Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Dissociative Disorders

Dissociative identity disorder Patients with DID also report lapses in memory, but will likely report additional dissociative symptoms and multiple episodes of memory lapses. Patients will likely also report a history of finding unexpected possessions and random fluctu

ations in abilities or skills. Posttraumatic stress disorder

Patients with PTSD are unable to consistently recall all or some details of the traumatic event, whereas patients with dissociative amnesia will not remember extended periods of time before and/or after the event. Of note, comorbidity of PTSD and dissociative amnesia is relatively common. Neurocognitive disorders Memory loss due to neurocognitive disorders (eg, seizure disorders, Alzheimer disease, and transient ischemic attack) is typically tied to additional deficits in cognition and disturbances in affect, attention, or behavior. Substance-related disorders Individuals with a long history of substance use disorder, especially alcohol, may experience blackouts during periods of extreme intoxication. If a longitudinal history reveals a pattern of memory deficits while the individual is intoxicated, it is likely that memory lapses are substance related. Substance-related disorders in the context of sexual assault Victims of sexual assault may also experience blackouts while voluntarily in toxicated or involuntarily intoxicated due to “date rape” drugs like γ -hydroxy butyrate (GHB). Should a sexual assault happen while the victim is intoxicated, it can be impossible to discern if the memory deficit is due to intoxication or Amnesia may follow a TBI. Unlike dissociative amnesia, memory deficits fol lowing TBI are usually accompanied by additional symptoms like disorientation and confusion. Neuroimaging abnormalities are also associated with TBI but not dissociative amnesia. Factitious disorder and malingering Some individuals may feign amnesia, especially if they stand to gain or to avoid legal or financial difficulties. If determined enough, some individuals may be able to maintain the deception indefinitely. Course and prognosis The symptoms of dissociative amnesia terminate abruptly. Recovery is complete with few recurrences. The condition may last a long time in some patients, es pecially in cases involving secondary gain. Disruptions in memory should be restored as soon as possible, or the repressed memory may form a nucleus in the unconscious mind where future amnestic episodes may develop. Recovery generally is spontaneous but is accelerated with treatment. dissociative amnesia as a result of trauma. Sequela related to traumatic brain injury

Dissociative Disorders

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