9/25/2023 0 Comments Fugue disorderA clinical interview and psychological testing were administered by the psychology team to understand the patient’s personality, cognitive functioning, and memory loss. His passive suicidal ideation faded as did his auditory hallucinations. He reported that the breakup with his fiancé caused him significant stress and anxiety, and thoughts and suspicion of infidelity brought up feelings of abandonment and paranoia, resulting in the installation of cameras in his house.įollowing the family meeting, the patient endorsed less anxiety. He was able to recollect some of his history but still could not recall the incidents leading to him leaving his home and travelling to a different state, where he was located at the time of admission. The primary team had a family meeting with his sister, and the autobiographical data were confirmed. Shortly after, he went missing, and his family filed an official missing person report. This led to the patient installing cameras around his home. She further described that prior to admission he was paranoid and evicted his fiancé from his home, believing that she had an affair with his boss. He was briefly in rehabilitation but did not complete it. The patient’s sister revealed that he recently lost his job and had an ongoing history of alcohol use. The patient continued to endorse depressive thoughts, suicidal ideation without plan or intent, and anxiety. After initiation of medications, he was slowly able to report his name with confusion and hesitation at first but settled with improvement over time. His former employer subsequently provided information about his sister.Ī selective serotonin reuptake inhibitor (SSRI) was started to target his depressed mood and anxiety. With the consent of the patient, the team contacted his employer by using the Google search engine for contact information. He recalled very limited information about his work. Throughout the admission, he continued to report various gaps in his memory including the days leading up to admission. He endorsed auditory hallucinations as “hearing voices” but could not make out what they were saying. No collateral history was available initially. On initial evaluation, the patient presented with social withdrawal, excessive cognitive rumination, and emotional avoidance and struggled with stress and negative affect while having difficulty expressing himself. The patient endorsed hopelessness and worthlessness, expressing “I don’t want to live anymore, I want to kill myself.” A full medical and neurologic evaluation showed no positive findings, and the patient was medically cleared and transferred to the inpatient psychiatry unit for psychiatric stabilization. During his brief admission on the medical floor, he had an interrupted suicide attempt. He was unable to answer most questions and perseverated “everything is so hazy.” Despite denying any drug use, the patient’s urine drug screen was positive for cannabinoids at admission. There was no form of identification in his possession. At that time, he was unable to recall his name, his current whereabouts, or any remote or short-term history. The last thing he remembered was being guided by the police toward the nearest hospital after reporting being attacked and hit on the head by strangers. Case ReportĪ middle-aged Hispanic man with unknown medical and psychiatric history admitted himself to the emergency department in a confused state. 6 We present a case of dissociative amnesia with fugue in a middle-aged man who experienced multiple psychosocial stressors. 5 Factors that can accelerate the rate of development of or worsen amnesia include longer duration, frequency, intensity, and age of exposure to a traumatic event. 3 It more commonly occurs in the third and fourth decade of life with relatively equal incidence among men and women 4 and shares a strong genetic component, accounting for about 50% of cases. 2Īlthough limited data are available, published studies estimate an incidence of dissociative amnesia with fugue in 0.2% of the general population. Stressful or traumatic events known to have caused cases of dissociative amnesia include war, natural disasters, and physical assaults. 1 In the absence of brain damage evidenced by structural neuroimaging, it is often referred to as dissociative or psychogenic amnesia. Retrograde amnesia is a form of memory loss generally preceded by brain injury or a psycho-traumatic event.
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