THE GREAT ESCAPE - A NEUROPSYCHOLOGICAL STUDY OF PSYCHOGENIC AMNESIA

This paper describes the neuropsychological test performance of a pati ent who experienced a ''fugue'' episode (functional retrograde amnesia ) lasting 7 days, but who continued to complain of a virtually complet e loss of autobiographical memory for well over a year. Subsequent evi dence revealed that she had been at least partially simulating her amn esia during this prolonged period. Neuropsychological testing took pla ce soon after admission to hospital, at intervals thereafter, and afte r an Amytal abreaction, which produced a substantial recovery of her m emories. On various anterograde tests, designed to detect simulation, the patient's performance was unimpaired, including recognition memory tasks, word-stem completion priming for ''neutral'' word-lists and fo r post-onset autobiographical material, and some aspects of semantic m emory. However, her pattern of performance on an autobiographical and a remote News Event test differentiated her From patients with organic amnesia, because she showed a grossly disproportionate autobiographic al memory loss and an extreme recency effect. In addition, a rating sc ale, on which she showed impaired feelings-of-knowing for items from h er autobiographical memory, suggested simulation. On a word-completion task for pre-onset autobiographical material, she showed absent ''pri ming'' relative to ''baseline'' material. However, following the Amyta l abreaction, there was a substantial improvement on this task, relati ve to recognition and cued recall performance. This finding has been i nterpreted within an hierarchical model of awareness in memory, derive d from studies of normal memory and organic amnesia; and it is suggest ed that patients with ''psychogenic amnesia'' may manifest different l evels of awareness for differing memories.