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.
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Dr K Podoll
Klinik für Psychiatrie und Psychotherapie der RWTH Aachen
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