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强迫性强迫观念性混淆的遗忘表现(关于在一次记忆咨询中出现的约3例患者)

[Amnesic presentations of the compulsive obsessional confusions (about 3 patients appearing in a consultation of memory)].

作者信息

Thomasantérion C, Cadet L, Dirson S, Laurent B

机构信息

Unité de Neuropsychologie, Service de Neurologie, CHU Bellevue, 42055 Saint-Etienne cedex 02, France.

出版信息

Encephale. 2002 Mar-Apr;28(2):154-9.

Abstract

Disorders or complaints of memory are a frequent cause of consultation in depression, major anxiety and psychiatry disease with personality disorders. We report 3 patients with obsessive compulsive disorder (OCD), without diagnosis and treatment, examined in a specialized memory consultation. They always had OCD with cognitive checking. Diagnosis of transient global amnesia and temporal complex seizure were discussed in 2 cases. Psychometric impairment only was observed in first free recall of a verbal memory task and was no specific. Behavioural during testing seemed to be very important to analyse. First, a 49-year-old man consulted because he had stereotyped transient amnesia lasted one minute, 2 or 3 times a week, since 6 months. He was a teacher. Transient amnesia always occurred during lessons. Suddenly he didn't know where he was or what he was speaking about. Episodes lasted one minute. After them, he had no confusion and no difficulty in concentration but intense anxiety. In an another hand, when he was in his car, after lessons, he could forget where he was during some minutes. CT scan and EEG were normal. Neuropsychological tests only objectived impairment in first free recall of Grober and Buschke's words. Patient explained that he could not prevent to check responses. He told us checking obsessive compulsive disorder during since long time ago. We discussed clear differences which existed between seizure and ruminations or preoccupations. Secondly, a 55-year-old woman was afraid of her memory performances. She was medical secretary and had no problem in her work but she would like a memory consultation to reassure herself. She was neither depressed nor anxious. She presented curious production in fluency task. She had to produce as many animals's names as possible: she could say 35 names which was an excellent performance but only in alphabetic order! Neuropsychological tests objectived impairment in her first free recall of Grober and Buschke's words. She tried in her first free recall to remember words in alphabetic order. She explained how she was bound to range everything in alphabetic order! She had a lot of rituals. She thought that she had an obsessive compulsive disorder but never consulted about this. The observation illustrated suspiscions about memory operations which could be observed in patients group with obsessive compulsive disorders. Finally, a 62-year-old man told us that he had presented a transient global amnesia during 4 hours. He had an important appointment and was upset about that. He didn't go to it and wandered in his flat. He always asked the same questions and forgot everything. He had no neurological deficit. He was anxious, sad and cried several times. He perfectly remembered the episod and thought that he had a panic attack! Verbal memory tests only objectived difficulties in his first free recall of Grober and Buschke words as the two others patients. He had a story of obsessive compulsive disorder with checking and rituals. In this observation, we discussed clear differences which existed between panic attacks and global transient amnesia. We analyzed patterns of neuropsychological performances which illustrated clinical features of obsessive compulsive disorder. These three patients impaired in their first free recall of verbal memory task. It is not a specific result. We observed during psychometric evaluation, strategic processing which impaired episodic memory: patients tried to check their performances. Memory complaints only were observed in checking obsessive compulsive disorder. It is a difficulty or a doubt about memory capacities. Difficulties could be due to particular cognitive processes who pertubate normal memory capacities.

摘要

记忆障碍或主诉是抑郁症、重度焦虑症以及伴有人格障碍的精神疾病患者前来咨询的常见原因。我们报告了3例未经诊断和治疗的强迫症(OCD)患者,他们在专门的记忆咨询门诊接受了检查。他们均患有伴有认知检查行为的强迫症。其中2例患者曾被讨论过短暂性全面遗忘症和颞叶复杂癫痫的诊断。在一项言语记忆任务的首次自由回忆中仅观察到心理测量方面的损害,且并无特异性。测试过程中的行为表现对于分析似乎非常重要。首先,一名49岁男性前来咨询,他自述自6个月以来每周有2至3次刻板性短暂遗忘发作,每次持续1分钟。他是一名教师,短暂性遗忘总是在授课期间发作。突然,他不知道自己身在何处或正在谈论什么。发作持续1分钟。发作过后,他没有意识混乱,注意力也没有困难,但会感到强烈焦虑。另一方面,课后当他在车内时,有时会在几分钟内忘记自己身处何地。CT扫描和脑电图检查均正常。神经心理学测试仅发现其在Grober和Buschke词汇的首次自由回忆中有损害。患者解释说他无法阻止自己检查答案。他告诉我们他患有强迫检查行为的强迫症已经很久了。我们讨论了癫痫发作与反复思考或先占观念之间存在的明显差异。其次,一名55岁女性担心自己的记忆表现。她是一名医疗秘书,工作上没有问题,但她希望进行记忆咨询以让自己安心。她既不抑郁也不焦虑。在流畅性任务中她表现出奇特的情况。她需要尽可能多地说出动物的名字:她能说出35个,这是非常出色的表现,但她只能按字母顺序说出!神经心理学测试发现她在Grober和Buschke词汇的首次自由回忆中有损害。她在首次自由回忆中试图按字母顺序记住单词。她解释了自己如何总是将一切都按字母顺序排列!她有很多仪式行为。她认为自己患有强迫症,但从未就此事咨询过。该观察结果表明了对强迫症患者群体中可能观察到的记忆操作的怀疑。最后,一名62岁男性告诉我们他曾出现过4小时的短暂性全面遗忘。他有一个重要的约会,为此感到心烦意乱。他没有赴约,在公寓里徘徊。他总是问同样的问题,什么都记不住。他没有神经功能缺损。他焦虑、悲伤,还哭了好几次。他对这段经历记得很清楚,认为自己是惊恐发作!言语记忆测试仅发现他在Grober和Buschke词汇的首次自由回忆中与其他两名患者一样存在困难。他有强迫检查行为和仪式行为的强迫症病史。在这次观察中,我们讨论了惊恐发作与短暂性全面遗忘之间存在的明显差异。我们分析了神经心理学表现模式,这些模式说明了强迫症的临床特征。这三名患者在言语记忆任务 的首次自由回忆中均有损害。这并非特异性结果。我们在心理测量评估过程中观察到,策略性加工损害了情景记忆:患者试图检查自己的表现。仅在强迫检查行为的强迫症中观察到记忆主诉。这是对记忆能力的一种困难或怀疑。这些困难可能是由于特定的认知过程干扰了正常的记忆能力。

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