Malingering was also an important differential diagnosis therefore, psychology consultation was requested. The family was not opposed to Mr A’s sexual orientation.ĭuring hospitalization, the neurology department was consulted, and after complete neurologic workup, including electroencephalogram and brain imaging, the neurology team ruled out organic causes of transient amnesia. They were in a relationship for about 1 year, but his mom did not notice emotional changes in Mr A after the breakup. When asked about any recent stressor, the mother recalled that about a week ago Mr A had broken up with his partner. He had no history of seizure or head trauma. His mom denied symptoms of depression, anxiety, mania, and/or psychosis. Mr A scored 27/30 on the Mini-Mental State Examination 6 he lost 3 points in the attention domain. He denied hallucinating and had no intentions to harm himself or anyone else. The immediate recall was intact, but he was unable to provide important details pertaining to his life. He was oriented in time, place, and person but had impaired attention and concentration at the time of the examination. When asked how he was doing, Mr A said, “confused.” His mood was “okay,” and his affect seemed flat and somewhat guarded with no concern for his memory loss ( la belle indifference). The human immunodeficiency virus and rapid plasma reagin tests were also negative. Results of other routine investigations including complete blood count, complete metabolic profile, ammonia level, B 12 level, thyroid function tests, and liver function tests were also within normal limits. Findings of a head computed tomography scan and magnetic resonance imaging were within normal limits. Mr A did not recall how or why he came to the parking lot.Īt admission to the inpatient psychiatry unit, Mr A’s urine drug screen tested negative for any illicit substances. She called his friends, and they were able to locate him in the parking lot of a convenience store. Later in the evening, his mom got concerned and started calling and sending him text messages, which went unanswered. He slept until 1 pm on Sunday, woke up, and left the house without telling anybody. When he reached home, Mr A failed to recognize his mother, dog, siblings, and belongings. Considering the situation, Mr A’s supervisor sent him home at 9:30 am. The next day (Sunday) when Mr A was at work, the mother got a call from Mr A’s supervisor at his office stating that he did not recognize his friends and that he was asking what he was supposed to do at work. According to his mother, he was doing fine until 2 days ago (Saturday). He had difficulty remembering things for the past 2 days. Mr A, a 20-year-old man with no past medical and psychiatric history, was brought to the emergency department by his mother (Monday). This case shows a need for early diagnosis and psychological support for these patients in a timely manner.Ĭase report. 5 It becomes prudent for health care professionals to make themselves aware of this disorder to prevent misdiagnosis and unnecessary investigations. 4 The prevalence of dissociative fugue disorder is very low, estimated at 0.2%. 3 Severely traumatized patients with a history of sexual abuse are highly likely to use dissociation as a primary psychological defense. 2 The onset is usually sudden and predicated by a traumatic or stressful life event. Per the DSM-5, dissociative amnesia with dissociative fugue is the “purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.” 1 (p156) As the name fugue implies, the condition involves psychological flight from an overwhelming situation. To the Editor: Dissociative fugue is a subtype of dissociative amnesia.
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