Psychiatry - O. K. Napryeyenko 2001

General Psychiatry
Memory and Attention Disorders

Memory is the mental process of encoding (fixation), retaining (retention), retrieving (reproduction), and recognizing information traces. Much like perception reflects objective reality in the present moment, memory reconstructs previously perceived reality. It bridges the past and the present, gives human experience continuity, serves as the foundation of mental development, and constitutes one of the core prerequisites of intellect.

The following types of memory are distinguished:

✵ motor memory (manifested as The ability to reproduce movements and behavior, forming The basis of skills and habits);

✵ visual (sensory) memory;

✵ emotional (affective) memory;

✵ logical memory;

✵ mechanical memory (unlike logical memory, it relies on rote memorization without connecting material according to logical laws).

Based on The Nature of dominant activity, one can also speak of Other types of memory (auditory, visual, gustatory, olfactory, tactile, and kinesthetic—the sense of body position in space).

During encoding, new information is fixed and consolidated by linking it with previously acquired knowledge. The memorization process can be either involuntary or voluntary. Voluntary memorization is purposeful, whereas involuntary memorization lacks a specific goal and occurs seemingly "on its own."

There are two MAIN TYPES OF memory retention: short-term and long-term memory. Short-term memory is characterized by the retention of information from a few seconds to one or two days. This working memory is associated with the Circulation of bioelectric impulses through closed Neural Pathways. If this process lasts long enough, its traces undergo irreversible structural Changes in the protein molecules of Neurons, becoming consolidated and forming the basis of long-term memory. Information is stored in this type of memory for months or years. The retrieval process involves activating long-term memory material and transferring it to working memory. Retrieval is closely linked to the retention and encoding of material.

The processes of encoding, retrieval, and recognition are active components of memory. The state of consciousness plays a crucial role in them. In the event of a complete loss of consciousness for a given period, memories are absent. In cases of partial impairment, encoding and reproduction are fragmentary, and memories remain incomplete and inaccurate.

The morphofunctional basis of memory is the coordinated functioning of a complex Brain apparatus—the cortical centers of analyzers, the Papez circuit structures (hippocampus, mammillary bodies, Hypothalamus, cingulate gyrus), the reticular formation, and glial elements of the brain.

Normal memory varies among individuals. It is influenced by factors such as training, emotions, fatigue, Sleep deprivation, as well as somatic and neuropsychiatric disorders. Memory changes significantly with age. Impairments may manifest as greater or lesser disorders of its components. In old age, the ability to encode new material about current events is more frequently impaired, while the capacity to recall impressions of the past remains intact.

In Clinical Psychiatry, the following memory pathologies are distinguished:

1) hypermnesia;

2) hypomnesia and amnesias (retrograde, anterograde, anteroretrograde, retarded, fixation, progressive);

3) paramnesias (pseudoreminiscences, confabulations, cryptomnesias).

Hypermnesia, hypomnesia, and amnesias are classified as quantitative memory disorders, whereas paramnesias are qualitative disorders.

Hypermnesia manifests as an enhanced ability to retrieve information from the past, often accompanied by an increased capacity for encoding. It is observed in manic states (bipolar affective disorder), Schizophrenia with affective fluctuations, and fever.

Hypomnesia (weakening of memory) is manifested by difficulties in encoding or retrieving material, or it may affect both processes simultaneously. It is observed in asthenic and depressive states, vascular and organic brain diseases, and the Cytology/cytology/16.html">Early stages of senile dementia. Such patients struggle to acquire new information and recall events in an incomplete, blurred manner.

Amnesia is the loss of memory for events over a specific period. It occurs in organic brain lesions, chronic alcoholism, and following the loss or clouding of consciousness. When memory loss refers to events preceding the impairment of consciousness, it is termed retrograde amnesia. Anterograde amnesia is characterized by memory gaps for the period following the restoration of consciousness. The combination of both conditions is defined as anteroretrograde amnesia. If memory impairment arises some time after regaining consciousness, retarded amnesia is diagnosed.

Fixation amnesia refers to the loss of the ability to encode current events, dates, and names.

Progressive amnesia is characterized by a progressive loss of the ability to memorize, accompanied by the gradual depletion of memory reserves. This process occurs in the reverse order of memory acquisition—ranging from recently acquired information to older memories (the law of regression of memory, or Ribot's law). The last material to be lost is long-acquired, well-organized memory related to automated skills.

Anekforia is a memory disorder (primarily affecting retrieval) in which specific events or images are recalled only when prompted by the recollections of other people.

Systemic amnesia is a memory loss associated with psychological trauma that affects not specific time intervals, but rather the content of specific details. Memory of the general situation remains preserved.

Amnesia affecting a specific time frame is observed in paroxysmal and twilight states of consciousness, Epilepsy, HEAD trauma, severe brain infections, and pathological intoxication. Persistent memory decline is characteristic of cerebral atherosclerosis, cerebral Syphilis, progressive paralysis, severe chronic intoxications, and epileptic dementia.

Qualitative memory disorders include paramnesias, which are distortions or illusions of memory. These comprise pseudoreminiscences, confabulations, and cryptomnesias.

Pseudoreminiscences are the simplest and most common type of paramnesias. They are characterized by a false recollection of time, wherein a long-past event is recalled as having occurred recently. A patient who has spent a long time in a psychiatric hospital, when asked what they did the previous evening, recounts a visit to the cinema, meeting colleagues, or some other entirely real event from their past.

In confabulation, memory gaps are filled with fantastic, invented recollections. The content of a confabulation may involve incredible events that never actually happened and could not have occurred in the patient's life (meetings with prominent figures, brilliant discoveries, extraordinary adventures). Such fantastic confabulations are observed in progressive amnesia and certain types of Thought Disorders (paranoid-hallucinatory syndrome / paraphrenic delusions).

Cryptomnesia is a memory distortion manifested by its weakening and the loss of the distinction between events actually experienced by the patient and those heard about, seen in a dream, or read. In some cases, what was heard, seen, or read is recalled as an event from one's own biography (The Mechanism of appropriation); in other cases, conversely, real events from the patient's life are recalled as having been heard, seen, or read, or as having happened to other people (the mechanism of alienation).

The so-called reduplicative paramnesias have been described, in which the patient reproduces the same events in various versions—as being identical and yet different at the same time. This type of paramnesia is closely related to the aforementioned phenomenon of derealization.

Hysterical phantasms involve inventing extraordinary events that never actually occurred, driven by a desire to put oneself in the center of attention. This is observed in hysteria and hysterical personality disorder. The patient vividly experiences their fictitious perception as something plausible.

Paralytic phantasms involve inventing absurd content characteristic of dementia. This is observed, for example, in progressive paralysis.

Memory disorders include, in particular, Korsakoff's amnesic syndrome in chronic alcoholism, first described in 1887. It is characterized by a combination of fixation, retrograde, and anterograde amnesia, amnesic disorientation, and paramnesias (pseudoreminiscences, confabulations). Korsakoff's syndrome is frequently accompanied by confabulatory confusion, fatigability, lethargy, inactivity, and sometimes euphoria. In addition to chronic alcoholism, Korsakoff's amnesic syndrome also occurs in other organic brain lesions, intoxications, tumors, and progressive paralysis.

Attention is a form of Organization of mental processes manifested through selectivity, a specific degree of concentration, and relative stability. As an organizing factor of active behavior, attention makes it possible to focus on an object that, in turn, is capable of attracting attention.

Conditioned connections that arise upon the repeated satisfaction of a need determine the concentration and selectivity of the act of attention, which fundamentally originates as an orienting reflex. The selectivity of attention stems from The formation of a source of excitation—a dominant focus—in the Cerebral Cortex. The concentration of attention is associated with intensified excitation within the dominant focus, accompanied by the inhibition of other cortical areas. The relative stability of attention depends on the ability of the dominant focus to maintain excitation. Traditionally, passive and active attention are distinguished.

Passive attention is essentially an unconditioned orienting reflex to stimuli of vital significance. The primary need for self-preservation compels the Organism to orient itself—to pay attention. Active attention involves intent and carries an element of creativity. In this case, attention is directed toward the object through the conscious organization of mental activity, which is shaped in The process of social experience, taking into account interests, Background, and profession. A person learns to concentrate attention not necessarily on high-intensity stimuli, but also on weak ones if they are relevant to the activity. Within the norm, attention varies among individuals. It changes in the same person depending on their interest in the object, mood, state of consciousness, fatigue, and the intake of alcohol, drugs, or medications.

Attention is a complex function. It comprises A number of qualities, namely: span; distribution; shifting; concentration; stability.

An important quality is the span of attention—the ability to grasp a number of objects simultaneously. Associated with this characteristic is the distribution (shifting/dividing) of attention, which consists of the ability to monitor objects of different natures simultaneously. The skill of dividing attention is individual and can be improved through training.

Of great importance for mental activity is the ability to switch attention from one object to another. Normally, this occurs purposefully, while maintaining concentration and stability.

The concentration and stability of attention provide the capacity to focus in a particular direction for a prolonged period. Insufficient stability of attention leads to distractibility and inattentiveness.

The following forms of disorders of active attention are observed.

Distractibility of attention is an excessive lability of attention, shifting it rapidly from one object to another. It is characteristic of the manic phase of manic-depressive psychosis. The reverse phenomenon—sluggishness of attention—is observed in the depressive phase of the same bipolar disorder, as well as in chronic epidemic encephalitis and other organic brain lesions.

Insufficient capacity for shifting attention (inertia) is associated with rigidity of thought and a tendency toward circumstantiality, and is inherent in patients with epilepsy and organic brain lesions. A reduction in attention and impairments in its distribution are observed in vascular brain disorders, particularly cerebral atherosclerosis.

Exhaustibility of attention is typical of asthenic patients with severe, prolonged somatic illnesses, those suffering from neurasthenia, and individuals with organic brain lesions.

Aprosexia is the complete loss of attention.

Pronounced dementia is accompanied by the complete disintegration of active attention. Passive attention remains intact longer, with the patient still turning toward a source of intense light or sound.

A peculiar distortion of attention is observed in schizophrenia. The patient focuses on pathological experiences (hallucinations, obsessive-compulsive states, delusions). In some cases, schizophrenia is also accompanied by a general weakening of attention, its distractibility, and sluggishness.

Review Questions

1. The definition of memory, its types, and processes.

2. Classification of memory disorders.

3. Acute episodic amnesia.

4. Transient amnesias.

5. Progressive amnesia.

6. Paramnesias — pseudoreminiscences, confabulations, cryptomnesias, reduplicative paramnesias.

7. Definition of attention, its types, and properties.

8. Attention disorders. Diseases characterized by impairments in attention and memory.