Session Eight (Anomalies of Autobiographical Memory)

Question 1

What are the 4 important anomalies of autobiographical memory?

Answer 1

1) Psychogenic Amnesia
2) Confabulation
3) Delusional Memory
4) False Confession

Question 2

What are the factors strongly associated with Psychogenic Amnesia?

Answer 2

• Extreme emotion or stress
• Depression
• Past history of transient organic amnesia
• (possibly) Damage to the frontal lobe control mechanisms

Question 3

Distinguish Confabulation from Delusional Memory?

Answer 3

Confabulation has a Neurocognitive cause

Delusional Memory is caused by Psychosis

Question 4

What are the two forms of Confabulation?

Answer 4

• Spontaneous (a persistent and unprovoked outpouring of erroneous memories. patients will normally launch right into these without being asked a question)
• Momentary (fleeting intrusion errors or distortions, produced in response to a challenge to memory. seen in memory tests)

Question 5

Very briefly outline the factors that can lead someone into making a false confession?

Answer 5

• Individual factors, such as depression and low self-esteem
• Situational factors, such as police interviews or the crime being widely publicised
• These combine to produce source memory errors, which lead to the person internalising these false memories and confessing to something they didn’t do.

Question 6

Define Psychogenic Amnesia and outline the two broad types?

Answer 6

PA = A disorder characterised by abnormal memory functioning in the absence of structural brain damage or a known neurobiological cause.

Two types:

• Global (which includes Focal Retrograde Amnesia and Fugue States)
• Situation-Specific (seen most commonly relating to crimes, either in victims or perpetrators. Common in PTSD as well)

Question 7

What is a ‘Fugue State’?

Answer 7

A syndrome consisting of:

• Sudden memory loss, of both autobiographical memory AND the sense of personal identity
• Normally associated with a period of ‘wandering’
• Lasting a few hours-days and no longer
• And leaving the patient with a subsequent amnesic gap on recovery for the period of the fugue

Question 8

What factors predispose someone to entering a Fugue State?

Answer 8

• Severe precipitating stress (e.g. Marital, Financial, War)
• Depression (especially Suicidal Ideation)
• History of transient organic amnesia (e.g. previous head injury, alcohol issues, epilepsy)

+/- some possible personality factors

Question 9

Give some of the key features of Psychogenic Amnesia?

Answer 9

• Islets of preserved memory (will remember some small details e.g. “I’m here to meet someone but I can’t remember my name”)
• Semantic knowledge is sometimes preserved, sometimes impaired.
• Procedural knowledge unaffected
• Responsive to cueing (i.e. will recover memory based on random cues in the world around them)

Question 10

What are the two important types of global psychogenic amnesia?

Answer 10

Fugue State and Focal Retrograde Amnesia. Main difference is in FRA you don’t see Antegrade amnesia and the memory disorder is more persistent.

Question 11

What is Focal Retrograde Amnesia?

Answer 11

• RA in the absence of any antegrade memory loss
• Sometimes accompanied by an initial loss of personality identity
• Unlike fugue state, memory disorder persists
• Often follows a mild concussion or other such cerebral event
• Brain imaging usually normal

Question 12

How common is amnesia in homicide suspects?

Answer 12

23-47% of cases.

Also quite common in other violent crimes, rarely seen in non-violent crimes

Question 13

In what sorts of homicide cases is amnesia sometimes seen?

Answer 13

• Crimes of Passion (tend to be unpremeditated, committed in a state of extreme emotional arousal, often against a family member or spouse. Amnesia usually lasts a few minutes to an hour)
• Alcoholic or Drug Intoxication cases (normally in someone with a prolonged history of abuse)
• Psychotic Paramnesia (delusional or deluded account of the offence)
• Organic/Brain based Disorders (e.g. epileptic automatism, hypoglycaemia)

Question 14

What evidence is there to suggest that homicide amnesia is a real thing not just a simulation?

Answer 14

• Consistent story in many people who report it
• Often give themselves up once they realised what they’ve done
• Subjective accounts are very similar to proven amnesias
• Victims and eyewitnesses also quite commonly show impaired recall
• No legal advantage to claiming amnesia

Question 15

Outline the normal ‘Hierarchy of Memory’?

Answer 15

• Conscious recollection of events (remembering)
• Knowing that events or incidents happened without explicit recollection
• Familiarity judgements (recognition)
• Implicit unaware memory (comes from priming, skill learning and conditioning)

Question 16

What is Confabulation?

Answer 16

A symptom of brain disease whereby gaps in memory are patched up with made up stories, often ridiculous in nature but sometimes ‘real’ memories that have become jumbled up or retrieved inappropriately.

Caused by Neurological Amnesia.

Question 17

What has research suggested to be the cause of Spontaneous Confabulation?

Answer 17

Frontal Lobe Pathology.

• Luria showde how medial frontal lesions caused memory ‘contamination’
• Stuss showed that EEG, CT and psych testing of 5 patients with confabulation were all consistent with frontal lobe damage.
• Kapur showed that as scores on measures of frontal lobe function improved, confabulation decreased.
• More recent research by turner showed Ventro-medial and/or Orbito-frontal lesions could lead to Confabulation

Question 18

Describe the confabulations of patients with frontal lobe pathology?

Answer 18

• Spontaneous (not limited to test situations)
• Strong conviction
• Extreme resistance to persuasion
• Preoccupying
• Often bizarre

Question 19

In what patients do you see Momentary or Provoked Confabulation?

Answer 19

All. Test found provoked confabulation behaviour could be elicited immediately in patients with Korsakoff’s or Alzheimer’s BUT given enough time healthy controls begin to show it as well. About 50% of all patients displayed it, and equal amounts of K’s and controls showed it by the end of the trial.

Suggests confabulation is a normal response to a weak or failing memory.

Question 20

What is a ‘full house’ of Wernicke features?

Answer 20

• Confusion
• Ataxia
• Nystagmus
• Ophthalmoplegia

Question 21

What are the 6 features of a Confabulation Battery?

Answer 21

1) Personal Semantic Memory (where were you born)
2) Episodic Memory (what did you do last xmas)
3) Orientation in Time and Space (what month is it)
4) General Semantic Memory (when did WW1 start)

Then two ‘Don’t Know’ tests, where the patient is supposed to say they don’t know the answer to these questions, but if they are confabulating they may make stuff up:

5) Episodic ‘don’t know’ (what did you do on the 13th of March 1998)
6) Semantic ‘don’t know’ (what I Marilyn Monroe’s father do)

Question 22

Give some examples of confabulations (within the context of the confabulation battery)

Answer 22

Several different types of confabulation:

• Personal Semantic; Misremembering facts about oneself e.g. I’ve just come back from Canada.
• Episodic; Misremembering events in their life e.g. Married a local girl
• Orientation; Date and location
• General Semantic; knowledge like Princess Di died in a car crash

Respond to Don’t Know tests by making up stuff.

Question 23

What are the 4 main theories explaining confabulation?

Answer 23

1) Context Memory Confusions (or source monitoring deficits)
2) Trace Specification or Verification
3) Motivational Theory
4) Interactionist Theory (combination of the above)

Question 24

Outline the Context Memory Confusion/ Source Monitoring Deficit theory of Confabulation?

Answer 24

In these theories, confabulation occurs when individuals incorrectly attribute memories as reality, or incorrectly attribute memories to a certain source. Thus, an individual might claim an imagined event happened in reality, or that a friend told him/her about an event he/she actually heard about on television.

“Old recollections with present impressions”

Suggests the patients ‘temporal consciousness’, their location in space and time, as intact but malfunctioning. Patients are aware of their past present and future (this is in contrast to severe amnesia) but misattribute information from it.

Question 25

Outline the Trace Specification/Verification Deficits theory of Confabulation?

Answer 25

This theory describes 3 components to memory that may be damaged leading to errors:

• Descriptor, which leads to Trace Verification and if damaged can cause inappropriate retrieval
• Mediator; which helps with strategic control and if damaged can cause implausible responses
• Editor; which helps with checking vs task requirements and if damaged can lead to errors.

Question 26

Outline the Motivational Theory of Confabulation?

Answer 26

• Points out that confabulation tends to occur to people in times of distress and the world they create through their confabulations is one of harmony and comfort rather than discord and distress.
• Suggests they are doing it out of a desire for self-protection
• Make life more bearable

Question 27

What is Delusional Memory?

Answer 27

A false memory arising in the context of psychosis. (term can also mean a true memory which stimulates a deluded interpretation)

Question 28

What are the similarities and differences between confabulations and deluded memories?

Answer 28

Similarities:

• Held as absolute convictions
• Not amenable to argument
• Arise spontaneously
• Often bizarre and preoccupying

Differences:

• Psychosis rather than amnesia (therefore respond rapidly to anti-psychotics)
• Systematised around a single theme
• Not necessarily associated with executive or frontal dysfunction

Question 29

What 5 reasons have been proposed to explain why someone might make a false confession?

Answer 29

• To protect a real criminal
• To relieve guilt over a real or imagined previous transgression
• Morbid desire for publicity and/or notoriety
• Inability of some individuals to distinguish their imagination from reality (seen in psychosis)
• Coerced by police

Question 30

False Confessions have been attributed to a state of “memory distrust” in the confessor, what can cause this effect?

Answer 30

• Compliance
• Low self-esteem
• Depression
• Coercion
• High suggestibility

All these lead to memory distrust, which can lead to internalised confabulation with varying degrees of conviction

Question 31

Describe the process by which source amnesia occurs in false confessions.

Answer 31

Mixture of:

• Wide publicity of offence/ external sources of information
• Social coercion (most often from repeated questioning)
• Low self-esteem and depression

Cause Source Memory errors
Cause Faulty Attributions
Cause Internalisation (with fluctuating degree of conviction)

Question 32

What is a Source Memory Error?

Answer 32

A source-monitoring error is a type of memory error where the source of a memory is incorrectly attributed to some specific recollected experience.