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Gedächtnis zu haben, stellt eine der zentralsten Funktionen des menschlichen Gehirns dar und ermöglicht es uns, in der Gegenwart aus der Vergangenheit für die Zukunft zu schöpfen. Wie wird Gedächtnis unterteilt? Wie erfolgt die Gedächtnisverarbeitung auf der Hirnebene? Welche Erkrankungen gehen mit Auswirkungen auf das Gedächtnis einher?

Autobiographical-episodic memory is considered to be the most complex of the five long-term memory systems. It is autonoetic, which means, self-reflective, relies on emotional colorization, and needs the features of place and time; it allows mental time traveling. Compared to the other four long-term memory systems-procedural memory, priming, perceptual, and semantic memory-it develops the latest in phylogeny and ontogeny, and is the most vulnerable of the five systems, being easily impaired by brain damage and psychiatric disorders. Furthermore, it is characterized by its fragility and proneness to distortion due to environmental influences and subsequent information. On the brain level, a distinction has to be made between memory encoding and consolidating, memory storage, and memory retrieval. For encoding, structures of the limbic system, with the hippocampus in its center, are crucial, for storage of widespread cortical networks, and for retrieval again a distributed recollection network, in which the prefrontal cortex plays a crucial role, is engaged. Brain damage and psychiatric diseases can lead to what is called "focal retrograde amnesia." In this context, the clinical picture of dissociative or functional or psychogenic amnesia is central, as it may result in autobiographical-emotional amnesia of the total past with the consequence of an impairment of the self as well. The social environment therefore can have a major impact on the brain and on autobiographical-episodic memory processing. This article is categorized under: Psychology > Memory

In 2022, the first revised version of the S3 guidelines on obsessive-compulsive disorder will be published under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). This article contains a summary of the most important recommendations for therapy in a condensed form. There were no major changes in the central basic therapy recommendations compared with the first version of the guidelines, as the evidence base has not fundamentally changed since then. Cognitive behavioral therapy (CBT) with exposure and response management is the most effective form of therapy for this clinical picture and therefore the therapy of first choice. Regarding pharmacotherapy, selective serotonin reuptake inhibitors are the first-line medications. They are indicated when CBT with exposure is not available or has not been effective, when CBT is rejected by the patient and in the patient's personal preference for medication, or to increase the readiness for CBT with exposure. New recommendations include, e.g., the use of Internet therapy, and recommendations for the use of CBT and exposure, e.g., also in group format, including video conferencing if appropriate as well as in intensive format.Unter Federführung der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) erscheint 2022 die erste revidierte Fassung der S3-Leitlinie Zwangsstörungen. Dieser Beitrag enthält eine Zusammenfassung der wichtigsten Empfehlungen zur Therapie in komprimierter Form. Wesentliche Änderungen der zentralen Therapieempfehlungen haben sich im Vergleich mit der ersten Version der Leitlinie nicht ergeben, da sich die Evidenzlage seither nicht grundlegend verändert hat. Kognitive Verhaltenstherapie mit Exposition und Reaktionsmanagement ist die wirksamste Therapieform bei diesem Krankheitsbild und daher die Therapie der ersten Wahl. Bezüglich der Pharmakotherapie sind selektive Serotoninwiederaufnahmehemmer die Medikamente der ersten Wahl. Sie sind dann indiziert, wenn kognitive Verhaltenstherapie (KVT) mit Exposition nicht verfügbar ist oder nicht wirksam war, wenn KVT vom Patienten abgelehnt wird, bei persönlicher Präferenz des Patienten für Medikamente oder um die Bereitschaft für KVT mit Exposition zu erhöhen. Neue Empfehlungen betreffen u. a. den Einsatz von Internettherapie sowie Empfehlungen zur Anwendung von KVT und Exposition auch im Gruppenformat, gegebenenfalls auch per Videokonferenz, sowie in intensiver Form.

"False memories, memory distortions, confabulations, and other forms of memory aberrations and deficits occur in everyday life and – more frequently – in neurological and psychiatric patients. We studied such changes of memories in 42 patients with alcoholic Korsakoff’s syndrome, 18 with clipped or ruptured aneurysms of the anterior communicating artery [ACoA], 41 with a diagnosis of dissociative amnesia, and 52 healthy control individuals. All three patient groups had severe memory deficits. The neurological patients had deficits both with respect to acquiring new semantic and episodic memories, while the psychiatric patients were unable to retrieve episodic memories only. Both the neurological and the psychiatric patients had major problems in retrieving old episodic memories. However, the groups differed in that way, that the neurological patients tried to compensate their deficits by showing numerous confabulations (especially patients from the Korsakoff’s group), while the group with ruptures and repairs of their ACoAs showed a considerably tendency towards producing false memories. The psychiatric patients, on the hand, demonstrated a total lack of retrieving episodic memories from their past and showed no efforts to invent or generate alternative memories. It is concluded that especially the prefrontal cortex (frontal lobes) and its associated structures (mediodorsal thalamus, which is regularly degenerated in patients with Korsakoff’s syndrome) are relevant in controlling proper and accurate retrieval of information. This statement also seems to be confirmed from functional imaging results in patients with dissociative amnesia who show a reduced prefrontal metabolism. For normal individuals, states which reduce alertness (e.g., fatigue, sleep deprivation) and consequently dampen prefrontal control functions, similarly can lead to a heightened degree of fragile memory retrieval."

"Episodic or episodic-autobiographical memory is considered to be a significant attribute of human cognition, depending on autonoetic consciousness and allowing mental time travel into past and future. Furthermore, episodic memory is embedded in an appraisal system, in which individual episodes are evaluated. We used patients with a condition of ‘dissociative amnesia’ in order to study interdependencies between emotion and memory. Dissociative amnesia leads to a blockade of retrieving episodic memories, while the retrieval of general knowledge (“semantic memory”) is still possible usually. Forty-one patients with a diagnosis of dissociative amnesia were investigated neuropsychologically. Sixteen of them were subjected to fluor-positron-emission-tomography to study possible changes in their brain. Main questions were (a) in what ways their old – “forgotten” – memories differ from newly acquired ones, and (b) what are possible brain mechanisms leading to the dichotomy between emotional and non-emotional memory retrieval, respectively failure of retrieval. Results indicate that the forgotten or blocked personal memories are much more complex and self-centered than the semantic ones and require more effort for retrieval. Furthermore, blocked memories seem to remain in a subconscious, disconnected state, hindering the proper association between cognition and emotion. It was found that the failure of episodic retrieval is accompanied by a dysfunction or desynchronization between emotion- and fact-processing regions of the brain."

This chapter first gives an overview of possible philosophical positions on freedom and determinism (incompatibilism vs. compatibilism) based on a text by Ansgar Beckermann. It then continues to present the essential psychological experiments on the bases of which the existence of free will is disputed in cognitive neurosciences. It is argued that the conclusions drawn from these experiments are not substantive.

The psychiatric disease of dissociative amnesia is described and illustrated with case reports. It is emphasized that dissociative amnesia has a stress or trauma-related etiology and that affected individuals, contrary to the still dominant clinical belief, are frequently more severely and enduringly affected. That means, most of them show severe retrograde amnesia for their biography, usually accompanied by changes in their personality and sometimes also by alterations in other cognitive and emotive domains. As many patients show the phenomenon of “la belle indifference”, their motivation for therapy or treatment of their amnesia is reduced. Patients also seem to a high degree to possess immature, unstable personality features. Nevertheless, a number of quite divergent, though largely not evidence-based, therapeutic approaches exist and are described. They are divided into (a) psychopharmacological and somatic treatments, (b) psychotherapeutic interventions, and (c) neuropsychological rehabilitation. Furthermore, detailed treatment strategies are provided.

Zusammenfassung. Dissoziative Amnesie verläuft unter Umständen chronisch und kann zu lebenslanger Arbeitsunfähigkeit führen. Die Krankheit tritt gehäuft im Zusammenhang mit Migration auf und verläuft dann schwerer als in anderen Fällen. Sie ist im Grunde reversibel, d. h., der Abruf der Gedächtnisinhalte ist nur blockiert. Betroffen sind Patienten, die nicht verarbeitete Stress- und Traumaerlebnisse als Hintergrund haben und dann ein erneutes Stresserlebnis erfahren, welches zum dissoziativen Amnesiezustand führt. Es wird postuliert, dass in erster Linie Patienten betroffen sind, die im neuen Heimatland nicht ausreichend und ihrem Anspruch entsprechend Fuß fassen konnten. Mangelnde Sprachkenntnisse und eine nicht den Erwartungen entsprechende neue Arbeitssituation sind am ehesten als Gründe anzuführen.

The term 'episodic memory' was coined by Endel Tulving, who also created a classification in several memory systems. This classification is presented, and it is described which predecessors existed for the partition of memory into systems. The 'episodic memory system' is discussed as being in general equivalent with the 'episodic-autobiographical memory system'. It is seen as an emotionally colorized system. A special paragraph is devoted to the 'perceptual memory system', as this was not included in Tulving's previous schemes of memory systems. More recent sub-categorizations of the 'episodic memory system' are presented and a perspective on the future of the episodic memory system is developed.

Memory disorders without a direct neural substrate still belong to the riddles in neuroscience. Although they were for a while dissociated from research and clinical arenas, risking becoming forgotten diseases, they sparked novel interests, paralleling the refinements in functional neuroimaging and neuropsychology. Although Endel Tulving has not fully embarked himself on exploring this field, he had published at least one article on functional amnesia (Schacter et al., 1982) and ignited a seminal article on amnesia with mixed etiology (Craver et al., 2014). Most importantly, the research of Endel Tulving has provided the researchers and clinicians in the field of dissociative or functional amnesia with the best framework for superiorly understanding these disorders through the lens of his evolving concept of episodic memory and five long term memory systems classification, which he developed and advanced. Herein we use the classification of long-term memory systems of Endel Tulving as well as his concepts and views on autonoetic consciousness, relationships between memory systems and relationship between episodic memory and emotion to describe six cases of dissociative amnesia that put a challenge for researchers and clinicians due to their atypicality. We then discuss their possible triggering and maintaining mechanisms, pointing to their clinical heterogeneity and multifaceted causally explanatory frameworks.

The memory impairment of neurological and psychiatric patients is seen as occurring mainly in the autobiographical-episodic memory domain and this is considered to depend on limbic structures such as the amygdala or the septal nuclei. Especially the amygdala is a hub for giving an emotional flavor to personal memories. Bastin et al. fail to include the amygdala in their integrative memory model.

Das Gedachtnis stellt den wohl bedeutendsten Bereich menschlichen Lebens dar. Dies hat schon im vorletzten Jxahrhundert der Physiologe Ewald Hering (1870) vorausgesehen, der damals schrieb: Das Gedachtnis verbindet die zahllosen Einzelphanomene zu einem Ganzen, und wie unser Leib in unzahlige Atome zerstieben musste, wenn nicht die Attraktion der Materie ihn zusammenhielte, so zerfiele ohne die bindende Macht des Gedachtnisses unser Bewusstsein in so viele Splitter, als es Augenblicke zahlt (Hering 1870, S. 12).

Dissociative disorders are heterogeneous with respect to clinical features, course, antecedents and treatment. Among them, dissociative amnesia occupies a special place, at times encroaching on the borders between neurology and psychiatry. Herein we describe dissociative amnesia according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders and outline data on its epidemiology, neurobiology, neuroimaging, clinical and differential diagnosis, neuropsychology, comorbidities, prognosis, treatment and rehabilitation. To enable a neuroscientific approach to its diagnosis, we outline the memory division into short-term and long-term memory, elaborating on the content-based classification of the long-term memory systems. Dissociative amnesia most commonly manifests itself in its retrograde variants (including dissociative fugue), but anterograde variants can also occur. Dissociative amnesia may be overlooked when it occurs on a background of mixed antecedents and comorbidities. Comprehensive neuropsychological assessment – including tests tapping on all memory systems and symptom validity tests – is still insufficiently integrated in the clinical practice, although it could aid in securing an accurate diagnosis, especially in cases with mixed antecedents or concomitant forensic or litigation backgrounds. Presently there is a paucity of treatment and rehabilitation methods for dissociative amnesia. Developing research evidence-based consensus guidelines for diagnosis and treatment is an essential goal. This review contains 6 figures, 7 tables, and 60 references. Key Words : consciousness, episodic-autobiographical memory, mnestic block syndrome, neuroimaging, serial-parallel-independent model, personal identity, stressful life events, malingering, trauma, feigning

Autobiographical amnesia is found in patients with focal or diffuse brain damage ("organic amnesia"), but also without overt brain damage (at least when measured with conventional brain imaging methods). This last condition is usually named dissociative amnesia at present, and was originally described as hysteria. Classically and traditionally, dissociative amnesia is seen as a disorder that causes retrograde amnesia in the autobiographical domain in the aftermath of incidents of major psychological stress or trauma. In the present study one of the probably largest published collections of patients (28) with psychogenically caused autobiographical amnesia, who were assessed with comprehensive neuropsychological tests, will be described and documented in order to identify variables which are central for the occurrence of dissociative amnesia. The presented cases demonstrate that autobiographical amnesia without direct brain damage can have very mixed clinical presentations, causes and consequences. The described cases of psychogenic amnesia are clustered according to a number of manifestations and features, which include a reduced effort to perform cognitively at a normal level, a forensic background, anterograde (instead of retrograde) autobiographical amnesia, the fugue condition, concurrent somatic diseases, and their appearance in childhood and youth. It is concluded that autobiographical amnesia of a psychogenic origin may occur within a variety of symptom pictures. For all patients, it probably serves a protective function by offering them a mechanism to exit a life situation which appears to them unmanageable or adverse.

Im deutschen Sprachgebrauch ist Handeln im Normalfall zielgerichtetes Agieren, wahrend in anderen, auf dem Lateinischen basierenden Sprachen, die Differenzierung zwischen zielgerichtetem und nicht zielgerichtetem Agieren entfallt (agere, to act). Ursachen und Motive von Handlungen zu erforschen ist Ziel mehrerer Wissenschaftsdisziplinen. Die Neurowissenschaften haben den Rahmen der Handlungsuntersuchungen noch erweitert, indem sie von exekutiven Funktionen sprechen und damit auch die theoretische Planung von Handlungen und das dazu notwendige vorausschauende Denken einbeziehen.

The historical roots of memory research—mainly from the period between 1870 and 1920—are described with emphasis on human memory. First, data from experimental psychology are reviewed; thereafter principal contributions from the old traditions of psychiatry and psychoanalysis are given and then relations between brain tissue damage and memory deficits are outlined. Experimental as well as clinical studies of that time already provided evidence for theoretical ideas on memory systems, which resemble those en vogue today. Furthermore, significant and still valid findings were reported on the contribution of bottleneck structures of the limbic system for mempry encoding. Among these, the mammillary bodies, thalamic nuclei, and the medial temporal lobe were most consistently mentioned. Furthermore, early findings from psychiatric patients revealed similar forms of dissociative states as found presently and indicated that these disease conditions occur much more in young than in older adults.

We herein present a 51-year-old single female inpatient with treatment-resistant recurrent depressive disorder. Her most recent depressive episode has been severe and followed a chronic course, lasting for longer than 2 years. During the exacerbation of the patient's suicidal thoughts and plans, we repeatedly and independently observed vegetative and behavioural changes of the therapy-accompanying dog of the patient. Our findings suggest a role for dog-assisted therapy for augmenting treatment as well as for enhancing and developing novel adjunctive strategies for risk assessment in patients with chronic depression and suicidality. Possible social-biological mechanisms and underpinnings are discussed, by drawing on the available literature and comparative psychology. Collaboration with animal behaviourists and animal welfare scientists, in order to improve behavioural and physiological data interpretation and humaneness of dog-assisted therapy, is emphasised as a crucial component of future research.

Lane et al. view the process of memory reconsolidation as a main ingredient of psychotherapeutic change. They ascertain that in cognitive behavioral therapy (CBT) high priority is given to the “semantic structure.” We argue that memory-related mechanisms of change in CBT are more nuanced than the target article presents. Furthermore, we propose to partially shift the focus from the process of reconsolidation to the retrieval operations.

Learning is described as a universal attribute of animals that is accompanied by diverse changes in the nervous system. On the brain level, memory is seen as being represented in distributed neural networks. On the behavioral level, memory is seen as divided along a time- and a content-based axis (short-term, working, long-term memory; procedural memory, priming, perceptual and semantic memory (knowledge system), and episodic-autobiographical memory). Neurological and psychiatric disease conditions can be used to determine brain regions that act as bottleneck structures in information processing.