying the traumatic event in addition emotional content is remembered during intrusive memories for example a veteran of combat may have intrusive memories not just of the sights and sounds of war but also the whizzing of bullets Intrusive memories are likely to occur for anyone who has undergone a traumatic event, from being in a car accident to watching a family member die.

For most of us, intrusive memories subside over time, and they may occur in people who clearly do not have a PTSD diagnosis. Indeed, in a study of people who have been in car crashes, more than 75% of people have reported intrusive memories in the first few weeks after being in the crash. That number was reduced to under 25% a year after the accident. However, in patients with PTSD, the intrusive memories persist long after the initial traumatic event, sometimes for many years.

Nonetheless, for many people, intrusive memories may lie below the threshold of a PTSD diagnosis. Because we know that most people who experience trauma will also experience intrusive memories, but not all people who experience intrusive memories will develop PTSD, it's instructive to ask if individual differences in memory encoding affect PTSD To simplify, do characteristics of encoding affect the onset of PTSD? Consider two victims of trauma, one with a vivid visual imagery system and the other with a less vivid imagery system. Which people is more likely to use semantic or contextual based encoding? Given that intrusive memories and PTSD are characterized by vivid visual retrieval, people with more or better visual imagery may be at more risk of developing PTSD.

This turns out to be the case. There is a positive correlation between better visual imagery systems and the development of PTSD after trauma. One of the goals for treatment of PTSD is to reduce or eliminate the intrusive memories that occur.

The idea here is that if there are fewer intrusive memories, people with PTSD will be able to focus on the issues rather than the traumatic event or events. Various strategies have been used to reduce intrusive memories including drug treatment, sleep deprivation, and cognitive interference. Treatment focused on cognitive interference is the idea that working memory has a limited capacity and distracting information interferes with retrieval. Whereas in most contexts, these limitations are problems, they can be put to good use in the case of intrusive memories and PTSD. In one study playing the attention-grabbing game Tetris, after being exposed to disturbing images interfered with the intrusive memories of those images in both the near term and at longer retention intervals but with people not diagnosed with ptsd another study found that counting back from ten interfered with the retrieval of intrusive auditory memories Linder, I and colleagues in 2019 tested the idea about interference directly with patients who had been in severe automobile accidents.

Hospitalized patients were randomized into an interference condition, playing Tetris after recalling the accident, and an attention-demanding control condition, filling out an activity lab. One week later, the people in the interference condition showed a marked reduction in intrusive memories relative to those patients in the control condition. This suggests that engaging in memory interfering activities can reduce intrusive memories. However, the authors point out that both patient groups showed equivalent anxiety and depression symptoms.

Thus, it is not clear if focusing on the reduction of intrusive memories is enough to really impact the severity of PTSD. There is also evidence that suggests that people with PTSD have mild amnesiac problems for everyday memories. We know that PTSD is characterized by intrusive memories, but because people with PTSD deal with the repeated retrieval of memories that they would prefer not to, it is also possible to consider that people with PTSD may be impaired with respect to the retrieval of normal memories. That is, we might expect to see general memory deficits in patients with PTSD. In the case of patients with PTSD, the constant retrieval of traumatic events may interfere with the retrieval of related memories of a non-traumatic nature.

Thus, it is consistent with memory theory. of interference and related dynamics that this might occur. A number of studies illustrate this impairment. For example, Chow 2017 found that self-reported memory deficits correlated with actual memory deficits in military veterans with PTSD. Sachet and colleagues in 2018 also found both memory and mental health issues associated and metamemory deficits in patients with PTSD relative to a control sample.

For example, the authors compared patients with PTSD to a control sample on a cue target learning task. So, for example, they had to learn word pairs like bear and wolf. Later, participants tried to recall the second word in response to the first.

They also made feeling of knowing judgments. Sachet and colleagues found that patients with PTSD recalled fewer target words and showed lower feeling of knowing judgment accuracy than control patients. Thus, there is evidence to support the idea that patients with PTSD have mild memory deficits relative to controls. Thus, people with PTSD have problems with both too much remembering of traumatic events, as well as memory deficits for non-trauma related material.

So just to give an interim summary, psychogenic amnesia is a term that covers all forms of amnesia that are not directly linked to disruption or injury to the brain. Psychogenic amnesias are caused by psychiatric disorders or psychological trauma. rather than physical injury to the brain.

In psychogenic amnesia, we occasionally see a loss of personal identity. However, in most cases of psychogenic amnesia, there may be substantial retrograde amnesia, but no loss of identity. In order to treat psychogenic amnesia, one must first treat the underlying depression before engaging in memory therapy to retrieve memories of the past dissociative amnesia is a condition in which only the traumatic event or events closely related to the trauma are not remembered dissociative fugue is the psychogenic amnesia in which in which the patient forgets their personal identity in addition to access to his or her autobiographical past treatments for fugue involve reducing the levels of stress experienced and then presenting the person with various cues in order to help the person retrieve their past and their identity. Post-traumatic stress disorder is a psychological trauma that is caused by exposure to a traumatic stressor. One of the chief symptoms of PTSD is an inability to stop the retrieval of memories that are related to the traumatic event.

People with PTSD may also have deficits in other areas of memory retrieval. Intrusive memories are a major symptom of PTSD, but they may also occur in people without PTSD. Engaging in memory-interfering activities that tax working memory can reduce intrusive memories and may help people with PTSD.

To begin our discussion of schizophrenia and memory deficits in schizophrenia specifically, once again I'm going to start with an illustrative case study. So James is a mild-mannered zookeeper. He works at a small zoo and tends to the tropical birds.

He knows the scientific and common names of the kind of birds in his care, as well as their diets and temperaments he is very gentle and kind with the birds and seems to have a way of calming down even the most agitated bird once an injured wild heron landed in the baboon enclosure james entered the enclosure stared off the angry baboons and gently picked up the equally agitated heron and brought it to the veterinarian James lives in a small trailer just adjacent to the zoo and attends a church nearby that he can walk to. Every so often, James forgets to take his medications for schizophrenia. When he does so, he believes that the CIA has bugged his trailer, that the KGB has implanted electrodes in him which control him, and that the only thing preventing one or the other of these organizations from assassinating him, is the actual presence of Jesus on the zoo grounds.

When he experiences these beliefs, he excuses himself, returns to his trailer, and takes his medications immediately. Once back on his medications, these delusions dissipate, and James returns to being a kind-hearted zookeeper. Schizophrenia is a relatively rare... rare but well-publicized psychiatric condition. People with schizophrenia have a chronic and severe psychiatric disorder, which mainly affects how a person thinks, and this in turn affects how they feel and behave.

In some cases, people with schizophrenia appear to no longer be focused on an external reality, but rather some internal mental construction. We distinguish here between the reality of schizophrenia and how it is portrayed in popular media. In movies, people with schizophrenia are often violent and terrifying, whereas in reality people with schizophrenia are no more or less violent than typical people.

In the movies, people with schizophrenia hear voices and see hallucinations all the time. But in reality this is rare. although a distorted sense of consciousness and lack of awareness are hallmarks of schizophrenia even when treated however people with schizophrenia have a host of cognitive problems including issues with memory and metamemory as with the other psychiatric conditions reviewed in this lecture our concerns are less with what causes schizophrenia and how to treat it but rather the nature of memory deficits seen in people with schizophrenia.

We do not have space to consider the substantial data of what happens in the brains of people with schizophrenia. Suffice to say that abnormal functioning is seen in the dorsolateral prefrontal cortex, which is an area associated with attentional control and memory, the parietal lobe, and an assortment of subcortical structures. Memory problems in people with schizophrenia emerge in two main areas. People with schizophrenia have deficits in working memory and episodic memory.

The working memory deficits appear to be related to attentional or central executive functioning, which can then lead to performance declines in many ways. Remember that the central executive is defined as the attentional mechanism of working memory. Working tasks get complicated, this aspect of cognition must guide the person toward allocating attention in appropriate ways.

If the neural mechanisms underlying the central executive are affected from schizophrenia, performance in many areas may suffer. Moreover, research indicates that people with schizophrenia show deficits in all aspects of working memory, including the visual-spatial sketchpad, and the phonological loop, as well as the central executive. Again, to be clear, the concerns of this lecture are to explore memory issues in schizophrenia and not to review what we know about schizophrenia in general.

To illustrate the deficit in working memory in people with schizophrenia, Van Snelberg and colleagues in 2016 Compared working memory performance among a sample of medicated people with schizophrenia, a sample of unmedicated people with schizophrenia, and a control group, Van Snelberg and colleagues used an interesting task to assess working memory. Patient were presented with images of eight odd objects designed to be difficult to verbalize. These objects were presented simultaneously on a computer screen. and were allowed to remain there participants were simply asked to touch the image of each of the eight objects but only once each if you retouched an object that had previously been touched that was considered an error the goal was to touch all of the objects with eight touches thus the task called upon working memory as a person needs to remember which objects have already been touched in order to avoid retouching them. Van Snelberg and colleagues then were able to use this task as a means to determine if people with schizophrenia had deficits in working memory, which indeed they did.

Van Snelberg and colleagues found that control patients made fewer errors and responded faster than both patient groups. The medicated people with schizophrenia did better on the task. than the unmedicated people with schizophrenia, although they did not do it faster.

This result suggests that the medication people take for schizophrenia allows them to better allocate their attentional resources and therefore show higher performance in tasks, though still not at levels seen in comparison people. People with schizophrenia also show deficits in encoding with episodic memory relative to control populations. For example, Bacon and colleagues showed that people with schizophrenia and control participants So, for example, Bacon and colleagues showed people with schizophrenia and control participants line drawings of fictional animals. The participants were instructed to learn the names of the animals and recall the name when shown the picture again later. Thus, the participant may see a picture of an odd flightless bird and be told that it is called the Yelky.

bacon and colleagues also asked participants to report feeling of knowing judgments for the picture named pears in anticipation of a future recognition test although the accuracy of the feeling of knowing judgments did not differ for the people with schizophrenia and the healthy controls there were significant differences in the amount recalled people with schizophrenia recalled fewer of the fictional animal names then did controls when presented with the picture, thereby demonstrating a deficit in episodic memory. Sahakian and Quapel in 2018 looked at people with non-clinical schizophrenia, often referred to as schizotypy. These are individuals with the characteristics of schizophrenia. but not serious enough to require psychiatric care.

Like people with schizophrenia, those with schizotypy show deficits in free recall from episodic memory and deficits in strategies used to initiate recall. The next question concerns the cognitive and neurological reasons for why people with schizophrenia show deficits in memory. Gammond and colleagues in 2017 were interested in potential encoding deficits in people with schizophrenia, although they focused on encoding into semantic memory rather than episodic memory.

In their study, people with schizophrenia and control participants studied visual image pairs in the context of different semantic memory strategies. In one condition, the participants were asked to determine if the visual image pairs were in the same category as each other, and in a second condition, if the objects by the visual image pairs were different sizes in real life. If the participants saw a picture of an apple and a picture of a strawberry, the answer to both questions would be yes. Both an apple and a fruit belong to the category fruit and the strawberry is smaller than the apple.

If participants saw a picture of a pair of pants and a ladybug, the answer to the first question would be no, but the answer to the second question would be yes. A pants and ladybug don't belong to the same category. However, a ladybug is considerably smaller than a pair of pants.

Gammond and colleagues allowed some participants to use their own study strategies, but they encouraged others to use semantic processing by looking for potential relationships between the objects. Later, a recognition test occurred, and Gammond and colleagues did the study while participants were being monitored in an fMRI so they could examine both behavioral results and the and neuroimaging results. The behavioral results showed that people with schizophrenia had considerable deficits in recognition memory relative to controls when left to their own study methods.

However, the people with schizophrenia improved and were comparable to the control group when prompted to use good study strategies. Thus, Gammond and colleagues conclude that memory deficits seen in people with schizophrenia may be more about strategic use of memory rather than raw encoding ability. Now we'll talk about ADHD and the associated memory deficits with this disorder.

So attention deficit disorders are commonly prescribed developmental disorders. seen in children and adults. It is commonly abbreviated as ADHD for attention deficit hyperactivity disorder. Although ADHD does not go away in adulthood, the vast majority of research on ADHD focuses on how it affects children, particularly of elementary school age. According to the National Institute of Mental Health, attention deficit hyperactivity disorder is a neurologically based disorder characterized by deficits in attention and often accompanied by hyperactivity or impulsivity.

all of which interfere with normal development and normal functioning in children with ADHD. ADHD is diagnosed in children as young as preschool age when it typically reveals itself in hyperactivity. However, there are forms of ADHD that do not include the hyperactivity component. More common in males than females, ADHD has been the subject of a tremendous volume of research in recent years.

It is estimated that approximately 5% of the population can be diagnosed with ADHD. ADHD can cause many problems for people, both in terms of the development of self-esteem and underachievement relative to peers without ADHD. Our focus here is on memory deficits seen in ADHD, most of which center around working memory. Attention Deficit Hyperactivity Disorder, or ADHD, is a neurologically based disorder characterized by deficits in attention, which may include hyperactivity and impulsivity. The prevalence and demographics associated with ADHD is that most research focuses on children either of school age or preschool age, and it's more prevalent in males and females.

and 5% of the population is estimated to have ADHD. The impact of ADHD is that it can lead to issues with self-esteem and also underachievement compared to peers without ADHD, impacting both academic performance and personal development. And there are memory deficits, right? So this is going to be our focus. And most of the deficits related to ADHD are concerned with working memory.

So, one of the major deficits in ADHD occurs in the domain of working memory. Indeed, studies show that people with ADHD have deficits across all components of working memory, from the phonological loop, to the cognitive loop, to the cognitive loop, to to the visual spatial sketchpad to executive functioning. Working memory tasks have shown that deficits in people with ADHD include both the forward and backward digit span, visual working memory tasks, and a host of other working memory deficits.

Working memory deficits in ADHD are also associated with many other issues in ADHD. that cause lifelong problems, including the link between deficits in working memory and reading disorders. Luckily, there do not appear to be deficits in episodic memory in people with ADHD.

So unlike working memory, episodic memory remains relatively intact in individuals with ADHD, showing no significant deficits. So given the host of issues with ADHD and working memory, an important research question is whether or not working memory training can improve working memory in people with ADHD and therefore potentially alleviate some of the other symptoms. The thinking here is that if working memory can be improved in people with ADHD, then it is likely that cognitive deficits that spring from problems with working memory can may also be reduced.

Ackerman and colleagues in 2018 conducted a study that directly addressed this question. In the study, medicated and unmedicated adolescents with ADHD ages 11 through 15 were given working memory training and compared with age-matched controls without ADHD. Working memory training is a practice first introduced in the early 2000s and is now quite standardized. The study was conducted in the United States in the United States of America in the United In the Ackerman and Colleagues study, participants with ADHD were trained on tasks such as the digit span, the backward digit span, and a visual-spatial task known as the Corsi task, in which the participant has to tap pictures of blocks in the same pattern as demonstrated by a computer or the experimenter.

A number of other working memory-related tasks were used as well. In all tasks, the control participants scored higher than patients with ADHD. However, like the control participants, The participants with ADHD improved from pre-training to post-training on all of the tasks. However, for patients with ADHD, improvement was only measured if the participants were medicated.

Unmedicated participants did not show across-the-board improvement. Thus, this study replicated a number of consistent findings concerning people with ADHD and working memory. There is a deficit in working memory with ADHD. Second, working memory can improve performance for both people with and without ADHD.

However, in order for the training to be successful, people with ADHD must be on their medications. Ackerman and colleagues showed that improvements in working memory were reliably correlated with the reduction of other symptoms, such as impulsivity and hyperactivity. Thus, working memory training has additional benefits.

In some, people with ADHD have a primary deficit in attentional control as well as hyperactivity and impulsivity. Because of the deficit in attentional control, they have deficits in working memory, although no comparable deficits in long-term memory processes, such as episodic memory. Direct training of working memory skills can be of use to people with ADHD.

Okay, so the final neuropsychological disorder that we're going to discuss in today's lecture is autism. So autism is a range or spectrum of disorders that develop in young childhood and persist throughout life. which center on deficits in social communication and social interaction including deficits in language emotion perception theory of mind and often repetitive or restrictive behaviors that covers a lot of ground but there is still much debate as to what exactly is autism at its core in severe cases autistic children may be extremely slow to learn language and unresponsive to social cues.

In these extreme cases, some autistic adults may also have a limited ability to use language. In a less severe form of autism known as Asperger's syndrome, intelligence is normal or above normal but people with Asperger's have difficulties with social communication and interaction. Memory problems are not considered a diagnostic characteristic of autism.

Indeed, some people with Asperger's syndrome may have memory abilities in some domains such as encoding into semantic memory that greatly exceed those of typically developing individuals. So, like I said, memory problems are not a core diagnostic feature of autism. Some individuals with Asperger's syndrome in particular may excel. in encoding information into semantic memory in particular. Thus, there is ongoing discussion about the precise nature of autism and its four characteristics, reflecting the complexity and variability within the autism spectrum.

Savant syndrome is a condition in which a person with autism demonstrates extraordinary cognitive abilities, usually in the domain of visual-based semantic memory. For example, Temple Grandin, a professor of animal science at Colorado State University, has been a spokesperson for people with autism for some time. Dr. Grandin claims to have extraordinary visual memory and is a professor of animal being able to remember knowledge and events and replaying them like a movie indeed she characterizes her memory retrieval as being like an internet search syndrome only looking for photographs and not texts Note, of course, that Grandin's self-description is not scientific data, as it is not generated through an experiment.

Other autistic memory savants excel in domains like math and music. One such person is Rex Lewis Clark, a young American piano player. Despite being blind and autistic, Lewis Clark has won numerous awards for his piano playing. Because he is blind, he must memorize all of the music that he plays. Hoppe, 2018, argues that these savant symptoms are more common in people with autism than the general population because people with autism tend to focus on specific details, more than general patterns of meaning or meaning-based processing.

Therefore, autistic savants, develop great encoding skills for specific details such as notes being played in a concerto or the specific details in a visual scene which can then be drawn upon if the individual has developed drawing or painting skills because individuals with autism may have deficits in planning and executive function they focus on details that they are good at There are two common memory deficits observed in people with autism. These deficits seem to cluster into two categories. The first set of deficits has to do with attentional control, with some people with autism showing poor attention to certain details that people without autism would process and then later recall. The second has to do with relational processing.

Both of these may stem from characteristics that drive people away from the normal way from attending to the social aspects of the environment or paying close attention to the meaning of information. Consistent with the idea of intentional control being impacted in people with autism, metamemory accuracy is also lower in people with autism than in comparison samples, at least for episodic memory materials. Other research suggests that people with autism show deficits in relational processing. which can lead to deficits in encoding for meaning-based information. This view is consistent with the experience of Temple Grandin, who describes her visual-based memory, which can be thought of as more similar to item-specific encoding.

The strategies of relational processing, which typically lead to good encoding of episodic information, appear to be compromised in people with autism, leading to poor memory relative to comparison individuals in at least some situations gage and bowler also point out the implications for this when considering people with autism as witnesses because the encoding of people with autism is more item specific than relational more accurate testimony will result from giving them specific cues that capitalize on item specific coding encoding rather than typical free recall instructions. To test the idea that relational processing is damaged in people with autism, Ring and colleagues in 2016 compared people with autism with people that don't have autism. In the study, participants were asked to study a set of three odd shapes placed in juxtaposition together. The task was to find the most suitable shape for the person.

was to be able to remember the shapes later, either in combination or by themselves. The task was set to equalize people with autism with the control condition, as the test used visual stimuli rather than written words, for which the comparisons the control group would have an advantage. Moreover, the nature of the task allowed Ring and colleagues to to compare a test that focuses on relational processing, namely recognizing the combination of shapes, and a test that focuses on item-specific processing, namely recognizing the individual shapes.

In keeping with the hypothesis that people with autism have deficits in relational processing, they scored lower on the test that looked at the order of combinations of shapes. Interestingly, people with autism scored lower on individual object recognition as well, suggesting that relational processing improves performance on that task as well as on that task as well, or that the deficits in memory in autism also sometimes generalize to item-specific processing. Although these data are equivocal in pinpointing relational processes as the problem in encoding for people with autism, they do demonstrate the overall problem with encoding seen in people with autism.

In summary, there is a general pattern of impaired memory performance in people with autism based on poor attention to social factors, deficits in attentional control, and in relational processing. In some people with autism, this is offset by extraordinary memory for item-specific visual information. So, just to summarize, the impact on test performance. was that research such as that conducted by Ring and colleagues in 2016 shows that people with autism perform worse on tasks requiring relational processing, as well as recognizing combinations of shapes.

They also sometimes perform poorly on item-specific tasks, which suggests they may have a general problem with encoding. So, as far as practical implications, for individuals with autism, item-specific memory may be stronger in some contexts, and providing specific cues can enhance accuracy in contexts like eyewitness testimony. However, overall, memory performance in autism tends to be impaired due to deficits in attentional control and relational processing.

So just to summarize what we've talked about thus far, memory deficits in schizophrenia primarily involve working memory and episodic memory, as individuals with schizophrenia often struggle with attentional control and central executive functions affecting their overall memory performance. ADHD is characterized by by significant deficits in working memory affecting all components, including the phonological loop, the visual-spatial sketchpad, and the central executive. And working memory issues in ADHD are linked to broader developmental and functional challenges that fortunately respond well to working memory training.

People with autism show common memory deficits, in attentional control and relational processing. While some may have extraordinary memory abilities in specific domains, overall memory performance can be impaired, particularly when processing relational information.

Transcript for:Memory and Mental Health

Transcript for:
Memory and Mental Health