Autobiographical Memory and ECT: A New Perspective

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Autobiographical Memory and ECT A New Perspective

• Barbara Dritschel Arlene Astell
• University of St Andrews School of Psychology

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Cognitive Adverse Effects of ECT

• Common complaint after ECT is impaired ability to
  retrieve autobiographical memory (McEhiney et al
  1995)
• Autobiographical memory (AM) refers to knowledge
  about ourselves in form of events and semantic
  information

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Assessment of Autobiographical memory dysfunction

• Columbia University Memory Interview (Sobin et
  al 1995)
• 281 directed questions about illnesses,
  employment history, places of residence, travel,
  emotional and everyday events in lives of
  patients and significant others
• Descriptive and yes/no responses required

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Dependent Measure from the Columbia University
Autobiographical Memory Interview

• Consistency of score of ratio of number of items
  in which the retesting response is inconsistent
  with baseline relative to total number of
  responses produced at baseline

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Personal and Impersonal Memory Test (Lisanby et
al 2000 Arch General Psychiatry)

• Involves recall of personal and impersonal events
  to categories
• Personal gifts given or received, illnesses in
  family or friends, major purchases made, trips
  taken to places at least 50 miles away,
  restaurants visited
• Impersonal birth/death of famous people,
  political changes, court cases, natural and
  man-made disasters, major news stories

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Measures from PIMT

• Number of unique events recalled for each
  category with a maximum of 20
• Number of details about events
• Reporting of date and month event occurred

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Percentage change in the number of personal and
impersonal events recalled by depressed patients
(n55) and normal controls (n23) at second-post
electroconvulsive therapy assessment relative to
baseline (Lisanby et al 2000 Arch Gen Psych)
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Percentage change in the number of details
recalled for remote and recent personal and
impersonal events at second post-electroconvulsive
therapy for depressed patients (n55) and normal
controls (n23) (Lisanby et al 2000 Arch Gen
Psychiatry)
Recent Remote
Recent Remote
Impersonal Event
Personal Event
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Percentage change in the number of personal and
impersonal events recalled by patients treated
with bilateral (BL)(n31) and right unilateral
(RUL)ECT(n24) at second (post-ECT) assessment
relative to baseline (Lisanby et al 2000 Arch Gen
Psychiatry)
Personal Events Impersonal Events
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Percentage change in the number of details
recalled for remote and recent personal and
impersonal events for patients treated with
bilateral (BL)(n31) and right unilateral
(RUL)(n24) electroconvulsive therapy at the
second post-ECT assessment relative to baseline
(Lisanby et al 2000 Arch Psych Gen)
Recent Remote Recent Remote
Personal Event
Impersonal Event
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Percentage change in the number of personal and
impersonal events recalled by depressed patients
(n33) and normal controls (n19) at the third (2
month follow-up) relative to baseline (Lisanby et
al 2000 Arch Gen Psychiatry)
Personal Event Impersonal Event
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Percentage change in the number of details
recalled for remote and recent personal and
impersonal events by depressed patients (n33)
and normal controls ( n19) at the third (2 month
follow-up) assessment relative to baseline
(Lisanby et al 2000 Arch Gen Psychiatry)
Recent Remote Recent
Remote Personal Event
Impersonal Event
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Summary of Pattern of deficits in recalling
autobiographical events

• Deficit greatest for events occurring closest in
  time to administration of ECT
• Retrieval of remote events occurring months or
  years before administration of ECT can also be
  impaired
• Retrograde amnesia for events usually improves
  during first few months after ECT but permanent
  amnesia can occur

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Treatment factors influence degree of retrograde
amnesia

• Bi-lateral administration results in more
  impairment than uni-lateral administration
  particularly for remote memories (Sackheim et al
  2000)
• High dosage bi-lateral ECT results in greatest
  impairments (Sackheim et al 2000)

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Missing elements from PIMT

• Fluency measure
• Does not systematically measure valence
• Confounds extended, specific and categoric
  recall
• Time-consuming

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Missing elements from Columbia University
Autobiographical Memory Interview (Sobin et al
1995)

• Consistency measure as focuses on memory for
  occurrence of events rather than details of the
  events
• Demonstrates no mood effects with ECT (McElhiney
  et al 1995) perhaps due to highly -structured
  format of interview
• Time-consuming

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Specificity of autobiographical recall A
neglected variable

• Interestingly work examining autobiographical
  memory (AM) deficits resulting from ECT has not
  examined the level of specificity with which AMs
  are recalled
• This AM deficit is focus of research in
  depression

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Specific autobiographical memory recall and
depression

• Impaired ability to retrieve specific
  autobiographical memory is well -established
  cognitive deficit associated with depression and
  vulnerability to relapse
• Specific autobiographical memory- memory for an
  event that occurred at specific time and place

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Errors in specific autobiographical recall

• Overgeneral categoric memory - refers to recall
  of collection of events (e.g., always feeling
  unsafe at night)
• Overgeneral extended memory - refers to recall of
  a single event that lasted more than one day
  (e.g., my trip to Australia)

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Assessment of AM specificity deficit

• Cueing technique whereby present individual cue
  words (e.g., sad, safe)
• Requires retrieval of specific memory of an event
  within 60 seconds
• Depressed more likely to respond with categoric
  memory than controls who produce more specific
  retrieval

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Premise of present study

• Possible that ECT results in further impairment
  in ability to retrieve specific AM
• Consequence of this impairment is further
  vulnerability to post-ECT relapse
• Examine this AM deficit in the context of other
  memory impairments displayed
• To further examine relationship between
  therapeutic and amnesic effects of ECT

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Aims of current study

• To test whether ECT impairs the ability to
  retrieve specific autobiographical memories
• How is this impairment in AM linked to the
  impairment seen in depression?
• Does ECT cause a different impairment or
  exaggerate the one found in depression?
• To describe if there is a time course of this
  effect.
• To investigate whether recall of recent specific
  events is more vulnerable to disruption than
  recall of remote specific events as is seen with
  other aspects of autobiographical memory(e.g.,
  Lisanby et al 2000)

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Goals of assessment

• Appropriate and acceptable to people with
  depression at all treatment stages
• Practical length
• Comprehensive assessment that can be completed in
  an hour or less
• Suitable for patients prior to treatment as well
  as sensitive to clinical demands of treatment

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Participants

• Consecutive sample presenting for ECT with
  depression
• Consecutive sample presenting for ECT without
  depression
• Control sample matched for diagnosis and severity
  but not receiving ECT
• All participants take prescribed medication
• All participants be able to give consent

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Tasks

• Autobiographical memory cueing task
• One Verbal memory measure(story recall)
• One Visual memory measure (figure copying)
• A measure of short-term memory(digit span)
• A measure of general cognitive functioning (
  MMSE)
• Depression measure (HAM-D)

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Procedure

• Assessment at baseline(prior to first ECT)
• After sixth ECT session
• At end of ECT treatment
• Two months after the end of treatment

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Possible Outcomes -gt Indices of Effectiveness and
Vulnerability

• No change in overgeneral recall -gt Pre-post ECT
• Negative change in overgeneral recall
  -gtPre-Post ECT
• Positive change in overgeneral recall -gtPre-Post
  ECT

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Patient Sample

• Case 1 Female aged 53
• Case 2 Female aged 71
• Case 3 Female aged 67

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Case 1 Female aged 53
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Case 2 Female aged 71
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Case 3 Female aged 67
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Preminary Conclusion

• Specificity of am retrieval is a sensitive
  measure

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Additional possible outcomes

• Interaction between time event occurred, time of
  assessment, type of treatment and specific AM
  deficit
• Bi-lateral treatment may result in more
  impairment of remote autobiographical recall over
  time
• Both types of treatment effect recall of recent
  specific autobiographical memory

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Future Directions

• Develop efficient tool for assessing ability to
  retrieve specific AM by looking at ability to
  retrieve recent versus remote memories- maybe
  only one dimension is important
• Consider cognitive interventions to avoid relapse
  that influence the ability to retrieve specific
  AM
• Examine how performance on cueing relates to
  performance on other measures of AM performance
  to get a better profile of experienced subjective
  impairments
• Examine underlying brain structures associated
  with ECT memory recall patterns