Psychiatry - H.T. Sonnyk 2003

General psychopathology and symptomatology of mental illnesses
Disorders of memory, attention, and intellect

Memory impairments.

Memory is a mental process involving the encoding, retention, and retrieval of past experiences, learned information, and other data.

Memory is closely linked to plasticity—a fundamental property of the Central Nervous system that enables it to change in response to stimuli and retain their traces. The core Functions of memory include encoding (memorization), retention, reproduction (recall), recognition, and forgetting (the elimination of unnecessary information).

Retention depends on The formation of a network of connections among individual Neurons, neuronal clusters, and various sensory analyzers. Retrieval is driven by the disinhibition of those temporary neural connections established during the retention phase.

Memory is generally divided into long-term and short-term types. Short-term memory relies on the Circulation of impulses through closed neural circuits, whereas long-term memory is sustained by RNA Synthesis. Working memory is a specialized variant of short-term memory; it utilizes information drawn from both long-term and short-term memory stores to accomplish specific cognitive tasks.

Dysfunction in any of these components leads to memory disorders. These disorders are broadly classified into hypermnesia (enhancement), hypomnesia and amnesia (reduction or loss), and paramnesia (distortion of memory).

Hypermnesia is a pathological enhancement of memory, commonly observed in affective psychoses, and occasionally in oligophrenia and Epilepsy.

Manic patients quickly encode, retain, and recall dates and events from their own lives. In depression, selective hypermnesia may occur; for instance, delusions of self-blame are often accompanied by vivid recollections of past mistakes. Hypermnesia is also seen in epileptic dysphoria, where patients recall the most trivial slights and unpleasant events.

Hypomnesia refers to memory weakening or regression. This condition typically follows a progressive trajectory and may eventually culminate in amnesia.

Ribot outlined four stages in the progression of hypomnesia:

1) Impairment of selective recall, making it difficult to retrieve contextually relevant information. Current events are forgotten (such as where an item was placed or what was recently eaten), while remote memories remain intact.

2) Difficulty in accessing past experiences and chronological sequences. Foreign languages, biographical details, and scientific knowledge begin to fade. Patients struggle to accurately place memories in time. While fragmentary memories persist, emotionally positive events are recalled most clearly.

3) Loss of the entire knowledge base, including dates and events. Deceased individuals are often believed to be alive, and patients lose orientation in time and even immediate surroundings—a state known as amnestic disorientation.

4) Complete reduction of memory, resulting in total amnesia.

Progressive hypomnesia occurs in senile psychoses, cerebral atherosclerosis, primary degenerative dementias (such as Pick's and Alzheimer's diseases), and progressive organic Brain disorders (including encephalitis, traumatic brain injury, and alcoholic encephalopathy). Mild hypomnesia is typically associated with neuroses, depressive affective psychoses, exhaustion, and fatigue.

Amnesia is characterized by gaps in memory—the loss of recollection for specific time intervals or particular emotional experiences.

Based on their underlying mechanisms, amnesias are divided into two main groups:

1. Fixation amnesia — the inability to form new memories, resulting in a complete lack of memory for current events.

2. Reproductive amnesias. Depending on their onset relative to the causative event, they are classified as retrograde, anterograde, anterograde-retrograde, retarded amnesia, and anecphoria.

Retrograde amnesia — the loss of memory for events that occurred prior to the onset of the illness.

Anterograde amnesia — the loss of memory for events occurring after the onset of the illness.

Anterograde-retrograde amnesia — a combination of both anterograde and retrograde amnesia, involving the loss of memories from both before and after the onset of the illness.

Retarded amnesia — a delayed form of amnesia characterized by the patient's ability to vividly describe past experiences (such as hallucinations or terror) immediately after recovering from a state of altered consciousness, only to forget them later.

Anecphoria — a memory impairment, primarily affecting retrieval, where specific events or mental images can only be recalled when explicitly prompted.

Specific types of amnesia:

Systemic amnesia is a memory loss associated with psychological trauma, which applies not to specific time intervals, but to particular details and contents, while the general situation is retained in memory.

Alternating amnesia: the patient does not remember their behavior during a state that is opposite to the one they are in at the time of examination. For instance, the patient is cheerful, active, and talkative, but after Sleep, they become calm and fail to recall themselves being cheerful.

Psychogenic amnesia (repressive amnesia, affectogenic amnesia): following psychological trauma, an individual forgets events that carry traumatic content.

Perforation amnesia: the omission of certain events resulting from The Use of psychoactive substances (such as alcohol).

Paramnesias: a pathological mental state manifested by memory disorders resulting from amnesia, where memory gaps are filled with false memories. Paramnesias are subdivided into confabulations, pseudoreminiscences, cryptomnesias, and phantasms.

Confabulation: a memory disorder characterized by filling memory gaps with fabricated memories and experiences of a fantastic nature. Occasionally, confabulatory confusion may develop—an influx of fabrications accompanied by false recognition of surroundings and people. It occurs in senile psychoses and forms part of The Structure of paraphrenic syndrome (confabulatory paraphrenia).

Pseudoreminiscence: false memories of a realistic nature regarding events that did not actually occur in the time period recalled by the patient, although they did take place or could have happened in the past. Pseudoreminiscences frequently fill the patient's memory gaps and are not always easily distinguishable from confabulations.

Cryptomnesia: a memory disorder in which what has been read, heard, or seen in a dream is perceived as having actually been experienced, while facts or thoughts borrowed from others or read in a book are considered one's own. Cryptomnesia is caused by memory errors and should not be equated with deliberate, conscious fabrication or plagiarism.

Paralytic fantasies: absurd fabrications that arise in cases of pronounced dementia, such as in progressive paralysis.

Hysterical phantasms: various fabrications of extraordinary events that never actually happened, driven by a desire to place oneself at the center of attention. This is observed in hysteria and hysterical psychopathy. With vivid emotional intensity, the patient experiences their false perception as something authentic.