ICL 10.1: Memory and Consciousness & Amnestic/Dissociative Disorders

Question 1

what things can cause altered consciousness?

Answer 1

1. dissociation –> amnesia, fugue, dissociative identity disorder
2. depersonalization
3. derealization
4. drugs
5. dementia
6. sleep
7. hypnosis
8. meditation

Question 2

what is short term memory?

Answer 2

aka working memory

holds small amount of information in conscious awareness (~ 10-12 seconds)

Question 3

what is long term memory?

Answer 3

considered to have unlimited storage capacity and can hold information over lengthy periods of time

Question 4

what is consolidation?

Answer 4

process where brain forms a permanent (more or less) representation of a memory, initially in hippocampus then cortex

Question 5

what is retrieval?

Answer 5

process of accessing stored memories aka remembering

Question 6

what is amnesia?

Answer 6

“failure of storage and retrieval”

inability to form or retrieve memories of events due to an injury or trauma (hippocampal damage)

Question 7

what is retrograde amnesia?

Answer 7

inability to retrieve memories of events that occurred before an injury or trauma

almost always related to declarative memory

Question 8

what is anterograde amnesia?

Answer 8

inability to form or retrieve memories of events that occur after an injury or trauma

almost always related to declarative memory

Question 9

what is declarative memory?

Answer 9

part of long-term memory containing factual information of people, events; things one can verbalize

associated with temporal lobes

Question 10

what are the subtypes of declarative memory?

Answer 10

1. semantic memory

2. episodic memory

Question 11

what is semantic memory?

Answer 11

part of declarative memory

records impersonal knowledge about the world

it’s a mental dictionary, encyclopedia: names of objects, days of week, math skills, seasons, words/language

Question 12

what is episodic memory?

Answer 12

part of declarative memory

records personal experiences that are linked with specific times and places

“autobiographical” record of personal experiences – stores life events, first date, 21st birthday; allows one to re-experience past events

Question 13

what is non-declarative memory?

Answer 13

aka procedural memory

how to do things that require motor or performance skills like riding a bike, swimming, playing the piano, suturing

associated with cerebellum, basal ganglia, supplementary motor area

Question 14

what is Wernicke-Korsakoff syndrome?

Answer 14

results from deficiency in thiamine (B1) almost always the result of chronic alcoholism

Wernicke = neurological disease (confusion, ataxia, eye abnormalities)

Korsakoff = form of dementia, memory loss

Question 15

what is the clinical presentation of Wernicke-Korsakoff syndrome?

Answer 15

1. pronounced anterograde amnesia (but retrograde amnesia can occur)
2. impairment to declarative memory – procedural/non-declarative remains intact
3. confabulation – patients are “masters” at creative remembering; fabricate stories and facts to make up for those missing from declarative memories

Question 16

what is a dissociative experience?

Answer 16

when a person’s awareness, memory, and personal identity become separated or divided

in dissociative disorders dissociative experiences are extreme, frequent, and disruptive

ex. absorbed in book, movie, game that lose all track of time
ex. daydreaming class and snap out of it only after you are called on for third time
ex. preoccupied with thoughts while driving that when you get to destination you remember little to nothing about the trip (portions of the trip)
ex. you wake up in a strange room and are unable to remember where you are or how you got there (vacation)

Question 17

what is dissociative amnesia?

Answer 17

dissociative amnesia is not the same as simple amnesia which involves a loss of information from memory, usually as the result of disease or injury to the brain

dissociative amnesia involves an inability to recall name, past and information related to personal identity and is typically NOT associated with brain injury/trauma, but with emotional trauma

Question 18

what is a dissociative fugue?

Answer 18

sudden travel from home, plus, confusion about one’s identity

Question 19

what is dissociative identity disorder?

Answer 19

aka multiple personality disorder

2 or more distinct personalities, shifts in consciousness

they are usually “alters” or different ways of coping with trauma

Question 20

what is depersonalization disorder?

Answer 20

feeling as though the body or personal self is strange; they feel disconnected from self

“this isn’t me”; you’re not connected to yourself

Question 21

what is derealization?

Answer 21

perception of objects in the external world are strange and unreal

disconnection from environment

you know who you are but you’re not connected to the world around you

Question 22

She was found in a hotel bathroom unconscious, with no signs of structural or neurologic abnormalities or alcohol or chemical consumption.

The woman could not remember her name, address, family, or any facts about her home life.

The amnesia persisted for nearly 10 months, until the feeling of blood on the woman’s fingers triggered the recollection of events from the night of onset of dissociative amnesia - she remembered having witnessed a murder that night in China. She recalled being unable to help the victim out of fear for her own safety. She came to remember other aspects of her life; however, some memories remained elusive.

Answer 22

dissociative amnesia

she lost connection to her episode memory, autobiographical memory, etc.

there was a real disconnect

she was using the repression defense! memory of the event and of herself were repressed subconsciously without awareness

Question 23

A 19-year-old college student suffered from sleep deprivation at the onset of depersonalization disorder. The young man experienced increased anxiety as he struggled to meet his responsibilities as a scholarship-dependent student athlete. Teammates expressed concern about his apparent distress to their coach, who arranged for the young man to speak with a therapist. The young man described feeling as though he were observing the interactions of others as if it were a film. The young man’s anxiety was determined to contribute to severe sleep deprivation, which triggered episodes of depersonalization.

Answer 23

depersonalization disorder

being disconnected from others, from my feelings and thoughts; you feel like someone else is talking and has taken over your body; you’re not connected to your words

derealization is about being disconnected from the environment; you know who you are and where you are but this bedroom may seem strange to you as you sit in it; all of the stuff seems unreal and strange

Question 24

how do you treat dissociative disorders?

Answer 24

generally treated with long-term psychotherapy including cognitive behavioral therapy (CBT), insight-oriented therapies, dialectical behavioral therapy (DBT), hypnotherapy

unlike DID, the length of an event of dissociative amnesia may be a few minutes or several years. If an episode is associated with a traumatic event, the amnesia may clear up when the person is removed from the traumatic situation. Similarly, once dissociative fugue is discovered and treated, many people recover quickly

medications can be used for comorbid (co-occurring) disorders and/or targeted symptom relief – these medications (such as antidepressants, anti-anxiety medications, or tranquilizers) can help control the mental health symptoms associated with the disorders; however, there are no medications that specifically treat dissociative disorders

Question 25

how do you treat dissociative identity disorder?

Answer 25

the majority of individuals with the disorder seek treatment for other psychological problems, such as depression, and DID is often difficult to detect. It may take a therapist years to notice symptoms of DID

there is a general lack of consensus in the treatment of DID, and research on treatment effectiveness focuses mainly on clinical approaches described in case studies

general treatment guidelines suggest a phased, eclectic approach with more concrete guidance and agreement on early stage; however no systematic, empirically-supported approach exists, and later stages of treatment have no consensus

even highly experienced therapists have few patients that achieve a unified identity

Question 26

what is the DSM5 criteria for dissociative identity disorder?

Answer 26

characterized by distinct episodes where one feels somehow separated from self, environment or thoughts and feelings

1. disruption of Identity characterized by two or more distinct personality states, which some cultures may describe as an experience of possession. There is a marked discontinuity in sense of self and with alterations in affect, behavior, consciousness, memory, perception, cognition and/or sensory motor function
2. recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting
3. symptoms cause clinically significant distress or impairment in social, occupational or other areas of functioning
4. the disturbance is not a normal part of broadly accepted cultural or religious practice
5. not due to effects of substances

Question 27

what is the DSM5 criteria for dissociative amnesia?

Answer 27

1. an inability to recall important autobiographical information, usually of a traumatic or stressful nature, not simply forgetting
2. the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
3. the episode is not attributable to the physiological effects of a substance or another medical condition

Question 28

what is the DSM5 criteria for dissociative fugue?

Answer 28

the same DSM5 criteria as dissociative amnesia but also includes purposeful travel or bewildered wandering away form home with amnesia for identity (autobiographical information)

Question 29

what is the DSM5 criteria for depersonalization/derealization disorder?

Answer 29

A. Presence of persistent or recurrent experiences of depersonalization, derealization, or both:

1. depersonalization: feeling unreal, detached, an observer of self; feeling detached from oneself (one has an awareness of this)
2. derealization: experiencing an unreality or detachment with respect to one’s surroundings

B. during these experiences, reality testing remains intact

C. the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

D. the episode is not attributable to the physiological effects of a substance, medication or another medical condition