A peripatetic and personal view of molecular immunology for one third of the century.
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Functional magnetic resonance imaging (fMRI) was used to study the neural correlates of neutral, stressful, negative and positive autobiographical memories. The brain activity produced by these different kinds of episodic memory did not differ significantly, but a common pattern of activation for different kinds of autobiographical memory was revealed that included (1) largely bilateral portions of the medial and superior temporal lobes, hippocampus and parahippocampus, (2) portions of the ventral, medial, superior and dorsolateral prefrontal cortex, (3) the anterior and posterior cingulate, including the retrosplenial, cortex, (4) the parietal cortex, and (5) portions of the cerebellum. The brain regions that were mainly activated constituted an interactive network of temporal and prefrontal areas associated with structures of the extended limbic system. The main bilateral activations with left-sided preponderance probably reflected reactivation of complex semantic and episodic self-related information representations that included previously experienced contexts. In conclusion, the earlier view of a strict left versus right prefrontal laterality in the retrieval of semantic as opposed to episodic autobiographical memory, may have to be modified by considering contextual variables such as task demands and subject variables. Consequently, autobiographical memory integration should be viewed as based on distributed bi-hemispheric neural networks supporting multi-modal, emotionally coloured components of personal episodes.
Neuroimaging studies and experimental data suggest that symptoms of posttraumatic stress disorder (PTSD) are associated with dysfunctions of neural circuits linking prefrontal cortex and the limbic system that have a role in autobiographic episodic memory. High-frequency repetitive transcranial magnetic stimulation (rTMS) of the right dorsolateral prefrontal cortex (DLPFC) has been suggested to be beneficial to patients with PTSD, transiently alleviating re-experiencing as well as avoidance reactions and associated anxiety symptoms. In healthy humans, converging evidence suggests that rTMS of the right DLPFC interferes with episodic memory retrieval. Hence, we hypothesize that daily applications of rTMS in PTSD patients may reduce access to the set of autobiographical stored events, that, if re-experienced, may cause the overt PTSD symptoms.
This study assessed how well the current classification system of the delusional misidentification syndromes (DMSs) represents the full range of misidentification phenomena encountered in self-descriptions of psychotic patients. To this end, a sample of 58 self-descriptions of ex-patients who had suffered from an episode of psychosis were reviewed. Misidentifications fitting the definition of one of the DMSs were identified in only 3 cases, whereas those fitting a general and broad definition were identified in 16 cases. It is argued that the restrictive nature of the currently dominant DMSs classification may have led to the neglect of a wide range of misidentification phenomena which do not fit the descriptions of any one of the classic DMSs. Proper identification, description and classification of these non-DMS misidentification phenomena is needed.
This report describes a male patient with temporal lobe epilepsy who developed a persistent paranoid-hallucinatory state at the age of 23. The essential feature of his delusion was that he had repeatedly lived part of his life, namely between the ages of 21 and 25 years. The patient repeatedly attempted suicide to escape the endless repetition. His paramnesia has some similarity with a déjà vu phenomenon, which is a common ictal manifestation of temporal lobe epilepsy. However, while only a sense of vague familiarity is evoked in a déjà vu phenomenon, conscious recollection is experienced during his paramnesia. We attempted to explain the pathophysiological mechanism of the patient's paramnesia in the framework of the current neurobiological theory of human memory.
The authors examined an autobiographical account of delusional misidentification found in Daniel Schreber's Memoirs of My Mental Illness. It is argued that writers with a history of mental illness can provide unique and accurate descriptions of complex psychiatric phenomena. These descriptions can convey the subjective experience of psychopathology and aid our understanding of the mechanisms giving rise to phenomena such as delusional misidentification.
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The author states that the current pessimistic impression of the potential of psychoanalysis as a therapy is largely due to the inclusion of a disproportionate number of inexperienced analysts in reports on groups of practitioners. To correct this bias, he summarizes his own experience of two decades as a full-time psychoanalyst, describing his successful analyses as well as his unsuccessful attempts. He concludes that the satisfaction of commitment to a psychoanalytic career comes from the fact that it confirms the usefulness of the analytic method as a means to assist others to achieve personal growth and to illuminate human mental life.
First-person narratives contain an inside view of mental disorder that can be useful in teaching, theory, and research. To bring earlier bibliographies up to date, the authors list eight anthologies and 63 autobiographies of hospitalized mental patients published since 1960.
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The life of the eighteenth-century English poet William Cowper, who suffered from recurrent major depression, or bipolar II disorder, is described. Since no effective treatment was available, Cowper's writings give an example of the natural history of major depression. They also illustrate the fate of a mental patient of the upper classes at that time. The authors discuss the relevance of Cowper's mother's death during his childhood to his depressive illness and draw attention to the poet's sensitive description of his own psychopathology and the lifelong course of his illness.
OBJECTIVE: This article brings to the present earlier bibliographies of books written by former mental patients. These books provide an inside view of mental disorder that can be useful in teaching, public education, theory, and research, and they have played a catalyzing role in mental health reform and in theory development. METHOD: The authors list seven anthologies and 48 autobiographies of former patients published since 1980 and introduce a classification system intended to increase the research value of this important archive. RESULTS: Recent books of this genre show more individuals with a mood disorder and more therapists and more women as authors. CONCLUSIONS: The research potential of these books suggests the value of an electronic database for classifying and retrieving the information they contain.
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