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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.

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.

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.

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.

Environmentally induced stress may lead to a phenomenon termed ‘mnestic block syndrome’. The memory changes primarily affect the patient's autobiography by either blocking the retrieval of old memories, or by impairing the formation of new memories. We studied patients with either form of amnesia neuropsychologically and with functional imaging methods. We obtained a right temporo-frontal hypometabolism in patients with psychogenic amnesia, restricted to their autobiography. We conclude that environmentally induced brain changes are due to the action of stress hormones leading to a block of memory-related information flow in the brain which can persist over decades.

Brain damage was traditionally seen as the product of a neurological disease or injury. Nevertheless, modern brain imaging techniques have provided increasing evidence for alterations in brain tissue and metabolism for a number of psychiatric disorders. Though for a while “dissociated” ( Spiegel, 2006 ) from the clinical and scientific arena, dissociative disorders have in the last several years received a renewed interest among several groups of researchers, who embarked on the work of disentangling their neural correlates. We review data from our own research as well as others, which point to distinct changes in brain regions underlying dissociative amnes(t)ic disorders. These changes may consist of overall reductions in brain metabolism or more selective alterations primarily in the right temporo-frontal cortices. Recent evidence with refined magnetic resonance imaging techniques furthermore reveals selective fiber degenerations in these regions. While these changes may persist and probably even intensify in some patients, they may be reversible in others – especially if treatment is carried out successfully within short time after onset. Implications of these findings for the pathogenetic conceptualization of dissociative amnes(t)ic disorders are outlined.

Introduction: Functional amnesia refers to various forms of amnesia, which have no direct organic brain basis. Psychological stress and trauma were etiologically linked to its development across various cultures. Methods: We have studied several patients With functional amnesia, employing neuropsychological and neuroimaging methods. Herein we provide a review of the current understanding of the phenomenology, neuropsychology and neurobiology of functional amnesia, which we illustrate by reference to five own case descriptions and other cases presented in the literature. Results: Functional amnesia is mostly of retrograde nature and presents in the form of a memory blockade or repression to recollect episodic-autobiographical events, which may cover the whole past life. Sometimes, the recollection impairment is localized to certain time epochs. In comparison to functional retrograde amnesia, functional isolated anterograde amnesia is much rarer and data on its neurobiology are scant. In patients with functional amnesia with pronounced retrograde episodic-autobiographical memory impairments, we identified changes in brain metabolism, above all reductions in the temporo-frontal regions of the right hemisphere. Recently, even subtle structural changes in the white matter of the (right) frontal cortex were described in functional retrograde amnesia by other researchers Conclusions: The disruption in recollection in functional amnesia is often accompanied by changes in personality dimensions, pertaining to cognition (self-related processing, theory of mind), autonoetic consciousness and affectivity. This suggests that functional amnesia is a multifaceted condition. We hypothesize that the recollection deficit in functional retrograde amnesia primarily reflects a desynchronization between a frontal lobe system, important for autonoetic consciousness, and a temporo-amygdalar system, important for evaluation and emotions. Despite assumptions that functional amnesia can always be reversed, several cases of functional amnesia were found to follow a chronic course, suggesting a need for longitudinal prospective studies to quantify possible global cognitive deterioration over time and its neural underpinnings. (C) 2012 Elsevier Ltd. All rights reserved.

Memory and time have multifaceted links. Along the time axis, memory is divided into short- and long-term memory. Another popular time-dependent distinction is between new and old memories and anterograde and retrograde memory impairments, respectively. Time-embedment characterizes the processing of mnemonic information, which encompasses the stages of registration, encoding, consolidation, and storage. Along the content axis, memory is partitioned into five long-term memory systems (procedural, priming, perceptual, semantic, and episodic), which are regarded to build up on each other from both a phylogenetic and ontogenetic perspective. These memory systems are accompanied by different niveaus of self and levels of consciousness. Among these long-term memory systems, the episodic memory system holds a special connection with time, which we aim to detail. In 2005, Tulving defined the episodic memory system as the conjunction of subjective time, autonoetic consciousness, and the experiencing self. Drawing on this last definition of the episodic memory, which lays an emphasis on the linkage to the self, Markowitsch has subsequently promoted the use of the construct “episodic-autobiographical” memory system. The episodic-autobiographical memory system features mental time travelling, an essential property that enables one individual to flexibly travel in subjective time in his/her past and, in addition, to flexibly project him/herself in the future. This property provides a “glue” for the self, supporting a coherent view of one's own person. According to Tulving and Markowitsch, it is unlikely that non-human animals possess the capacity for mental time travelling and the ability to “look into future” (“proscopy”). Furthermore, Tulving and Markowitsch had proposed that the ability for mental time travelling is dependent on age and intellect. Subsequent studies have confirmed that mental time travelling is one of the last features of the episodic- autobiographical memory system that achieves full functionality in humans and is the first one to be afflicted by old age, amnesia or neurodegenerative dementias (e.g., Alzheimer's dementia). At the brain level, the emergence of the capacity for mental time travelling is accompanied by ample structural and functional reorganization of elements of the brain networks supporting episodic-autobiographical memory, autonoetic consciousness, and self-referential processing. In human beings, damage to certain brain regions may alter the sense and consciousness of time in quite different ways. Herein, we have the goal to review changes in time perception and consciousness of time, which accompany different forms of amnesia. Patients with anterograde amnesia manifest an inability to consciously acquire new information for long-term storage and as a consequence are often “stuck in time”. ‘Chronotaraxis’ may accompany certain forms of preponderantly anterograde amnesia, as we aim to exemplify by drawing upon own cases, which were investigated medically, neuropsychologically, and with neuroimaging methods. Patients with retrograde amnesia manifest an inability to consciously retrieve already stored old mnemonic information, usually from the episodic-autobiographical memory domain. They lack the capacity to “ecphorize” old memories. Interestingly, the memory impairments are very similar in the patients with focal traumatic brain injuries and in those with psychogenic forms of amnesia: The patients are unable to engage in mental time traveling into their past. In addition, they show an impaired ability to imagine future personal events, being as a consequence trapped in a “noetic existence”. In psychogenic amnesia with pronounced retrograde memory impairments, we found (via functional neuroimaging) evidence of defective synchronization during retrieval between processing of affectively loaded personal events (that is presumed to preponderantly engage the right hemisphere) and fact-based processing (that is considered to preferentially recruit the left hemisphere). These data are relevant in the light of studies pointing to a right hemisphere bias for higher forms of consciousness. We conjecture that this synchronization abnormality not only leads to a memory blockade, but also to shrinkage of mental time traveling and loss of autonoetic consciousness in psychogenic or functional amnesic conditions.

Introduction Co-occurring impairments of episodic-autobiographical memory and theory of mind were described in several psychiatric and neuropsychiatric disorders. Despite sophisticated elaborations in theoretical domains, the relationship between episodic-autobiographical memory and social cognition remains unelucidated. Objectives This work’s objectives are establishing greater recognition of the possible contribution of episodic - autobiographical memory to social cognition, by resorting to data from developmental amnesia (a condition with onset in early childhood, caused by relatively selective bilateral damage to hippocampi). Aims We describe a young adult with amnesia with neurodevelopmental mechanisms. Methods The patient was investigated medically, psychiatrically, with extensive neuropsychological methods and with neuroimaging. Results Neuroimaging revealed grossly reduced hippocampi volumes bilaterally. There was no evidence of pathology in the underlying parahippocampal region or other areas. Performance on tasks that tapped on various aspects of social cognition was non-uniform, ranging from within normal limits to moderate impairment. Conclusions According to our knowledge, this is among the first case reports about a comprehensive evaluation of social information processing in a patient with amnesia with neurodevelopmental mechanisms. This patient showed impairments in performance in some laboratory tasks for social cognition, but not in others. This suggests that various components of social cognition may have different neural correlates; their unraveling may aid understanding of when and how episodicautobiographical memory contributes to social cognition. This study also emphasizes the need to employ various tasks to assess social cognition in patients with amnesia, which go beyond traditional laboratory paradigms.

Dissociative memory disturbances characterize dissociative disorders (such as dissociative amnesia, dissociative fugue, dissociative identity disorder, Ganser syndrome) and certain anxiety disorders (post-traumatic stress disorder). Across various cultures, they are recognized to be precipitated by psychological stress. In immigrant populations, stressful experiences arising during migration and acculturation could lead to somatic and psychiatric symptoms (including dissociative ones). A delayed onset of these symptoms - that at times occurs - may reflect a kindling sensitization or an incubation effect.ObjectivesWe review four patients who developed Dissociative Disorders (Dissociative Amnesia and Ganser Syndrome) on a background of stresses related to immigration.MethodsPatients were investigated medically, psychiatrically and neuropsychologically and in part neuroradiologically.ResultsPatients were adult males with Eastern or Central European background and no known previous psychiatric or medical illnesses. They immigrated to Germany or Canada and encountered several difficulties in the process of migration or adaptation to the new country. All developed severe psychiatric dissociative symptoms after objectively minor stresses, which occurred several years after their immigration to the new country of residence. Despite adequate treatment, their symptoms followed a chronic course. The patients’ neuropsychological profiles shared similarities, such as executive functioning deficits (e.g. limited cognitive flexibility) and impairments of emotional processing in addition to severe autobiographical amnesia.ConclusionsWe propose that stresses related to immigration and acculturation could trigger dissociative memory disorders in immigrants via a dysregulation of the hormonal stress responses, which is mediated by individual characteristics (cognitive flexibility, emotional processing abilities, language competence and cultural affiliations).