Psychogenic amnesia: syndromes, outcome, and patterns of retrograde amnesia (Harrison et al, 2017)

Continuing my tour of the weird and wonderful literature on "psychogenic" illnesses, I just saw this piece, one of the authors is Neil Harrison.

As you've probably already predicted, the diagnosis of psychogenic amnesia is largely one of exclusion (the patient doesn't seem to have a neurological illness or injury sufficient to explain their problems). Then that's followed with the usual interview designed to uncover adverse events or psychological factors that can be held up as the "cause".

These authors sifted through 18 years of records (UK hospital) and found 53 cases given the diagnosis (quite a small number). Three quarters were male. The cases are a bit of a mish-mash. 5 just had "memory gaps" lasting from a few hours to a few months. The others fell into two main categories:

Fugue state: a temporary state where the person loses memories for a large portion of their life, often including their identity.

Focal retrograde amnesia: loss of memories for a large portion of their past life, can sometimes follow a "fugue", but sometimes not.

I can't see any problems with that!!!

Here's one of the cases:

The paper examines their records, and not surprisingly, finds more notes about psychological factors (e.g. childhood adversity martial problems) in these folks than in neurological controls. They also scored higher than controls on self-report measures of depression.

One surprise was that there was a high incidence of previous head injuries (higher than in the neurological controls). A large proportion of cases also had a neurological history. I suppose doctors might have been more fastidious in recording history in these cases, because they were looking for possible causes. But then the head injury finding fits with the higher number of male than female cases (males more likely to suffer head injuries). And that is surely not a doctor bias thing, because if anything, their bias would be to diagnose more female cases as "psychogenic".

Edit: sorry, forgot the link: https://academic.oup.com/brain/article/140/9/2498/4080831

 

It occurred to me that finding more psychological factors in patients with otherwise difficult to explain symptoms could merely be a consequence of the diagnostic algorithm, which is something like this:

First they rule out the most serious organic illnesses. Then the most common organic illness. Then the less likely ones. Only when no organic cause is apparent do the search for psychological factors.

In other words, the more apparent an organic illness is, the less likely it is they ever start searching for psychological factors. This would result in finding much more psychological factors in patients with unexplained illness even if the real incidence of these psychological factors were the same for all patients.

 

In the real world the correlation with head injury and onset of brain conditions such as Alzheimers is now informing sports development programmes - football/ rugby/ boxing
Sometimes I feel I am in a parallel universe....

 

Yes, exactly!

Both this and the psychogenic fever example illustrate how the process works. The psychological "evidence" is "uncovered" during the process of confirming the psychogenic explanation. It doesn't matter if you can't find an obvious stressor. Keep prodding. You'll always find something, because nobody's life is perfect.

Nobody likes loose ends. Who wants to leave a case unsolved? So when all else fails, psychogenic explanations will always come through for you. Because the can never be disproved.

 

The Alien Chocolate Hypothesis

That's all well and good, but I've proved to my own satisfaction that the prevalence of Aliens stealing the last slice of chocolate cake in the refrigerator is the most likely answer, especially in workplaces and shared housing. After ruling out humans with refrigerator access, and their consequent statements of innocence, this is the only logical remaining conclusion.

*The existence of aliens in some form in the Universe is more likely than psychogenic explanations. Plus chocolate is yummy.

 

"following an interview under sedation"

WTF! Is that common? Does anyone actually believe what is said by patients under sedation? In what way is this ethical?

Edit : I should have said "Does anyone actually believe what is said by patients under sedation is reliable?"

 

Are you saying that he was given a mind altering drug and then interviewed? It does sound a bit like it.

 

Well, sedating someone usually does alter brain function - people are sleepy, can't talk very fluently, probably have memory problems etc. I've just never heard of anyone being interviewed under sedation before and it strikes me as being very, very dodgy.

Edit : The comment came from the quote in Woolie's first post, relating to Patient C.

 

It seems to be a thing:

Conscious sedation interview for psychogenic pseudosyncope
https://sci-hub.hk/https://linkinghub.elsevier.com/retrieve/pii/S0163-8343(13)00068-6

Drugs used in the linked study: midazolam and methohexital (used in anesthesia).

I know that drugs for anesthesia can make people say crazy things, like here

https://www.youtube.com/watch?v=txqiwrbYGrs

I'm intrigued by this technique. They could obtain all sorts of confessions from patients with this, with high enough doses.

 

This.

Only alligators on Sesame Street. If you want crocodiles you have to watch the Muppet Show.

http://muppet.wikia.com/wiki/Alligators_and_Crocodiles