Amnesia

Gavin C. M. McKay and Michael D. Kopelman APT 2009, 15:152-158. Access the most recent version at DOI: 10.1192/apt.bp.105.001586

Psychogenic amnesia: when memory complaints are medically unexplained

References Reprints/ permissions You can respond to this article at Downloaded from

This article cites 0 articles, 0 of which you can access for free at:http://apt.rcpsych.org/content/15/2/152#BIBL To obtain reprints or permission to reproduce material from this paper, please write to permissions@rcpsych.ac.uk http://apt.rcpsych.org/cgi/eletter-submit/15/2/152 http://apt.rcpsych.org/ on August 18, 2012 Published by The Royal College of Psychiatrists

To subscribe to Adv. Psychiatr. Treat. go to: http://apt.rcpsych.org/site/subscriptions/

Advances in psychiatric treatment(2009), vol. 15, 152–158 doi: 10.1192/apt.bp.105.001586

ARTICLE

Psychogenic amnesia: when memory complaints are medically unexplained
Gavin C. M. McKay & Michael D. Kopelman
SuMMARy

Gavin C. M. McKay was a Specialist Registrar in Neuropsychiatry at the Memory Disorders Clinic at St Thomas’ Hospital. He has obtained his certificate of completion of training and is now a locum consultant ingeneral adult psychiatry, maintaining a special interest in neuropsychiatry. Michael D. Kopelman is Professor of Neuropsychiatry at the Institute of Psychiatry, King’s College London, and Consultant Neuropsychiatrist with the South London and Maudsley NHS Foundation Trust, based at the Neuropsychiatry and Memory Disorders Clinic at St Thomas’ Hospital, London. Professor Kopelman has published widelyon many aspects of memory disorders (including the amnesic syndrome, Alzheimer’s and semantic dementia, confabulation, psychogenic amnesia, amnesia for offences, and false confessions), as well as calculation disorders, sleep disorder, post-traumatic stress disorder and neuroimaging. Correspondence Dr Gavin McKay, Mascalls Park, Mascalls Lane, Brentwood, Essex CM14 5HQ, UK. Email:Gavin@doctors.org.uk

The focus of this article is the assessment and management of medically unexplained (‘psychogenic’) amnesia, which we classify here as global or situation specific. Other psychiatric causes for memory disorder and neurological conditions that could cause diagnostic confusion are briefly reviewed, as are forensic aspects of memory complaints. Finally, brain and physiological mechanismspotentially associated with psychogenic amnesia are discussed.
DECLARATIon of InTEREST

loss, which we refer to here as ‘psychogenic’ amnesia (i.e. loss not due to identifiable brain disease).

Why ‘psychogenic’?
A number of terms have been used to describe medically unexplained amnesia, including ‘hysterical’, ‘psychogenic’, ‘dissociative’ and ‘functional’. Each requires the exclusion of anunderlying neurological cause and the identification of a precipitating stress that has resulted in amnesia. Unfortunately, the presence of amnesia may make it difficult to identify the stress until either informants have come forward or the amnesia itself has resolved. Both DSM–IV (American Psychiatric Association, 2000) and ICD–10 (World Health Organization, 1992) favour the term ‘dissociative’amnesia. Some have argued strongly for ‘functional’ amnesia as a description more acceptable to patients (Stone 2005). Others prefer ‘medically unexplained amnesia’. We favour ‘psychogenic’ amnesia, because it points to underlying psychological processes without assuming that any particular psychological mechanism is involved (a difficulty with ‘dissociative’ amnesia). Also, it does not specifywhether the memory loss is produced (partly or entirely) consciously (‘factitious’ or ‘exaggerated’ amnesia) or purely unconsciously (‘hysterical’ amnesia). The term ‘functional’ amnesia has the problem that the amnesia could in many respects be considered dysfunctional. However, regardless of the term used, the question remains, at what point, in cases of doubt, should the clinician assume that a...