Posttraumatische Belastungsstörung bei neurogener Amnesie für das traumatische Ereignis

Zusammenfassung:

Das Auftreten von Symptomen einer posttraumatischen Belastungsstörung (PTBS) bei Patienten mit neurogener Amnesie für das traumatische Ereignis wird anhand von 2 eigenen Fallbeobachtungen und 19 Fällen aus der klinischen Literatur beschrieben. Mit einer Ausnahme handelte es sich um Unfallopfer mit gedeckten Schädel-Hirn-Verletzungen. Nur bei etwa ³/₄ der Patienten waren die DSM-III-R-Kriterien der PTBS vollständig erfüllt. Bei 19 Patienten fanden sich traumabezogene unwillkürliche bewusste Erinnerungen (in Form wiederkehrender intrusiver Gedanken, Bilder oder Träume) bei vollständigem oder partiellem Fehlen willkürlicher bewusster Erinnerungen an das Trauma, was dafür spricht, dass den beiden Phänomenen verschiedene Gedächtnissysteme mit distinkten Hirnmechanismen zugrunde liegen. Die genannten klinischen Beobachtungen werden vor dem Hintergrund gegenwärtig vertretener neuropsychologischer Modelle multipler Gedächtnissysteme interpretiert. Die Kasuistiken zeigen, dass das deklarative episodische Gedächtnis nicht notwendig für die Ausbildung von Symptomen einer PTBS ist, sondern dass erhalten gebliebene Funktionen nichtdeklarativer Gedächtnissysteme eine hinreichende Bedingung hierfür darstellen.

Posttraumatic Stress Disorder in Patients with Neurogenic Amnesia for the Traumatic Event:

The development of symptoms of posttraumatic stress disorder (PTSD) in patients with neurogenic amnesia for the traumatic event is recorded in 2 own patients and in 19 cases from the clinical literature. With a single exception, all patients were accident victims with closed head injuries. Only about three quarters of the patients completely fulfilled DSM-III-R criteria of PTSD. Nineteen patients displayed involuntary conscious memories of aspects of the traumatic event (presenting as recurrent intrusive thoughts, images or dreams) co-existent with a complete or partial lack of voluntary conscious memories of the trauma, suggesting that different memory systems and distinct brain mechanisms subserve these phenomena. The said clinical observations are discussed against the background of current neuropsychological models of multiple memory systems. The recorded cases demonstrate that declarative episodic memory is not necessary for symptoms of PTSD to emerge, whereas preserved functions of non-declarative memory systems represent a sufficient condition for the development of PTSD symptoms.

Literatur

• 1 Markowitsch H J. Neuropsychologie des Gedächtnisses. Göttingen, Toronto, Zürich: Hogrefe 1992
• 2 Morgenstern C. Palmström. Berlin: Cassirer 1910
• 3 Sbordone R J. Neuropsychology for the attorney. Orlando: Deutsch Press 1991
• 4 Sbordone R J. Distinguishing traumatic brain injury from post-traumatic stress disorder. Neurolaw Letter, 3 May 1992
• 5 Price K D. Posttraumatic stress disorder and concussion: Are they incompatible?.  Defense Law J. 1994;  43 113-120
• 6 Sbordone R J, Liter J C. Mild traumatic brain injury does not produce post-traumatic stress disorder.  Brain Inj. 1995;  9 405-412
• 7 Lishman W A. Physiogenesis and psychogenesis in the ,post-concussional syndrome‘.  Br J Psychiat. 1988;  153 460-469
• 8 Mayou R, Bryant B, Duthie R. Psychiatric consequences of road traffic accidents.  BMJ. 1993;  307 647-651
• 9 McMillan T M. Post-traumatic stress disorder and severe head injury.  Br J Psychiat. 1991;  159 431-433
• 10 Horton Jr A M, Barrett D. Post-traumatic stress disorder masking head injury: a case report.  Arch Clin Neuropsychol. 1991;  6 195
• 11 Horton Jr A M. Posttraumatic stress disorder and mild head trauma: follow-up of a case study.  Percept Mot Skills. 1993;  76 243-246
• 12 Layton B S, Wardi-Zonna K. Posttraumatic stress disorder with neurogenic amnesia for the traumatic event.  Clin Neuropsychol. 1995;  9 2-10
• 13 Bryant R A. Posttraumatic stress disorder, flashbacks, and pseudomemories in closed head injury.  J Trauma Stress. 1996;  9 621-629
• 14 McMillan T M. Post-traumatic stress disorder following minor and severe closed head injury: 10 single cases.  Brain Inj. 1996;  10 749-758
• 15 King N S. Post-traumatic stress disorder and head injury as a dual diagnosis: „islands” of memory as a mechanism.  J Neurol Neurosurg Psychiatry. 1997;  62 82-84
• 16 McGrath J. Cognitive impairment associated with post-traumatic stress disorder and minor head injury: a case report.  Neuropsychol Rehabil. 1997;  7 231-239
• 17 Krikorian R, Layton B S. Implicit memory in posttraumatic stress disorder with amnesia for the traumatic event.  J Neuropsychiat Clin Neurosci. 1998;  10 359-362
• 18 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington DC: American Psychiatric Association 1994
• 19 Middleboe T, Andersen H S, Birket-Smith M, Friis M L. Psychiatric sequelae of minor head injury. A prospective follow-up study.  Eur Psychiatry. 1992;  7 183-189
• 20 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Washington DC: American Psychiatric Association 1987
• 21 Warden D L, Labbate L A, Salazar A M, Nelson R, Sheley E, Staudenmeier J, Martin E. Posttraumatic stress disorder in patients with traumatic brain injury and amnesia for the event?.  J Neuropsychiat Clin Neurosci. 1997;  9 18-22
• 22 Harvey A G, Bryant R A. Acute stress disorder after mild traumatic brain injury.  J Nerv Ment Dis. 1998;  186 333-337
• 23 Bryant R A, Harvey A G. Relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury.  Am J Psychiatry. 1998;  155 625-629
• 24 Harvey A G, Bryant R A. Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury.  Am J Psychiatry. 2000;  157 626-628
• 25 Rattock J, Ross B. Post traumatic stress disorder in the traumatically head injured (abstract).  J Clin Exp Neuropsychol. 1993;  15 403
• 26 Ohry A, Rattock J, Solomon Z. Post-traumatic stress disorder in brain injury patients.  Brain Inj. 1996;  10 687-695
• 27 Bryant R A, Marosszeky J E, Crooks J, Gurka J A. Posttraumatic stress disorder after severe traumatic brain injury.  Am J Psychiatry. 2000;  157 629-631
• 28 Alves W, Colohan A, O'Leary T, Rimel R, Jane J. Understanding posttraumatic symptoms after minor head injury.  J Head Trauma Rehabil. 1986;  1 1-12
• 29 Davidoff D A, Laibstain D F, Kessler H R, Mark V H. Neurobehavioral sequelae of minor head injury: A consideration of post-concussive syndrome versus post-traumatic stress disorder.  Cogn Rehabil. 1988;  6 8-13
• 30 McMillan T M. Minor head injury.  Curr Opin Neurol. 1997;  10 479-483
• 31 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale.  Lancet. 1974;  2 81-84
• 32 McMillan T M, Jongen E LMM, Greenwood R J. Assessment of post-traumatic amnesia after severe closed head injury: retrospective or prospective?.  J Neurol Neurosurg Psychiatry. 1996;  60 422-427
• 33 Hyer L, Walker C, Swanson G, Sperr S, Sperr G, Blout J. Validation of PTSD measures for older combat veterans.  J Clin Psychol. 1992;  48 479-599
• 34 Brickenkamp R. Test d2. Aufmerksamkeits-Belastungs-Test. Göttingen: Hogrefe 1981
• 35 Buschke H. Selective reminding for analysis of memory and learning.  J Verb Learn Verb Behav. 1973;  12 543-550
• 36 Tewes U. (Hrsg) .Hamburg-Wechsler-Intelligenztest für Erwachsene - Revision 1991. Göttingen: Huber 1991
• 37 Wechsler D. WMS-R. Wechsler Memory Scale-Revised. San Antonio: The Psychological Corporation 1987
• 38 Zimmermann P, Fimm B. Testbatterie zur Aufmerksamkeitsprüfung. Version 1.0 Würselen: Psytest 1993
• 39 Benson D F, Geschwind N. Shrinking retrograde amnesia.  J Neurol Neurosurg Psychiat. 1967;  30 539-544
• 40 Gentry L R, Godersky J C, Thompson B. MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions.  Am J Roentgenol. 1988;  150 663-672
• 41 Russell W R. The Traumatic Amnesias. New York: Oxford University Press 1971
• 42 Squire L R. Declarative and nondeclarative memory: multiple brain systems supporting learning and memory.  J Cogn Neurosci. 1992;  4 232-243
• 43 Ewert J, Levin H S, Watson M G, Kalisky Z. Procedural memory during posttraumatic amnesia in survivors of severe closed head injury. Implications for rehabilitation.  Arch Neurol. 1989;  46 911-916
• 44 Keane T M, Fairbank J A, Caddell J M, Zimering R T, Bender M E. A behavioral approach to assessing and treating post-traumatic stress disorders in Vietnam veterans. In: Figley CR (Hrsg). Trauma and its wake. Vol. I: The study and treatment of post-traumatic stress disorder New York: Brunner/Mazel 1985: 257-294
• 45 Kolb L C. A neuropsychological hypothesis explaining posttraumatic stress disorders.  Am J Psychiatry. 1987;  144 989-995
• 46 Meares R. The contribution of Hughlings Jackson to an understanding of dissociation.  Am J Psychiatry. 1999;  156 1850-1855
• 47 Meares R. The „adualistic” representation of trauma: On malignant internalization.  Am J Psychother. 1999;  53 392-402
• 48 Tulving E, Schacter D. Priming and human memory systems.  Science. 1990;  247 301-306
• 49 van der Kolk B A, Fisler R. Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study.  J Trauma Stress. 1995;  8 505-525
• 50 Brewin C R, Dalgleish T, Joseph S. A dual representation theory of posttraumatic stress disorder.  Psychol Rev. 1996;  103 670-686
• 51 Reisner H. Über situationsbedingte Erlebnisse in der epileptischen Aura.  Nervenarzt. 1943;  16 317-322
• 52 Robinson P K, Watt A C. Hallucinations of remembered scenes as an epileptic aura.  Brain. 1947;  70 440-448
• 53 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders, Third Edition. Washington DC: American Psychiatric Association 1980
• 54 Adler A. Mental symptoms following head injury. A statistical analysis of two hundred cases.  Arch Neurol Psychiat. 1945;  53 34-43
• 55 Brook S. Note to Schilder P, Neuroses following head and brain injuries. In: Brook S (Hrsg). Injuries of the Brain and Spinal Cord and Their Coverings. 3rd ed Baltimore: Williams & Wilkins Company 1949: 304-305
• 56 Ferenczi S. Über zwei Typen der Kriegsneurose.  Int Z ärztl Psychoanal. 1916/1917;  4 131-145
• 57 Ferenczi S. Die Psychoanalyse der Kriegsneurosen. In: Zur Psychoanalyse der Kriegsneurosen. Internationale Psychoanalytische Bibliothek, Nr. 1 Leipzig, Wien: Internationaler Psychoanalytischer Verlag 1919: 9-30
• 58 Freud S. Die Traumdeutung. Leipzig, Wien: Deuticke 1900
• 59 Freud S. Einige Bemerkungen über den Begriff des Unbewussten in der Psychoanalyse.  Int Z ärztl Psychoanal. 1913;  1 117-123