Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

Dissociative fugue Dissociative fugue is now diagnosed as a subtype (specifier) of dissociative am nesia. It is characterized by sudden, unexpected travel away from home, with the inability to recall some or all of one’s past. This is accompanied by confusion about identity and, often, the assumption of an entirely new identity. With disso ciative fugue, memory loss is sudden and is associated with purposeful, uncon fused travel, often for extended periods of time (days to months or even years). Patients lose part or complete memory of their past life and are often unaware of the memory loss. They assume an apparently normal, nonbizarre new identity. However, perplexity and disorientation may occur. Once they suddenly return to their former selves, they recall the time antedating the fugue, but they are amnes tic for the period of the fugue itself. Though technically rare, with a prevalence rate of 0.2% in the general pop ulation, it happens far more frequently than clinical experience would suggest, and occurs most often during times of war, following natural disasters, and as a result of personal crises with intense internal conflict. As is the case with dissociative amnesia, psychiatric interview, drug-assisted in terview, and hypnosis help reveal to the clinician and the patient the psychological stressors that triggered the fugue episode. Psychotherapy helps patients incorporate the precipitating stressors into their psyches in a healthy and integrated manner. Differential diagnosis Loss of memory may result from numerous other medical conditions, as noted in Table 16-4 . What distinguishes dissociative amnesia from many other causes of memory loss is that it is not due to a neurologic or other medical condition. TABLE 16-4. Differential Diagnostic Considerations in Dissociative Amnesia Dementia Delirium Ordinary forgetfulness and nonpathologic amnesia Amnestic disorder due to a medical condition Anoxic amnesia Cerebral infections (eg, herpes simplex affecting temporal lobes) Cerebral neoplasms (especially limbic and frontal) Epilepsy Metabolic disorders (eg, uremia, hypoglycemia, hypertensive encephalopathy, porphyria) Postconcussion (posttraumatic) amnesia Postoperative amnesia Electroconvulsive therapy (or other strong electric shock) Substance-related amnesia (eg, ethanol, sedative-hypnotics, anticholinergics, steroids, lithium, β -adrenergic receptor antagonists, pentazocine, phencyclidine, hypoglycemic agents, cannabis, hallucinogens, methyldopa) Transient global amnesia Wernicke-Korsakoff syndrome Sleep-related amnesia (eg, sleepwalking disorder)

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Dissociative identity disorders Other dissociative disorders Posttraumatic amnesia Posttraumatic stress disorder Acute stress disorder Somatoform disorders (somatization disorder, conversion disorder) Malingering and factitious amnesia (especially when associated with criminal activity)