There are very few case series of patients with acute psychogenic memory loss (also known as dissociative/functional amnesia), and still fewer studies of outcome, or comparisons with neurological memory-disordered patients. Consequently, the literature on psychogenic amnesia is somewhat fragmented and offers little prognostic value for individual patients. In the present study, we reviewed the case records and neuropsychological findings in 53 psychogenic amnesia cases (ratio of 3:1, males:females), in comparison with 21 consecutively recruited neurological memory-disordered patients and 14 healthy control subjects. In particular, we examined the pattern of retrograde amnesia on an assessment of autobiographical memory (the Autobiographical Memory Interview). We found that our patients with psychogenic memory loss fell into four distinct groups, which we categorized as: (i) fugue state; (ii) fugue-to-focal retrograde amnesia; (iii) psychogenic focal retrograde amnesia following a minor neurological episode; and (iv) patients with gaps in their memories. While neurological cases were characterized by relevant neurological symptoms, a history of a past head injury was actually more common in our psychogenic cases (P = 0.012), perhaps reflecting a ‘learning episode’ predisposing to later psychological amnesia. As anticipated, loss of the sense of personal identity was confined to the psychogenic group. However, clinical depression, family/relationship problems, financial/employment problems, and failure to recognize the family were also statistically more common in that group. The pattern of autobiographical memory loss differed between the psychogenic groups: fugue cases showed a severe and uniform loss of memories for both facts and events across all time periods, whereas the two focal retrograde amnesia groups showed a ‘reversed’ temporal gradient with relative sparing of recent memories. After 3–6 months, the fugue patients had improved to normal scores for facts and near-normal scores for events. By contrast, the two focal retrograde amnesia groups showed less improvement and continued to show a reversed temporal gradient. In conclusion, the outcome in psychogenic amnesia, particularly those characterized by fugue, is better than generally supposed. Findings are interpreted in terms of Markowitsch’s and Kopelman’s models of psychogenic amnesia, and with respect to Anderson’s neuroimaging findings in memory inhibition.

中文翻译：

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心因性健忘症：逆行性健忘症的综合征，预后和模式

患有急性心理记忆丧失（也称为解离性/功能性健忘症）的患者的病例系列很少，结果研究或与神经记忆障碍患者的比较研究也较少。因此，关于心理性健忘症的文献有些零碎，对个别患者的预后价值很小。在本研究中，我们回顾了53例精神病性健忘症患者的病例记录和神经心理学发现（比率为3：1，男性：女性），与21名连续招募的神经记忆障碍患者和14名健康对照者进行了比较。特别是，我们在评估自传记忆（《自传记忆访谈》）时检查了逆行性健忘症的模式。我们发现，患有心理记忆丧失的患者分为四个不同的组，我们将其归类为：（i）赋格状态；（ii）病因-病灶逆行性健忘症；（iii）轻微神经系统发作后的心因性局灶性逆行健忘症；（iv）记忆力不足的患者。虽然神经系统疾病的特征是相关的神经系统症状，但在我们的心理原因案例中，过去的头部受伤史实际上更为常见（P= 0.012），这可能反映了“学习情节”易诱发后来的心理健忘症。如预期的那样，丧失个人身份感仅限于心理上的群体。但是，在该组中，临床上的抑郁症，家庭/关系问题，财务/就业问题以及对家庭的不了解在统计上也更为普遍。自传性记忆丧失的模式在不同的心理原因群体之间是不同的：赋格病例显示出在所有时间段内事实和事件的严重而统一的记忆丧失，而两个局灶性逆行健忘症组表现出“逆向”的时间梯度，而相对的记忆力却很少。最近的回忆。3–6个月后，神游患者的事实得分提高到正常，事件得分接近正常。相比之下，这两个局灶性逆行健忘症患者的病情改善较小，并且继续表现出反向的时间梯度。总之，心因性健忘症的结果，特别是那些以赋格为特征的健忘症的结局要好于普遍预期。根据Markowitsch和Kopelman的心因性健忘症模型，以及关于安德森在记忆抑制方面的神经影像学发现，对发现进行了解释。