Descriptive Psychopathology: The Signs and Symptoms of ...

285 Chapter 11: Delusions and abnormal thought contentDelusional memoriesParamnesiaParamnesia is false memories derived from illusions in association with intenseemotion. Past events become distorted by the present emotional state or associateddelusions. When the patient is convinced of the validity of the clearly falsememories, the term is retrospective falsification or delusional memory. The schizophrenic“remembers” the implanting of the transmitter in his brain. The melancholic“remembers” past sins. The manic “remembers” being an infant in a palaceor great estate. Pseudo-memories can be described in great detail.Reduplicative paramnesia is the belief that present surroundings are false andrepresent a duplication of the real place. It is also a misidentification syndrome.Patient 1.4 believed her neighborhood was not real but a duplication fabricatedby aliens.State-dependent memory is the recall of events or learned material only whenthe person is in the same drug or medication-induced state under which theevent was experienced or the material learned. Patients with psychosis or severemood disorder experience this phenomenon and, when well, will not recalldramatic experiences that occurred when ill. When ill again, the memories areagain accessible and recalled. 54 Patient 11.4, when depressed or euthymic, couldnot recall events that occurred during manic periods.Patient 11.4During morning rounds, a 44-year-old manic man was examined. Every dayafter the initial examination, the patient sought out, greeted the examiner, andchatted with him for several minutes. After some months out of the hospital,the same patient was re-admitted for an episode of depression. Seeing theexaminer, he made no effort to engage in conversation and did not remembertheir meeting. Later that year, the patient was again re-admitted, this time in amanic episode. As soon as the examiner entered the unit, the patient rushed togreet him, saying he was the doctor that “knew what was going on”.Retrospective falsificationPseudo-memories are delusional falsifications of memory in which memoryengrams are distorted by illness and are offered by the patient as “proof” forhis present beliefs. One patient vividly described a childhood trip to the dentist,during which a transmitter was placed in his skull that now was the conduit forhis “voices” and the efforts to control his thoughts. Another described in detailthe inside of a flying saucer that he had invented many years before. Once thepatient recovers, the memory distortions also resolve.