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Concept: Fugue state

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Autobiographical amnesia is found in patients with focal or diffuse brain damage (“organic amnesia”), but also without overt brain damage (at least when measured with conventional brain imaging methods). This last condition is usually named dissociative amnesia at present, and was originally described as hysteria. Classically and traditionally, dissociative amnesia is seen as a disorder that causes retrograde amnesia in the autobiographical domain in the aftermath of incidents of major psychological stress or trauma. In the present study one of the probably largest published collections of patients (28) with psychogenically caused autobiographical amnesia, who were assessed with comprehensive neuropsychological tests, will be described and documented in order to identify variables which are central for the occurrence of dissociative amnesia. The presented cases demonstrate that autobiographical amnesia without direct brain damage can have very mixed clinical presentations, causes and consequences. The described cases of psychogenic amnesia are clustered according to a number of manifestations and features, which include a reduced effort to perform cognitively at a normal level, a forensic background, anterograde (instead of retrograde) autobiographical amnesia, the fugue condition, concurrent somatic diseases, and their appearance in childhood and youth. It is concluded that autobiographical amnesia of a psychogenic origin may occur within a variety of symptom pictures. For all patients, it probably serves a protective function by offering them a mechanism to exit a life situation which appears to them unmanageable or adverse.

Concepts: Clinical psychology, Fugue state, Dissociative amnesia, Anterograde amnesia, Psychogenic amnesia, Memory disorders, Hippocampus, Amnesia

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INTRODUCTION: Dissociative fugue is a psychiatric disorder characterized by amnesia coupled with sudden unexpected travel away from the individual’s usual surroundings and denial of all memory of his or her whereabouts during the period of wandering. Dissociative fugue is a rare disorder that is infrequently reported. Before now, no case of it had been reported in a medical student. CASE PRESENTATION: This article focuses on the report of a case of dissociative fugue symptoms in a 28-year-old male Nigerian medical student. CONCLUSION: The observation in this case report brings to the fore that dissociative fugue is often related to stressful life events and can be comorbid with a depressive disorder.

Concepts: Schizophrenia, Suicide, Dysthymia, Psychiatry, Dementia, Hippocampus, Fugue state, Mental disorder