Distinct Mental Disorder Research Articles

Cortical folding patterns are associated with impulsivity in healthy young adults.

Impulsivity is associated with distinct mental disorders but is also considered as a personality trait exhibited by healthy individuals. Current studies suggest that early stressful life events might cause higher impulsivity in the adulthood. Morphological features, which reflect early brain development, could provide valuable information regarding the origin of impulsive behavior. However, none of the previous MRI studies employed a methodology specifically designed to investigate the relationship between impulsivity and markers of brain development. In this regard, we aimed to investigate the relationship between cortical folding and the three distinct factors of impulsivity (attention, motor, and non-planning) in young healthy adults. Fifty-four right-handed healthy individuals were recruited for the study and underwent magnetic resonance imaging (MRI) at 3 Tesla. A surface-based analysis was used to calculate a local gyrification index (LGI). Impulsivity was examined by the Barratt Impulsiveness Scale (BIS-11) and related to LGI. Associations between LGI and BIS-11 scores were assessed using within-group correlations (p < 0.05, "cluster-wise probability" [CWP] corr.). BIS subscores were positively correlated with cortical folding in several distinct areas: Total and attention scores were positively correlated with LGI in the left postcentral gyrus, cingulate gyrus, precentral gyrus, pars opercularis of the inferior frontal gyrus, right middle temporal gyrus, superior parietal gyrus, pericalcarine gyrus, and lateral occipital gyrus (each p < 0.05 CWP corr.). BIS motor score was positively correlated with LGI in the left superior temporal, lingual and supramarginal gyrus (each p < 0.05 CWP corr.). BIS non-planning score showed a positive correlation with LGI in the pars opercularis of the right inferior frontal gyrus and the left middle temporal, precentral and superior parietal gyrus (each p < 0.05 CWP corr.). Furthermore, we found gender-specific differences in BIS-11-LGI-correlation in the middle and inferior frontal gyrus. Our findings illustrate the advantages of cortical folding as a marker of early brain development when investigating structural brain correlates of impulsivity in young adulthood. Further, they lend additional support to the notion that alterations in early neurodevelopment comprising fronto-temporo-parietal regions might give rise to higher impulsivity in healthy individuals.

"Prolonged grief disorder" and "persistent complex bereavement disorder", but not "complicated grief", are one and the same diagnostic entity: an analysis of data from the Yale Bereavement Study.

There exists a general consensus that prolonged grief disorder (PGD), or some variant of PGD, represents a distinct mental disorder worthy of diagnosis and treatment. Nevertheless, confusion remains over whether different names and proposed symptom criteria for this disorder identify the same or different diagnostic entities. This study aimed to determine whether PGD, complicated grief (CG), and persistent complex bereavement disorder (PCBD) as described by the DSM-5 are substantively or merely semantically different diagnostic entities. Data were derived from the Yale Bereavement Study, a longitudinal community-based study of bereaved individuals funded by the US National Institute of Mental Health, designed explicitly to evaluate diagnostic criteria for disordered grief. The results suggested that the difference between PGD and PCBD is only semantic. The level of agreement between the original PGD test, a new version of the PGD test proposed for ICD-11 and the PCBD test was high (pairwise kappa coefficients = 0.80-0.84). Their estimates of rate of disorder in this community sample were similarly low (∼10%). Their levels of diagnostic specificity were comparably high (95.0-98.3%). Their predictive validity was comparable. In contrast, the test for CG had only moderate agreement with those for PGD and PCBD; its estimate of rate of disorder was three-fold higher (∼30%); its diagnostic specificity was poorer, and it had no predictive validity. We conclude that PGD, PCBD and proposed ICD-11, but not CG, symptom-diagnostic tests identify a single diagnostic entity. Ultimately, brief symptom-diagnostic tests, such as the one proposed here for ICD-11, may have the greatest clinical utility.

Cyberchondria, cyberbullying, cybersuicide, cybersex: "new" psychopathologies for the 21st century?

Cyberchondria, cyberbullying, cybersuicide, cybersex: "new" psychopathologies for the 21st century?

SY03-2-1 * NIDA-ISAM FELLOWSHIP EXCESSIVE INTERNET USE AND ITS CORRELATION WITH NEGATIVE EXPERIENCES IN 25 EUROPEAN COUNTRIES

Introduction. The current debate on internet addiction is driven by question of whether it constitutes a distinct mental disorder. Our analysis of excessive internet use in adolescents offers an evidence for the line of research that distinguishes between addiction to the internet in general and addiction to specific online applications (as online games, cybersex, etc.) Method. We worked with the EU Kids Online II survey data representative for children aged 11 to 16 years in 25 European countries (N = 18,709). EIU was measured using five-items scale with one item for each of following criteria: salience, withdrawal, tolerance, conflict, and relapse. A set of regression models was used to assess the probabilities of various negative consequences for each EIU score. Results. Surprisingly consistent pattern was identified across Europe when controlling for country differences with the score of 2.5 on EIU doubling the probability of misbehaviours, health and mental health problems, and negative online experiences. Conclusion. Our results suggest that general internet addiction as measured by EIU scale occurs in children that suffer from much broader spectrum of both, online and offline, problems. Therefore, it might be better described as a symptom of behavioural problems rather than a separate psychological condition.

The absence of evidence is not the evidence of absence: The abusive personality as a disordered mental state

Does the perpetration of domestic violence reflect a distinct mental disorder? This essay does not and cannot definitely answer that question. Rather it aims to prompt a discussion of the various indices for surmising a position on this issue. For example, batterer behavior and attitudes are associated with severe psychopathology. Batterers are treated in intervention programs for an unnamed condition. Ultimately, domestic violence is contextualized as abnormal behavior. This paper reviews research in the field of domestic violence to establish a forum for discussion and debate about the potential for an abnormal mental state to describe the psychology of a batterer. This review posits that at minimum, the field of psychiatry should consider a review of batterer characteristics to formally investigate the “abusive personality” as a categorization of a distinct mental disorder.

L’utilisation de la réalité virtuelle dans le traitement des troubles mentaux

Virtual reality is a media allowing users to interact in real time with computerized virtual environments. The application of this immersive technology to cognitive behavioral therapies is increasingly exploited for the treatment of mental disorders. The present study is a review of literature spanning from 1992 to 2012. It depicts the utility of this new tool for assessment and therapy through the various clinical studies carried out on subjects exhibiting diverse mental disorders. Most of the studies conducted on tested subjects attest to the significant efficacy of the Virtual Reality Exposure Therapy (VRET) for the treatment of distinct mental disorders. Comparative studies of VRET with the treatment of reference (the in vivo exposure component of the cognitive behavioral therapy) document an equal efficacy of the two methods and in some cases a superior therapeutic effect in favor of the VRET. Even though clinical experiments set on a larger scale, extended follow-up and studies about factors influencing presence are needed, virtual reality exposure represents an efficacious, confidential, affordable, flexible, interactive therapeutic method which application will progressively widened in the field of mental health.

An agenda for symptom-based research

The network approach proposed by Cramer et al. suggests fascinating new directions of research on mental disorders. Research is needed to find evidence for the causal power of symptoms, to examine symptoms thoroughly, to investigate individual differences in edge strength, to discover etiological processes for each symptom, and to determine whether and why symptoms cohere into distinct mental disorders.

Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11.

Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.

Childhood Factitious Disorders—A “Hot” Case of Menstruation

Background: Factitious disorders are rarely reported in the pediatric gynecologic literature. We present a case of factitious menstruation in a ten year old prepubertal child. Case: A ten year old girl presented to her pediatrician’s office with an episode of vaginal bleeding. She reports bright red vaginal bleeding that over 4 days changed to an orange colored odorous discharge. The bleeding occured at regular intervals throughout the day. In the pediatrician’s office she was found to have a normal exam. A White Blood Cell count was 5.9 K/uL, Hemoglobin 13.3mg/dl, Hematocrit 38.8%, and the platelet count 276k. Sedimentation rate was 6 mm/hr, Thyroid Stimulating Hormone was 0.777 uIU/ml, Lutenizing Hormone 0.3 mIU/ml, Follicle Stimulating Hormone 9 mIU/ ml, Estradiol 7 pg/ml, and Free Thyroxine 1.15 ng/d. A computerized tomography (CT) scan of the abdomen and pelvis with nonionic contrast was within normal limits. There was no comment on the uterus, ovaries, or vagina. A non-contrast CT scan of the head is normal but with limited evaluation of pituitary gland. The patient was referred to an adolescent medicine specialist for further evaluation. Physical exam revealed a thin, pale prepubescent child. Breasts are prepubescent, SMR 1. Her abdomen was soft but tender to palpation in the left lower quadrant. Pubic Hair was SMR 1. Her external genitalia were normal. The hymen was annular and no discharge or erythema was present. The rectal exam was normal. A pelvic ultrasound demonstrated a prepubescent, anteverted uterus with an endometrial stripe 0.1 cm. There was no evidence of echogenic foreign body. The ovaries are normal. Gonorrhea/Chlamydia Nucleic Acid Amplification testing was negative. A genital culture grows 3+ normal flora. The patient was seen again in conjunction with a pediatric gynecologist. The vagina is irrigated with 20cc of saline. The effluent was clear. Heme testing from pad was negative. A few days later the mother found a vial of hot sauce in the child’s book bag. When confronted, the child confesses to placing the foreign liquid on the pad. A planned exam under anesthesia is thus avoided. Comments: A high index of suspicion is required in diagnosing factitious disorders. Psychosomatic illnesses have a wide spectrum of presentation and are likely more common than realized. There are three distinct mental health disorders in which a patient intentionally produces physical symptoms or illness: Malingering, Factitious Disorder, and Factitious Disorder by proxy. In Factitious Disorder the patient produces symptoms or signs to assume the sick role. Examples include induced infections and factitious fever. Malingering differs from Factitious Disorder in that in Malingering, the individual is consciously motivated by an external incentive, such as missing school or work. In Factitious Disorder the individual is usually not aware of the motivation behind the factitious behavior and external incentives are absent. Recognizing the possibility of factitious illness in patients who present with atypical clinical manifestations is imperative to reduce unnecessary risk to the patient through continued medical evaluations and to avoid long term psychopathology.

DSM-IV-TRand the Paraphilias

Abstract The DSM-IV-TR (2000) sets its own standards for inclusion of diagnoses and for changes in its text. The Paraphilia section is analyzed from the perspective of how well the DSM meets those standards. The concept of Paraphilias as psychopathology was analyzed and assessed critically to determine if it meets the definition of a mental disorder presented in the DSM; it does not. The Paraphilia diagnostic category was critiqued for logic, consistency, clarity, and whether it constitutes a distinct mental disorder. The DSM presents “facts” to substantiate various points made in the text. The veracity of these “facts” was scrutinized. Little evidence was found in their support. Problems with the tradition of equating particular sexual interests with psychopathology were highlighted. It was concluded that the Paraphilia section is so severely flawed that its removal from the DSM is advocated.

P.2.c.016 Antidepressant use and the risk of suicide, attempted suicide and overall mortality in a nation-wide cohort

Stable representation of information in distributed neural connectivity is critical to function effectively in the world. Despite the dynamic nature of the brain’s functional architecture, characterizing its temporal stability within a continuous state has been largely neglected. Here we characterized stability of functional architecture at a dynamic timescale (~1 min) for each brain voxel by measuring the concordance of dynamic functional connectivity (DFC) over time, compared between association and unimodal regions, and established its reliability using test-retest resting-state fMRI data of adults from an open dataset. After the measure of functional stability was established, we further employed another fMRI open dataset which included movie-watching and resting-state data of children and adolescents, to explore how stability was modified by natural viewing from its intrinsic form, with specific focus on the associative and primary visual cortices. The results showed that high-order association regions, especially the default mode network, demonstrated high stability during resting-state scans, while primary sensory-motor cortices revealed relatively lower stability. During movie watching, stability in the primary visual cortex was decreased, which was associated with larger DFC variation with neighboring regions. By contrast, higher-order regions in the ventral and dorsal visual stream demonstrated increased stability. The distribution of functional stability and its modification describes a profile of the brain’s stability property, which may be useful reference for examining distinct mental states and disorders.

A neurodevelopmental approach for helping gifted learners with diagnosed dyslexia and attention deficit/hyperactivity disorder (AD/HD)

Many intellectually and creatively gifted learners experience barriers to learning and development. These may be incorrectly diagnosed as distinct mental disorders, such as Attention Deficit Disorder, hyperactivity, dyslexia and so on. Medication, behaviour and remedial therapy are among the most frequently cited treatments. Emerging approaches to therapy, based on applied neuroscience and the importance of movement in structuring the brain, are finding that it is possible to ‘heal’ interactive links of dysfunctional behaviours and ensuing learning difficulties. This article presents a neurodevelopmental view of learning and attentional problems that are not uncommon in some gifted learners. By means of two case studies, a neurodevelopmental approach will be illustrated whereby such learners have been helped to overcome their learning barriers.

A case for establishing complicated grief as a distinct mental disorder in DSM-V

In this paper, we contend that complicated grief (CG) constitutes a distinct psychopathological diagnostic entity and thus warrants a place in standardized psychiatric diagnostic taxonomies. CG is characterized by a unique pattern of symptoms following bereavement that are typically slow to resolve and can persist for years if left untreated. This paper will demonstrate that existing diagnoses are not sufficient, as the phenomenology, risk factors, clinical correlates, course, and outcomes for CG are distinct from those of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and adjustment disorder (AD). It is argued that the establishment of CG as a diagnostic entity is essential because its symptoms are associated with enduring mental and physical health morbidity and require specifically designed clinical interventions. We conduct a critical review of all published evidence on this topic to date, demonstrating that the advantages of standardizing the diagnostic criteria of CG outweigh the disadvantages. In addition, recommendations for future lines of research are made. This paper concludes that CG must be established in the current nosology to address the needs of individuals who are significantly suffering and impaired by this disorder.

Toward a dimensional and psychometrically-informed approach to conceptualizing psychopathology

Most modern research on psychopathology is framed by the categorical model of mental disorders embodied in the Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994). Nevertheless, the categorical model of the DSM is incompatible with robust empirical observations about psychopathological variation, such as the tendency for multiple, putatively distinct mental disorders to occur in the same persons. The goal of this invited essay is to outline a potential alternative to the DSM’s categorical approach: a dimensional and psychometrically-informed approach to conceptualizing and studying psychopathology. We discuss the advantages of the dimensional approach, some modern statistical technologies that can be recruited in the service of the dimensional approach, and ways of integrating the dimensional approach with a behavioral approach to psychopathology assessment and research.

Recognizing LD, ADHD and TBI in Adults

Many adults have learning problems that interfere with success in educational or vocational endeavors. Learning disabilities (LD), attention deficit/hyperactivity disorder (ADHD), and traumatic brain injury (TBI) share features and may occur together in some individuals. Difficulty in differentiating these disorders may be exacerbated in adulthood, when developmental history is more remote. Basic knowledge of the characteristics of LD, ADHD and TBI can help adult educators to recognize symptoms, make appropriate referrals and individualize instruction and accommodations. Frameworks for Identification Operational definitions of LD and TBI are provided in the Individuals with Disabilities Education Act (IDEA), which applies to individuals only from birth through age 22. Children identified under IDEA as having a handicapping condition are eligible for special education services if need is established. ADHD is not specifically identified as an eligibility category under IDEA; however, children with ADHD may be eligible for special education services under the category of Other Health Impaired (OHI). While IDEA does not apply to adult learners who have graduated from high school, if services were obtained during school-age years, documentation of a disability may exist in school records. The Association on Higher Education and Disability (AHEAD) is an international organization supporting full participation in higher education for persons with disabilities. AHEAD has published guidelines for adult LD evaluation (Brinckerhoff et al., 1997). Guidelines for ADHD and TBI have not been published. The LD guidelines address qualifications of evaluators, recency of documentation, appropriate clinical documentation of LD, and evidence to establish the rationale to support recommended accommodations. While quite detailed, they do not provide diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-IV-TR, American Psychiatric Association [APA], 2000) provides a clinical framework for the diagnosis of developmental disorders, including LD and ADHD. In the DSM-IV-TR framework, TBI is not a distinct mental disorder, although psychological problems resulting from or associated with brain injury may be diagnosed and the associated brain injury reported. In the DSM-IV-TR, learning disabilities are referred to as disorders, for example, Reading Disorder or Disorder of Written Expression. Both Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA) protect the civil rights of individuals who have disabilities. A disability is described in Section 504 as a physical or mental impairment that substantially limits one or more major life activities. Persons with disabilities who have appropriate documentation are eligible for accommodations, modifications, or auxiliary aids, which will enable them to participate and benefit from all postsecondary educational programs and activities. While diagnostic criteria for LD, ADHD, and TBI are not provided in these laws, these disorders clearly fall under the umbrella of disability as described in Section 504 and ADA. While assessment and diagnosis might come from a variety of professionals using different terminology, it is clear that both ADA and Section 504 apply to adults with LD, ADHD or TBI. Descriptive Features The nature and definition of learning disabilities have long been debated (Lyon, 1994). However, most discussions refer to a lack of expected achievement in one or more academic areas in the face of apparently normal intelligence, sensory function, educational and cultural opportunity and motivation. LD is a developmental disorder, with features present from early childhood, although diagnosis may occur much later. IDEA and the DSM-IV-TR refer to determination of a significant discrepancy between general intelligence and achievement in one or more academic areas as a criterion; however, the methodology for determining significant discrepancy is not specified and in practice varies across settings (Lyon, 1994). …

Dosage and Imprinting Effects in Abnormalities of Human Chromosome 15

Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are distinct mental retardation disorders caused by paternal deficiency (PWS) or maternal deficiency (AS) of gene(s) in 15qll.2-ql3. We have constructed a 3.5 Mb yeast artificial chromosome (YAC) contig of the PWS/AS region and cosmid contigs of selected YACs at D15S13, SNRPN, S10, and S113. Cosmid clones have been used for fluorescence in situ hybridization (FISH) detection of deletions in PWS and AS patients. In addition, a total of 28 short tandem repeat polymorphisms (STRs) have been mapped to specific YACs in the contig, providing a highly informative set of markers for detection of deletion or uniparental disomy (UPD) in PWS and AS patients. Use of the 3 most informative markers in this region (S542, S128, and ASSCA-1) plus 3 markers distal on 15q (S123, S125, and S131) provide an efficient diagnostic strategy for UPD15.A combination of FISH and STR analysis has identified small deletions in one sporadic and one familial case of PWS (family O). Both deletions involve all or part of the SNRPN gene but do not extend telomeric to PAR-5 or PAR-1, two novel transcripts expressed exclusively from the paternal chromosome. However, expression of SNRPN, PAR-5, and PAR-1 is lost in both cases, implying the presence of an imprinting control region near SNRPN. The smallest deletion in family O is estimated at approximately 30-40 kb in size and involves a newly identified CpG island at the 5′ end of SNRPN which is methylated on the maternal chromosome. This small deletion in two PWS affected siblings was present in the father and the paternal grandmother, both of whom were phenotypically normal.

Prader-Willi syndrome: Diagnostic strategy with a cytogenetic and molecular approach

Prader-Willi syndrome (PWS) is a disorder characterized by neonatal hypotonia with poor suck, mild to moderate mental retardation, obesity beginning after 3 yr of age, hypogonadism and characteristic facial features. High resolution cytogenetic studies showed a deletion of the proximal chromosome 15q(q11–q13) region in approximately 50%. Interestingly, the same deletion was described in another distinct mental disorder: the Angelman syndrome (AS). This deletion was confirmed by molecular analyses, and a new mechanism was reported: uniparental disomy (maternal in PWS and paternal in AS) strongly implicate genomic imprinting in this chromosomal region. The principal aim of our group is to apply cytogenetic and molecular biology techniques to perform diagnosis and genetic counselling. Patient studies were usually based on high resolution cytogenetic analysis, quantitative Southern blotting (with D15S9, D15S11, D15S10, D15S12 loci) and dinucleotide repeat polymorphism assay by polymerase chain reaction (PCR) (IR4. 3R and GABARB3). The combination of these different methods allowed us to propose a diagnostic strategy for PWS.

Molecular dissection of the Prader-Willi/Angelman syndrome region (15q11-13) by YAC cloning and FISH analysis.

Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are distinct mental retardation disorders associated with deletions of proximal 15q (q11-q13) of different parental origin. Yeast artificial chromosome (YAC) clones were isolated for 9 previously mapped DNA probes from this region, and for one newly derived marker, LS6-1 (D15S113). A YAC contig of 1-1.5 Mb encompassing four markers (ML34, IR4-3R, PW71, and TD189-1) was constructed. Multi-color fluorescence in situ hybridization (FISH) analysis of interphase nuclei was combined with YAC contig information to provide the following order of markers: cen-IR39-ML34-IR4-3R-PW71-TD189-1-LS6++ +-1-TD3-21-GABRB3-IR10-1-CMW1-tel. FISH analysis was performed on 8 cases of PWS and 3 cases of AS, including 5 patients with normal karyotypes. All eleven patients were deleted for YACs in the interval from IR4-3R to GABRB3. On the proximal side of the deletion interval, 10/10 breakpoints fell within a single ML34 YAC of 370 kb. On the distal side, 8/9 breakpoints fell within a single IR10-1 YAC of 200 kb. These results indicate a striking consistency in the location of the proximal and distal breakpoints in PWS and AS patients. FISH analysis on a previously reported case of familial AS confirmed a submicroscopic deletion including YACs corresponding to LS6-1, TD3-21 and GABRB3 and supports the separation of the PWS and AS critical regions. Since these three YACs do not overlap each other, the minimum size of the AS critical region is > or = 650 kb.

Neurasthenia: A Paradigm of Social Psychopathology in a Transitional Society

A particular social aspect of an illness is reflected in an emphasis on those symptoms that the society considers socially detrimental and/or destabilizing. Thus, in the work- and production-oriented society, chronic fatigue, which affects one's productivity and ability to work, becomes a hallmark of neurasthenia or neurasthenia-like syndrome. In a society based on rigid social structures and severely limited possibilities for social change, excessive irritability and outbursts of anger are perceived as a greater threat to the stability of the existing social order, and therefore they come to dominate the concept of neurasthenia. In Yugoslavia, neurasthenia has been primarily conceived of as a manifestation of an accumulated social frustration and anger; neurasthenia has then been constructed as a mental disorder because anger was expressed in a way that the society considered inappropriate, maladaptive, and pathological. A far-reaching, underlying purpose of this conceptualization of neurasthenia has been a preservation of the social status quo. While neurasthenia as a distinct mental disorder remains controversial, its dependence on the social context cannot be denied. Although the designation of neurasthenia so often seems provisional, because it symbolizes limitations and failures of our diagnostic and nosological systems, it serves a definite social purpose, which varies from time to time, and from one culture to another.

Amnesia

Amnesia is a common clinical problem characterized by four features: (1) normal immediate recall, (2) impaired ability to learn, (3) relatively spared ability to retrieve previously learned material, and (4) preserved cognitive and personality characteristics. Amnesia occurs as a distinct mental disorder, and nine variations seen clinically are described here: Korsakoff's psychosis, posttraumatic amnesia, amnesia stroke, postoperative amnesia, postinfectious amnesia, anoxic amnesia, transient global amnesia following ECT, and psychogenic amnesia. The clinical findings which characterize and differentiate these disorders are presented, along with suggestions for management and a discussion of the the outcome of amnesia.