1. By Dr Salman Kareem
1st yr Resident PG
Department of Psychiatry

2. Disorder of Memory

3. memory
 Seven stages in memory
1. Adequate perception , comprehension, and response to
the material to be learned.
2. Short term storage
3. Formation of durable trace
4. Consolidation
5. Recognition that certain materials need to be recalled
6. Isolation of the relevant memory
7. Using the recalled material

4. Types
 Memory is of 3 types
i. Sensory
ii. Short term
iii. Long term

5. Sensory type
 Registered for each of the sense and its purpose is to
facilitate the rapid processing of incoming stimuli so
that the comparison can be made with material
already stored in short and long term memory.
 Fades within few seconds.
 Closely related to attention.

6. Short term memory
 Working memory/ primary memory
 For the storage of memory much longer than the few
seconds available to sensory memory.
 Aids the constant updating of one’s surroundings.

7. Long term memory
 When memories are rehearsed in the short term they
are encoded in the long term memory.
 Encoding is a process of placing information into what
is believed to be a limitless memory reservoir.
 Storage of material in long term memory allows for
recall of events from the past and for utilization of
information learned through educational system.

8.  Autobiographical memories- memories of events
that relate to oneself
 Flashbulb memories- specific type of
autobiographical memory in which the person
becomes aware of an emotionally arousing event.

9. Explicit memory
 Declarative/rational memory
 Patient is conscious that they are remembering.
 Hippocampus - stored
 2 types
i. Episodic memory- memory of specific events
ii. Semantic memory- memory of abstract facts

10. Implicit Memory
 Procedural/skills
 Limbic system (amygdala + cerebellum)
 Performance of tasks such as typing, swimming and
cutting a loaf of bread are also expressions of prior
learning but there is no active awareness of memory is
being reached in undertaking the particular skill.

11.  Process of remembering has 4 parts
i. Registration
ii. Retention
iii. Retrieval
iv. Recall

12. AMNESIA
 Partial or total inability to recall part experience and
events.
1. Organic
2. Psychogenic

13. Normal Memory failure
 If an item is not rehearsed the memory fades and
therefore cannot be retrieved.
 Normal memory decay
Proactive interference – old memories interfere with new
learning and hence recall.
Retroactive interference – new memories interfere with
learning of new material.

14. 1) Psychogenic amnesia
(i) Anxiety amnesia
 Psychogenic reactions
 Morbid anxiety- particularly in depressive illness.

15. (ii) Katathymic amnesia
 Motivated forgetting
 A set of ideas which are disturbing when conscious are
repressed in an attempt to avoid the affect which they
would otherwise produce.
 More persistent and circumscribed
 Conscious motivation to forget – suppression or
unconscious motivation – primary repression.
 No loss of personal identity
 Hysteria
 Normal persons with painful memories

16. (iii) Hysterical Amnesia
 Dissociative amnesia
 There is a complete loss of memory and personal
identity but the patient can carry out complicated
patterns of behavior and is unable to look after
himself.
 Often associated with fugue or wandering state.
 More common in those with prior history of head
injury.

17. 2) ORGANIC AMNESIA
(i)Acute coarse brain disease
Poor memory is due to disorders of perception and
attention and the failure to make a permanent trace.
Retrograde amnesia
Acute head injury
Amnesia which embraces the events just before the
injury
Disturbance of short term memory loss

18. Post traumatic amnesia:
 the period between loss of consciousness and
appearance of full awareness and memory
 duration is directly related to severity of the head
injury.

19.  Anterograde amnesia
Events occurring after the injury.
The patient is fully conscious ,but has no memory for
the events which occur.
Result of failure to make permanent traces.
Seen in
 Alcoholic blackout
 Delirium
 Twilight state due to epilepsy
 Pathological drunkenness

20. Transient global amnesia
 A sudden onset of retrograde amnesia covering a period of
few days upto several years.
 Perception and personal identity remain normal.
 An anterograde amnesia continues until recovery (up to
several hours)
 The amnesia subsequently shrinks to a period of half to 5
hours.
 Some pts there is evidence of ischemia in the territory of
the posterior cerebral circulation
 The immediate cause is probably b/l temporal or thalamic
lesions.

21. Sub acute coarse brain disease
 The pt is unable to register new memories.
 The memory disorder is characterized by inability to earn
new information (anterograde amnesia) and old
information (retrograde amnesia)
 Memories from remote past remains intact.
 Seen in
 Korsakoff’s syndrome
 CVA
 Multiple sclerosis
 Head injury
 ECT

22.  Chronic Coarse Brain disease
 The amnesia extends over many years.
 Ribot’s law of memory regression: In dementing
illness the memory of recent events is lost before the
memory for remote events.

23. Distortion of memories
 Paramnesia
 Falsification of memory by distortion.
I. Distortion of recall
II. Distortion of recognition.

24. Distortion of recall
 Retrospective falsification.
 Retrospective delusions
 Délusion memories
 Confabulations

25. Retrospective falsification
 The subject modifies his memories in terms of his general
attitudes.
 Unintentional and dependent on person’s current
emotional experiential and cognitive state.
 Seen in
 Normal people - degree of retrospective falsification is
inversely related to the degree of insight and self criticism of
the individual
 Hysterical personality
 Depressive illness
 Agitated depression
 Mania

26. Retrospective delusions
 The pt dates back his delusions.
 Could be regarded as delusional retrospective
falsification.
 schizophrenia

27. Confabulations
 Pictorial thinking (Leonard) , Memory Hallucinations
(Bleuler)
 A false description of an event , which is alleged to have
occurred in the past.
 Filling in of gaps in memory by imagined or untrue
experiences.
 Diminishes as the impairment worsens.
 2 broad patterns emerge – embarrassed type in which the
patient tries to fill in gaps as memory as a result of an
awareness of a deficit , fantastic type in which the lacunae
is filled by details exceeding the need of memory
impairment.

28.  Embarrased is more common.
 Seen in
 Organic states
 Hysterical psychopaths
 Amnestic syndrome
 Chronic schizophrenia

29.  False memory- recollection of an event which did not
occur which the individual believes did take place.
 Screen memory- recollection that is partially true and
partially false.
 Pseudologia fantastica- fluent plausible lying that
occurs in those without organic brain pathology such
as personality disorder of anti social and hysterical
type.

30.  Munchausen’s syndrome- variant of pathological
lying in which the individual presents to the hospital
with bogus medical illness , complex medical histories
and often multiple surgical scars.

31. Ganser’s Syndrome
 Voibereden/ approximate answers - Pt understands the
question but deliberately avoids the correct answer
 Clouding of consciousness with disorientation
 Auditory and visual hallucination
 Amnesia during the period for which symptoms were
manifest.
 Seen in
 hysterical pseudo dementia
 Conversion symptoms
 Recent head injury
 Infection
 Severe emotional stress

32.  Cryptamnesia- experience of not remembering that
one is remembering.
 Hyperamnesia – Exaggerated registration, retention
and recall.

33. Disorders of recognition.
Déjà vu
 The subject has the experience that he has seen or
experienced the current situation before, although it
has no basis in fact.
 The sense of recognition is never absolute.
 Normal people
 Temporal lobe lesions

34.  Jamais vu – event that has been associated before is
not experienced with appropriate feelings of
familiarity.
 Déjà entendu : feeling of auditory hallucination
 Deja pense – new thought as having been previously
occurred.

35. Misidentification
 Positive misidentification
 Negative misidentification.

36. Positive misidentification
 Pt recognizes strangers as his friends and relatives
 Some pts assert that all of the people whom they meet
are doubles of real people.
 Confusional state
 Acute schizophrenia
 Chronic schizophrenia

37. Negative misidentification
 Pt denies that his friends and relatives are people
whom they say they are and insists they are strangers
in disguise
 Excessive concretization of memory images.

39. consciousness
 A state of awareness of the self and the environment.
 Active consciousness – when the subject focuses his
attention on some internal or external event.
 Passive consciousness: when the same events attract
the subject’s attention without any conscious effort on
his part.

40. Distractability
 Disturbance of active attention
 the pt is diverted by almost all new stimuli and habituation
to new stimuli takes longer than usual.
 Seen in
 Fatigue
 Anxiety
 Severe depression
 Mania
 Schizophrenia
 Organic states

41. Orientation
 Capacity of a person to gauge accurately the time space
and person in his current setting.
 Time –
 Is labile
 Quite readily disturbed by
 rapt concentration.
 Strong emotion
 Organic brain factors.

42.  Space
 Disturbed later than time
 Unable to find his way or place
 Person
 Patient fails to remember his own name and identity.
 Lost with greatest difficulty,

43. Ways which consciousness can be changed
 Dream like changes of consciousness
 Lowering of consciousness
 Restriction of consciousness

44. Dream like changes of
consciousness
 There is a lowering of the level of consciousness which
is a subjective experience of a rise in the threshold for
all incoming stimuli
 Pt is disoriented for time place , but not for person.
 Clinical features
 Visual hallucination
 Unable to distinguish between mental image and
perceptions.

45.  Disordered thinking as in dream showing excessive
displacement, condensation and misuse of symbols.
 Auditory hallucinations – common elementary rarely
continuous voices, organized hallucinations take form
off odd disconnected words or phrases.
 Other hallucinations of touch , pain, electric feelings,
muscle sense and vestibular sensations often occur.
 When underlying physical illness is severe, insomnia is
marked.

46.  Occupational delirium : when the pt is restless and
carries out the actions of his trade.
 Subacute delirious state : mild degree of delirium ,
where pt may have a general lowering of consciousness
during the day and be incoherent and confused, while
at night delirium often occurs with visual
hallucinations.

47. Lowering of consciousness
 Pt is apathetic, generally slowed down , unable to
express himself clearly and may perseverate.
 After some weeks there is remarkable partial recovery
and the pt is left with mild organic defect.
 Seen in
 Severe infections, like typhoid and typhus
 Arteriosclerotic disease following CVA

48. Restriction of consciousness
 There is some lowering down of level of consciousness
and the awareness is narrowed down to few ideas and
attitudes which dominate the pts mind.
 Twilight state : there is a
• A restriction of the morbidity changed consciousness
• A break in the continuity of consciousness
• Relatively well ordered behaviour.
• Commonest- epilepsy

49.  Hysterical twilight state: the restriction of
consciousness resulting from unconscious motives

50. The End