Abnormal Psychology

694 CHAPTER 15

Amnestic Disorder

Mrs. B. was not delirious and had not been delirious in the nursing home; she knew

who and where she was and her cognitive diffi culties—her memory problems—were

not transient. In addition to forgetting about planned activities, she’d been forget-

ting whether she’d taken her medications and forgetting doctor’s appointments. The

neuropsychologist needed to determine the extent of her memory problems and

whether they were worse than those normally associated with aging.

“When questioned about her memory and thinking, she reported that she had “been

off track” some before her move and attributed this to [an] “imbalance” resulting from

the many stresses that she had experienced in her life. She was vague in describing

what she had found stressful, naming the death of her husband (many years before)

and the loss or theft of some belongings (how and when unclear)....

“Mrs. B. had some reservations at fi rst about being asked more questions about her

memory and mood, but as the interview continued, she became more comfortable and

worked with good effort. Testing proceeded very slowly because of her tendency to

digress, reminiscing about events from her early life or about current circumstances. In

general, she was more willing to talk than to participate in structured assessment.”

(LaRue & Watson, 1998, p. 6)

For some older people, the only signifi cant cognitive function that is impaired is

memory—in particular, the ability to store new information or to recall or recognize

information already stored. Mrs. B.’s memory problems seem to be limited to recent

events—such as scheduling appointments—rather than events in her distant past.

Either type of memory problem may indicate amnestic disorder. In this section we

examine amnestic disorder and its neurological causes in more detail.

What Is Amnestic Disorder?

The key characteristic of amnestic disorder is impaired memory while other men-

tal processes remain relatively intact. The memory problem may involve diffi culty

storing new information or recalling previously stored information. DSM-IV-TR al-

lows the clinician to specify whether the memory impairment is transient (lasting

from a few days to a maximum of 1 month—a type that may arise as a result of

seizures), or is chronic (lasting for longer than 1 month). The memory problem is

Amnestic disorder
A cognitive disorder characterized by
impaired memory while other mental
processes remain relatively intact.

Confabulate
To create stories in order to fi ll in gaps in
memory.

may behave accordingly and get hurt—or hurt other people—in

the process.

• Delirious people may become either restless and agitated or
  sluggish and lethargic, or they may rapidly alternate between
  these two states. Delirium most commonly occurs among
  the elderly, the terminally ill, and patients who have just had
  surgery.


• Symptoms of depression, anxiety, dissociation, psychosis,
  and substance use can appear similar to some symptoms of
  delirium.


• Delirium can arise from substance intoxication or withdrawal;
  however, for a diagnosis of delirium related to substance
  use, the symptoms must be more severe than would normally
  arise from intoxication produced by, or withdrawal from, the
  particular substance. Delirium can also arise from a medical
  condition such as an infection or head trauma or following
  surgery.
  
  
  • Treatment for delirium that targets neurological factors often
    addresses the underlying physical cause, typically through
    medication. Antipsychotic medication may be given when treat-
    ment for the underlying condition isn’t possible or will take time
    to take effect.
  
  
  • Treatments that target psychological and social factors include
    correcting sensory impairments, helping patients increase their
    awareness of the here and now, and educating people who
    interact with the delirious patient about the symptoms of the
    disorder.
  
  
  
  

Making a Diagnosis

• Reread Case 15.2 about Ms. Richardson, and determine whether
  or not her symptoms meet the criteria for delirium. Specifi cally,
  list which criteria apply and which do not. If you would like more
  information to determine her diagnosis, what information—
  specifically—would you want, and in what ways would the
  information infl uence your decision?