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Dissociative amnesia — Clinical Guidelines

Overview

Dissociative amnesia is characterized by an inability to recall personal information, typically autobiographical events, due to psychological factors rather than neurological impairment. Unlike transient global amnesia, dissociative amnesia does not involve immediate recall or remote memory loss and often has psychological triggers 3.

Diagnosis

Key Diagnostic Criteria: Sudden onset of memory loss for personal information, absence of neurological deficits, presence of psychological stressors or trauma 3.

Recommended Tests: No specific laboratory tests; diagnosis primarily clinical, often requiring exclusion of organic causes through neuroimaging (e.g., MRI) and neurological examination 1 8.

Grading: Not typically graded; diagnosis based on clinical criteria and exclusion of other conditions 1 8.

Management

First-Line Treatments: Psychotherapy, particularly trauma-focused therapies like Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) 3.

Adjunctive Treatments: Supportive counseling, stress management techniques, and in some cases, pharmacotherapy targeting associated symptoms like anxiety or depression (e.g., SSRIs) 3.

Special Populations

Pediatrics: Limited specific data; management focuses on supportive psychotherapy and addressing underlying trauma 4.

Elderly: Considerations for comorbid conditions; cognitive rehabilitation and supportive psychotherapy are crucial 8.

Comorbidities: Management should address both dissociative amnesia and coexisting conditions, integrating psychological and medical treatments 3.

Key Recommendations

Primary Treatment with Psychotherapy: Initiate with trauma-focused psychotherapies such as CBT or EMDR to address underlying psychological triggers 3 (Evidence: Strong).

Exclusion of Organic Causes: Conduct thorough neurological evaluations and neuroimaging to rule out transient global amnesia or other neurological conditions 1 8 (Evidence: Moderate).

Supportive Counseling and Stress Management: Incorporate supportive counseling and stress reduction techniques to enhance overall psychological well-being 3 (Evidence: Moderate).

References

1 Harrison M, Williams M. The diagnosis and management of transient global amnesia in the emergency department. Emergency medicine journal : EMJ 2007. link 2 Merritt P, Hirshman E, Hsu J, Berrigan M. Metamemory without the memory: are people aware of midazolam-induced amnesia?. Psychopharmacology 2005. link 3 Baxendale S. Memories aren't made of this: amnesia at the movies. BMJ (Clinical research ed.) 2004. link 4 Vargha-Khadem F, Salmond CH, Watkins KE, Friston KJ, Gadian DG, Mishkin M. Developmental amnesia: effect of age at injury. Proceedings of the National Academy of Sciences of the United States of America 2003. link 5 Veselis RA, Reinsel RA, Feshchenko VA, Dnistrian AM. A neuroanatomical construct for the amnesic effects of propofol. Anesthesiology 2002. link 6 Kettaneh A, Gobron C, Fain O, Mohib S, Thomas M. Calculi and memory. European journal of neurology 2001. link 7 Veselis RA, Reinsel RA, Feshchenko VA. Drug-induced amnesia is a separate phenomenon from sedation: electrophysiologic evidence. Anesthesiology 2001. link 8 Brown J. ED evaluation of transient global amnesia. Annals of emergency medicine 1997. link70013-1) 9 Huff JS, Plunkett HG. Anterograde amnesia following triazolam use in two emergency physicians. The Journal of emergency medicine 1989. link90262-x) 10 Mazzucchi A. Transient global amnesia: definition and clinical phenomenology. Italian journal of neurological sciences 1988. link 11 Zinelli P, Nasuto S, Miari A. Transient global amnesia: case-reports. Italian journal of neurological sciences 1988. link 12 Accurti I, Proli F. Transient global amnesia: a personal series of idiopathic and post-traumatic cases. Italian journal of neurological sciences 1988. link 13 Gallassi R, Stracciari A, Morreale A, Lorusso S, Ciucci G. Transient global amnesia follow-up: a neuropsychological investigation. Italian journal of neurological sciences 1988. link 14 Rebucci GG. Could a neurohormonal mechanism be involved in transient global amnesia?. Italian journal of neurological sciences 1988. link 15 Downes JJ. Classroom reality orientation and the enhancement of orientation--a critical note. The British journal of clinical psychology 1987. link

Dissociative amnesia