[A clinical study of generalized amnesia].

Six cases of generalized amnesia were reported. Generalized amnesia caused by phenomena of genuinely psychogenic origin is a rare psychological disorder and spontaneous recovery from amnesia in a comparatively short period of time is one of the characteristics of this disorder. Three of the cases in this report developed amnesia which was prolonged in comparison with previously reported cases. A comparison between these six cases and previously reported cases of amnesia elucidated the general characteristics of this disorder, differential diagnosis from other disorders, the development of a new identity during the amnestic period, amnesia as an alternative to suicide, factors related to prolonged amnesia, and its treatment. Although differential diagnosis from other disorders, especially from malingering, is sometimes difficult, the patient's attitude toward amnesia, the development of the clinical course of amnesia, the premorbid personal history, and interpersonal relationships should be carefully observed and evaluated in order to differentiate generalized amnesia from malingering. During the amnestic period it was observed that three of the cases believed that they had names of other persons, and two of them recalled personal histories completely different from their own. Previously, such phenomena have been mainly discussed from the view-point of pseudologia fantastica or malingering in Japan. The author discusses how a new identity could be developed in cases of generalized amnesia. According to Abeles, et al., generalized amnesia can sometimes serve as psychological suicide. The author emphasizes that the patient's suicidal risk should be evaluated carefully, even if he or she does not seem highly suicidal superficially. Excessive haste to recover from amnesia may heighten the suicidal risk or help develop a distorted personal identity. The principle for the treatment is to exclude an unnecessary therapeutic manipulation and maintain a consistent and comprehensive psychotherapy. The author also discusses factors with which the duration of amnesia can be evaluated in the initial treatment planning. The premorbid personality, the premorbid social adjustment, previous conflicts leading to amnesia, the whole clinical picture of amnesia, the whereabouts of the patient's family, and the suicidal ideation should all be taken into account.