Title: Autobiographical Memory and ECT: A New Perspective
1Autobiographical Memory and ECT A New Perspective
- Barbara Dritschel Arlene Astell
- University of St Andrews School of Psychology
2Cognitive 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
3Assessment 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
4Dependent 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
5Personal 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
6Measures 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
7Percentage 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)
8Percentage 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
9Percentage 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
10Percentage 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
11Percentage 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
12Percentage 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
13Summary 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
14Treatment 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)
15Missing elements from PIMT
- Fluency measure
- Does not systematically measure valence
- Confounds extended, specific and categoric
recall - Time-consuming
16Missing 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
17Specificity 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
18Specific 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
19Errors 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)
20Assessment 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
21Premise 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
22Aims 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)
23Goals 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
24Participants
- 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
25Tasks
- 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)
26Procedure
- Assessment at baseline(prior to first ECT)
- After sixth ECT session
- At end of ECT treatment
- Two months after the end of treatment
27Possible 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
28Patient Sample
- Case 1 Female aged 53
- Case 2 Female aged 71
- Case 3 Female aged 67
29Case 1 Female aged 53
30Case 2 Female aged 71
31Case 3 Female aged 67
32Preminary Conclusion
- Specificity of am retrieval is a sensitive
measure
33Additional 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
34Future 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