PSYCHIATRY.docx

7/25/2019 PSYCHIATRY.docx

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PSYCHIATRY

REPORT ON NEW DEVELOPMENT

AND MANAGEMENT OF AMNESIC

DISORDER

Reporters:

Flores, Beatriz

Ramos, Cristine

Salva, Kristyle

Villafrana, Kiel

!al"arria#a, $lla

INTRODUCTION

Amnesia is "e%ne" as t&e total or partial loss of memory' T&ere is onsi"era(le

&etero#eneity re#ar"in# amnesi syn"romes' Reports of several types of amnesia

an (e fo)n" in t&e literat)re to t&is "ate an" t&ere is also #reat "iversity in t&e


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ne)ropsy&opat&olo#y of amnesia' Amnesi syn"rome an (e o(serve" in several

pat&olo#ies an" its onset is pro#ressive or s)""en, transient or permanent' In s&ort,

it is important to onsi"er t&e etiolo#ial, or#ani, pro#ressive an" linial riteria in

amnesia lassi%ation'

HOW IS AMNESIA DIAGNOSED?

Initially, t&e &ealt& are professional *ill nee" to r)le o)t any ot&er possi(le a)ses

of memory loss, inl)"in# "ementia, Alz&eimer+s "isease, "epression, or a (rain

t)mor' It *ill re)ire a "etaile" me"ial &istory - t&is may (e "i.)lt if t&e patient

"oes not remem(er t&in#s, so family mem(ers or are#ivers may also &ave to (e

present' T&e patient+s permission to tal/ a(o)t &is0&er me"ial "etails *it&

some(o"y else is nee"e"'

T&e Healt&are Provi"er *ill try to over t&e follo*in# iss)es:

o Can the patient remember recent events an!"#r rem#te events $events

%&rther bac' in time()o When !i! the mem#r* pr#b+ems start)

o ,#- !i! the mem#r* pr#b+ems ev#+ve)

o Were there an* %act#rs -hich ma* have ca&se! the mem#r* +#ss s&ch as a

hea! in.&r* s&r/er* #r str#'e)o Is there a %ami+* hist#r* #% an* ne&r#+#/ica+ #r ps*chiatric !iseases #r

c#n!iti#ns)o Detai+s ab#&t the patient0s a+c#h#+ inta'e1

o Is the patient c&rrent+* #n an* me!icati#n)

o ,as the patient ta'en i++e/a+ !r&/s s&ch as c#caine mari.&ana etc1)

o Are the patient0s s*mpt#ms &n!erminin/ his"her abi+it* t# +##' a%ter

himse+%"herse+%)o D#es the patient have a hist#r* #% !epressi#n)

o ,as the patient ever ha! cancer)

o D#es the patient have a hist#r* #% sei2&res)

P&ysial Assessment:

o Re1e2es

o Sensory f)ntion

o Balane

o Some ot&er aspets of t&e (rain an" nervo)s system'

C&e/ Patient+s:

o 3)"#ment

o S&ort-term memory

o 4on#-term memory


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DIAGNOSTIC TESTS

In or"er to %n" o)t *&et&er t&ere is any p&ysial "ama#e or (rain a(normality, t&e

"otor may or"er:

o An 5RI 6ma#neti resonane ima#in#7 san - 8se" in "etetin# a t)mor in t&e

(rain'o A CT 6omp)terize" tomo#rap&y7 san in9)ry7'

o An $$ 6eletroenep&alo#ram7

o Bloo" tests may also reveal t&e presene of any infetion, or n)tritional

"e%ienies'

TREATMENT OF AMNESIA

As of no*, t&ere is no /no*n treatment yet for amnesia' Ho*ever, many forms of

amnesia %2 t&emselves *it&o)t (ein# treate"'

o Co#nitive t&erapy

8s)ally t&ro)#& a spee&0lan#)a#e t&erapist, may (e &elpf)l for mil" to

mo"erate memory loss'

o Psy&ot&erapy

Sometimes it may (e e;etive for some patients' Hypnosis an (e an

e;etive *ay of reallin# memories t&at &ave (een for#otten'

o o me"iations are )rrently availa(le for treatin# most types of amnesia'

Sometimes it is appropriate to a"minister a "r)# alle" Amytal 6so"i)m

amo(ar(ital7 to people s);erin# from amnesia' T&e me"iine &elps some people

reall t&eir lost memories' ?erni/e-Korsa/o; syn"rome involves a la/ of t&iamine,treatment inl)"es replain# t&is vitamin an" provi"in# proper n)trition' Alt&o)#&

treatment, *&i& also nee"s to inl)"e alo&ol a(stinene, an &elp prevent f)rt&er

"ama#e, most people *on=t reover all of t&eir lost memory' If an )n"erlyin# a)se

for t&e amnesia is i"enti%e", t&ere are national or#anizations t&at an provi"e

a""itional information or s)pport for t&e in"ivi")al an" t&eir families'


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AMNESIA REHABILITATION

5any re&a(ilitation te&ni)es are at)ally )se" to treat amnesi in"ivi")als,

espeially t&ose *&o s);er from antero#ra"e amnesia' Interventions may fo)s on

t&e )se of compensatory techniques, s)& as omp)ters, (eepers, *ritten notes,

"iaries or t&ro)#& intensive trainin# pro#rams involvin# t&e ative partiipation of

t&e in"ivi")al, as *ell as &is0&er family an" frien" irle' In t&is perspetive,environmental adaptation techniques are )se", s)& as t&e compensatory

technique education to trainin# 6e2erise7, or#anizational strate#ies, vis)al

ima#ery an" ver(al la(ellin#' In a""ition, ot&er te&ni)es are also )se" in

re&a(ilitation, s)& as impliit tas/s, spee&, an" mnemote&ni met&o"s 6Cierone

et al' @7' So far, it &as (een proven t&at e")ation te&ni)es of ompensatory

strate#ies for memory "isor"ers are e;etive in in"ivi")als *it& minor tra)mati

(rain in9)ries 6or"on et al' @7' In mo"erately or severely in9)re" in"ivi")als, t&e

most e;etive interventions are t&ose appealin# to e2ternal ai"s, s)& as remin"ers

in or"er to failitate parti)lar /no*le"#e or s/ill a)isition' T&e p)rpose of t&ese

e2ternal ai"s is to en&ane t&e in"ivi")al=s f)ntional level rat&er t&an t&e memory

f)ntion per se 6Cierone et al' @7' Reality orientation techniquesare alsoonsi"ere" in onf)se" in"ivi")als *it& "e%its in t&e retro#ra"e an" antero#ra"e

memory, as *ell as spatio-temporal "isorientation' T&eir p)rpose is to en&ane

orientation )sin# stim)lation an" repetition of t&e (asi orientation information

6Corri#an et al' DE7' T&ese te&ni)es are applie" on an in"ivi")al 6informal

approa&7 or a #ro)p (asis 6formal approa&7 an" &ave (een )se" in pop)lations of

patients primarily presentin# *it& "ementia an" &ea"-in9)re" patients 6!eni)s et

al' DDEG "e )ise et al' @7'

RELEARNING AND COMPENSATING

Re&a(ilitation &as t*o primary omponents:

' Relearnin# for#otten s/ills@' Compensatin# for more en")rin# impairments

5)& of *&at a s)rvivor &as learne" in &er lifetime still is present in &er (rain after

t&e tra)ma' Severe" onnetions (lo/ aess to t&is information an" t&e patient

an+t reall &o* to perform many ativities' T&ro)#& "irete" trainin# an" persistent

pratie, re&a( repro#rams t&e (rain, esta(lis&in# ne* onnetions amon# t&ese

still-present po/ets of information, ena(lin# t&e patient to rea)ire for#otten

s/ills'

espite t&e (est e;orts of yo)r s)rvivor an" &er re&a( team, serio)s (rain "ama#e

al*ays res)lts in some impairment t&at annot (e reme"ie"' To lea" a f)ll life, yo)r

s)rvivor m)st learn *ays to *or/ aro)n" &er ne* "e%its' In re&a(ilitation, s&e *ill

(e ta)#&t to reo#nize an" ompensate for &er impairments'

Sometimes, ompensation means a &an#e in (e&avior' T&is is alle" applyin#

ompensatory strate#ies' For e2ample, a person *it& a "iminis&e" memory


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nearly everyone *it& a (rain in9)ry is ta)#&t to /eep a "etaile", "aily s&e")le to

/eep &er from aimlessly or ine.iently passin# &er time'

WHEN SHOULD REHABILITATION BEGIN?

In an i"eal *orl", re&a(ilitation (e#ins as soon as t&e s)rvivor is me"ially sta(le'

>o patient s&o)l" (e /ept in an a)te &ospital settin# or a n)rsin# &ome any lon#er

t&an neessary' Com(inin# t&e (rain+s nat)ral &ealin# proess *it& re&a(ilitative

t&erapy is r)ial to t&e s)ess of one+s reovery'

Resear&ers &ave learne" t&at s)rvivors (ene%t most from re&a(ilitation *&en t&ey

&ave rea&e" 4evel J or on t&e Ran&o Sale'

References:

http://www.medicalnewstoday.com/articles/9673.php?page!

http://al".org

http://www.nhs.u#/conditions/psychotherapy/$ages/%ntroduction.asp&
http://www.medicalnewstoday.com/articles/9673.php?page=2http://alz.org/http://www.nhs.uk/conditions/psychotherapy/Pages/Introduction.aspxhttp://alz.org/http://www.nhs.uk/conditions/psychotherapy/Pages/Introduction.aspxhttp://www.medicalnewstoday.com/articles/9673.php?page=2


6/11

FURTHER RESEARCH ABOUT MODERN APPROACH TO AMNESIA

Brain Prosthesis Designe to He!" Peo"!e With Me#or$ Loss

(y 3i!ita Debnathon e*s - 3 $

$2perts &ave "evelope" a (rain prost&esis t&at an replae or s)pport a "ama#e"

part of t&e (rain an" &elp people *it& memory loss pro(lems an" form memories as

e.iently as any ot&er person'

T&e prost&esis, *&i& inl)"es a small array of eletro"es implante" into t&e (rain,

&as performe" *ell in la(oratory testin# in animals an" is )rrently (ein# eval)ate"

in &)man patients'

T&e "evie t&at relies on a ne* al#orit&m *as "esi#ne" ori#inally at 8niversity of

So)t&ern California an" teste" at ?a/e Forest Baptist 5e"ial Centre in >ort&Carolina'

T&e resear&ers e2plaine" t&at *&en yo)r (rain reeives t&e sensory inp)t, it

reates a memory in t&e form of a omple2 eletrial si#nal t&at travels t&ro)#&

m)ltiple re#ions of t&e &ippoamp)s, t&e memory entre of t&e (rain'

At ea& re#ion, t&e si#nal is re-eno"e" )ntil it rea&es t&e %nal re#ion as a *&olly

"i;erent si#nal t&at is sent o; for lon#-term stora#e'

If t&ere is "ama#e at any re#ion t&at prevents t&is translation, t&en t&ere is t&e

possi(ility t&at lon#-term memory *ill not (e forme"'

T&at is *&y an in"ivi")al *it& &ippoampal "ama#e 6for e2ample, ")e toAlz&eimer=s "isease7 an reall events from a lon# time a#o - t&in#s t&at *ere

alrea"y translate" into lon#-term memories (efore t&e (rain "ama#e o)rre" - ()t

&ave "i.)lty formin# ne* lon#-term memories'

Son# an" Ber#er fo)n" a *ay to a)rately mimi &o* a memory is translate" from

s&ort-term memory into lon#-term memory, )sin# "ata o(taine" %rst from animals,

an" t&en from &)mans'


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T&e prost&esis is "esi#ne" to (ypass a "ama#e" &ippoampal setion an" provi"e

t&e ne2t re#ion *it& t&e orretly translate" memory'

T&at is "espite t&e fat t&at t&ere is )rrently no *ay of Lrea"in#L a memory 9)st (y

loo/in# at its eletrial si#nal'

LIt is li/e (ein# a(le to translate from Spanis& to Fren& *it&o)t (ein# a(le to)n"erstan" eit&er lan#)a#e,L sai" Te" Ber#er from 8SC Viter(i S&ool of

$n#ineerin#'

In &)n"re"s of trials on")te" *it& nine patients, t&e ne* al#orit&m a)rately

pre"ite" &o* t&e si#nals *o)l" (e translate" *it& a(o)t D perent a)ray'

T&e resear& *as presente" at t&e JMt& Ann)al International Conferene of t&e I$$$

$n#ineerin# in 5e"iine an" Biolo#y Soiety in 5ilan, Italy'

So)re: IA>S

Rea" more: Brain Prost&esis esi#ne" to Help People ?it& 5emory 4oss

&ttp:00***'me"in"ia'net0ne*s0(rain-prost&esis-"esi#ne"-to-&elp-people-*it&-

memory-loss-E-'&tmNi2zzJ2roze

EMDR

$ye 5ovement an" esensitization an" Reproessin# 6$5R7 6S&apiro, DD, @7

is a met&o" t&at *as "evelope" (y Franine S&apiro in t&e early DD+s' $5R is a

s&ort term psy&o"ynami psy&ot&erapy met&o" t&at fo)ses on &elpin# t&e

patient0lient to aess an" proess previo)sly for#otten painf)l tra)mati memory'

Amnesia for an event or relations&ip nee" not only (e tra)mati in nat)reG memoryrelatin# to painf)l e2perienes of self in interation *it&in families is also very

ommonly for#otten from mi"-a"olesene on*ar"' In fat )nresolve" t&o)#&ts of

self in interation an" feelin#s *it& re#ar"s to a tro)(lin# parent-&il" relations&ip

often )n"erlies one+s later 6Bremner et al', DDJ7 responses to a tra)mati event6s7,

i'e' earlier stress an" tra)ma set t&e sta#e for t&e later e2pression of PTS

symptoms' ?&en painf)l memory is for#otten, it (eomes trappe" in t&e (rain an"

entral nervo)s system 6C>S7 6van "er Kol/, DD(7, is presente" in later

ne)ro(iolo#ial alterations of ne)ral ir)itry 6van "er Kol/, DD(7 an" is

ina"vertently internalize" an" reenate" in later a")lt sripts 6o)l"in# O o)l"in#,

DMG van "er Kol/, DDa7' 4ater stressors an" a#in# allo* t&e e2pression of

symptoms of &roni psy&iatri, a;etive, or p&ysial illness 6van "er Kol/, DDa7t&at li/ely *ill some"ay re)ire psy&op&armaolo#ial intervention aor"in# to

to"ay+s stan"ar"'

T&e $5R t&erapy session &elps t&e patient to reall an" proess "i;erent aspets

of a tro)(lin# or painf)l memory relatin# to a tra)mati event or emotional loss'

?&at *as e2periene" as painf)l *it& reall at t&e start of t&erapy, after t&erapy, is

no lon#er painf)l' In a""ition, t&e #eneral aro)sal state of t&e patient an"


8/11

e2periene of )nomforta(le symptoms "erease in response to pro#ress in t&erapy'

S)essf)l proessin# of ea& painf)l memory removes a layer of stress t&at &a"

(een previo)sly e2presse" in ne)ro(iolo#ial terms an" t&ro)#& symptoms prior to

t&e ompletion of t&e $5R proessin#' T&e "ereases in aro)sal an" p&ysiolo#ial

meas)res t&at ome *it& omplete proessin# of painf)l or tra)mati memory

sim)lates one+s sense of *ell (ein#, similar to t&at e2periene" in response tos)essf)lly remitte" psy&op&armaolo#ial t&erapy' As *ill (e "emonstrate" in a

f)t)re setion of t&is *e( site, t&e stress response ten"s to re")e t&e f)ntional

inte#rity of ertain ortiolim(i re#ions, e'#' pACC an" t&e &ippoampal formation,

an" t&is pro")es alterations in ne)ral ir)itry, in t&eir meta(olism as *ell as in

t&e synt&esis, release an" seretion of ertain stress ne)ro&ormones an"

ne)roimm)ne mar/ers' S)essf)l t&erapies *or/ to improve t&e f)ntion of t&ese

areas to promote t&e mo")lation of t&e stress response'

)rin# t&e $5R assessment 6S&apiro, DD, @7 t&e t&erapist ompletes a

t&oro)#& assessment an" &istory *it& t&e patient, &elps t&e patient to reate an"

esta(lis& a safe plae, an" loo/s to i"entify t&e ne#ative o#nition+ t&at &as (een

assoiate" *it& a ne#ative event6s7 or relations&ip6s7 t&at impats on t&e patient+s)rrent sense of self' T&e t&erapist t&en in)ires into t&e most "ist)r(in# sensory

aspet to t&e tra)mati event or relations&ip 6feelin# sore *it& &avin# (een (eaten

or &earin# an#er in an a##ressor+s voie7, viseral (o"y messa#es 6sin/in# feelin# in

t&e pit of one+s stoma& or &eart po)n"in#7, ne#ative emotion 6sa"ness7 *&i&

aompanies t&e ne#ative o#nition 6I am not #oo" eno)#& or I am )nlova(le7' T&e

$5R t&erapist monitors t&e patient+s sense of "ist)r(ane an" preferre" t&o)#&t

of self *it& S)(9etive 8nits of ist)r(ane 6S8S7 an" Vali"ity of Co#nition 6V


9/11

sessions 6Rot&(a)m, DDM7' After t&ree mont&s of $5R t&erapy an" a t&ree mont&

follo*-)p, om(at veterans *it& post-tra)mati stress "isor"er reporte" re")tions

in symptoms of memory intr)sion, avoi"ane, an" aro)sal, an" reporte" overall

improvements *&en ompare" *it& veterans reeivin# ro)tine are 6Carlson et al',

DDE7'

T&e st)"ies note" a(ove "o)ment $5Rs e.ay at re")in# symptoms an"p&ysiolo#ial meas)res in response to t&e proessin# of a sin#le tra)mati event,

()t anot&er note" after t*o sessions of $5R, t&at more sessions *ere nee"e" to

resolve a tra)ma 6S&e/ et al', DDE7' T&e pop)lation of @ in"ivi")als in t&is st)"y

presente" many "ysf)ntional (e&aviors, s)& as s)(stane a()se, inareration,

frien"s&ips *it& in"ivi")als *&o &a" en#a#e" in prostit)tion, an" relations&ips *it&

partners *&o *ere in )rrent inareration *it& &istories of s)(stane a()se' In

linial pratie s)& patient pop)lations ten" to present &roni stress &istories of

m)ltiple tra)mas 6p&ysial an"0or se2)al a()ses7 an" emotional losses t&ro)#&o)t

t&eir lives' Anot&er st)"y "i" a %ve-year follo*-)p of previo)s $5R t&erapy an"

fo)n" t&at t&erape)ti (ene%ts e2periene" imme"iately after $5R t&erapy *ere

lost at follo*-)p 65a/lin et al', @7' T&is st)"y li/e t&e one note" a(ove )se" asample pop)lation of veterans *&o *ere "esri(e" as entren&e" an" &ronially

ill+' T&e fat t&at (ot& sample pop)lations *ere note" to (e severely "ysf)ntional

an" &ronially ill s)##est t&at t&ey presente" &istories of m)ltiple tra)mas in t&eir

lifetime an"0or )nresolve" feelin#s *it& re#ar"s to emotional losses' T&e in"ivi")als

)m)lative stress responses to t&ese ot&er tra)mas *ere not ao)nte" for in t&e

proessin# of one sin#le tra)mati event' T&is "ynami *o)l" ma/e t&e met&o"

appear ine;et)al, (ea)se several sessions *ere at)ally nee"e" to proess

n)mero)s tra)mas to pro")e lon#-term e;etive res)lts'

After s)essf)l $5R t&rerapy, posttreatment salivary ortisol levels *ere

si#ni%antly re")e" in response to "e2amet&asone &allen#e an" *ere alsoassoiate" *it& re")tions in pereive" sensitivity to t&e impat of prior aversive

life events an" in an2iety symptoms 6He(er et al', @@7' In a SP$CT ne)roima#in#

st)"y post-treatment ativations of t&e peri#en)al anterior in#)late *ere stron#ly

orrelate" *it& post-treatment "ereases in sensitivity to relivin# tra)ma an" rate"

"istress val)es as *ell as re")tions of an2iety symptoms t&at met previo)sly

assi#ne" PTS "ia#nosis 64evin et al', DDD7'

In s)mmary, $5R, a s&ort term psy&o"ynami t&erapy met&o" &as (een teste"

(y many resear&ers for its s&ort-term an" lon# term e;etiveness' ?it& in"ivi")als

*it& limite" tra)mas in t&eir &istories t&e $5R t&erapy met&o" &as (een fo)n" to

(e s&ort, "iret, an" proven to (e )ite e;etive' Ho*ever, *it& in"ivi")als *it&

m)ltiple tra)mas an" many emotional losses in t&eir &istories, t&e proessin# of asin#le tra)mati event is not s).ient (y itself to o;set t&e ne)ro(iolo#ial asa"e

preipitate" (y a lifetime of &roni, )m)lative responses to stressf)l interations

*it& t&e environment' A plan nee"s to (e "evelope" *it& t&ese in"ivi")als to

a""ress an" tar#et ea& tra)ma *it& ea& s)ee"in# $5R session'


10/11

A no%e! thera"e&ti' a""roa'h (or an e)isting r&g re%erses a 'onition in

e!er!$ "atients *ho are at high ris+ (or e#entia &e to A!,hei#er-s

isease. resear'hers at /ohns Ho"+ins Uni%ersit$ (o&n0

T&e "r)#, ommonly )se" to treat epilepsy, alms &yperativity in t&e (rain of

patients *it& amnesti mil" o#nitive impairment 6a5CI7, a linially reo#nize"

on"ition in *&i& memory impairment is #reater t&an e2pete" for a person=s a#ean" *&i& #reatly inreases ris/ for Alz&eimer=s "ementia, aor"in# to t&e st)"y

p)(lis&e" t&is *ee/ in >e)roIma#e: Clinial'

T&e %n"in#s vali"ate t&e 3o&ns Hop/ins team=s initial onl)sions, p)(lis&e" t&ree

years a#o in t&e 9o)rnal >e)ron' T&ey also losely mat& t&e res)lts in animal

st)"ies performe" (y t&e team an" sientists else*&ere' >e2t, ne)rosientist

5i&ela alla#&er, t&e lea" investi#ator, &opes t&e t&erapy *ill (e teste" in a lar#e-

sale, lon#er-term linial trial'

Hippoampal over-ativity is *ell-"o)mente" in patients *it& a5CI an" its

o)rrene pre"its f)rt&er o#nitive "eline an" pro#ression to Alz&eimer=s

"ementia, alla#&er sai"'

L?&at *e=ve s&o*n is t&at very lo* "oses of t&e atypial antiepilepti levetiraetam

re")es t&is over-ativity,L alla#&er sai"' LAt t&e same time, it improves memory

performane on a tas/ t&at "epen"s on t&e &ippoamp)s'L

T&e team st)"ie" E s)(9etsG M of t&em *ere normal &ealt&y partiipants an" t&e

rest &a" t&e symptoms of pre-"ementia memory loss "e%ne" as a5CI' $veryone

*as over years ol", *it& an avera#e a#e of a(o)t M'

T&e s)(9ets *ere #iven varyin# "oses of t&e "r)# an" also a plae(o in a "o)(le-

(lin" ran"omize" trial' Resear&ers fo)n" lo* "oses (ot& improve" memory

performane an" normalize" t&e over-ativity "etete" (y f)ntional ma#netiresonane ima#in# t&at meas)res (rain ativity ")rin# a memory tas/' T&e i"eal

"osin# fo)n" in t&is linial st)"y mat&e" earlier prelinial st)"ies in animal

mo"els'

L?&at *e *ant to "isover no*, is *&et&er treatment over a lon#er time *ill

prevent f)rt&er o#nitive "eline an" "elay or stop pro#ression to Alz&eimer=s

"ementia,L alla#&er sai"'


11/11

on sales of pro")ts relate" to &er inventors&ip of intellet)al property' T&e terms of

t&ese arran#ements are mana#e" (y t&e )niversity in aor"ane *it& its on1it-

of-interest poliies'

'ournal Reference:

Arn#+! 3a''er Mari+*n S1 A+bert Gre/#r* 4ra&ss Car#+ine L1 Spec' Miche+a

Ga++a/her1 Resp#nse #% the me!ia+ temp#ra+ +#be net-#r' in amnestic mi+! c#/nitive

impairment t# therape&tic interventi#n assesse! b* %MRI an! mem#r* tas'

per%#rmance1 Ne&r#Ima/e5 C+inica+ 6789: ;5

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