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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."