Descriptive Psychopathology: The Signs and Symptoms of ...

327 Chapter 13: Testing and psychopathology of cognitive dysfunctionassessed by testing the patient’s fund of information. This information is greatlyinfluenced by education, and includes such things as naming the presidents orprime ministers of the country, capital cities, and prominent geographic placesand their relationships. The new learning of semantic information is assessed byasking the patient to learn and later recall several items. 36 Recalling the items inthe similarities test is used for this purpose.Episodic (autobiographical) memory is memory for information known only toa person being tested and to “others who were there at the time”. Examplesinclude a particular birthday party and a first date. Episodic memory can beassessed by asking the patient at the end of the testing procedures to describe thetasks that were asked and other events that occurred during the evaluation.History-taking also assesses the patient’s episodic memory.Anterograde and retrograde amnesiaWhen episodic and semantic memories are poorly acquired or retrieved, newlearning is impaired. The patient is said to have anterograde amnesia. Mild tosevere anterograde amnesia occurs after closed head injuries. The longer theperiod of anterograde amnesia following the injury, the more likely there willbe problems later in life (e.g. seizures, behavioral syndromes). 37 The patientappears unsure and interacts as if some recent events did not occur, or they areunable to recall recent event-related information. Subjectively patient’s describefeeling “fuzzy headed” and as if “in a fog”.Delayed recall of rehearsed verbal (similarities) and visual information(shapes) is one test for anterograde amnesia. Anterograde amnesia is associatedwith lesions involving the temporal lobes and the diencephalon. Occipital lobelesions are also associated with visual anterograde amnesia. 38 During a courseof ECT about half of patients experience temporary anterograde amnesia thatresolves in 2–6weeks following the last treatment. 39Retrograde amnesia refers to the loss of previously acquired information. Mostamnestic syndromes are defined by substantial retrograde amnesia.Meta-memoryMeta-memory is the subjective judgment about one’s own memory capabilities. Itis influenced by the present state of emotion. Patients who are depressed subjectivelyexperience their performance to be worse than in fact, while those in maniaor with the frontal lobe disinhibited syndrome experience their performanceto be better than in fact. Patients with temporal lobe epilepsy overestimatetheir memory capacities and their self-monitoring is less accurate for verbal ornon-verbal recall depending on the side of the seizure focus. 40