Dissociative Amnesia with Dissociative Fugue and Psychosis: a Case Report from a 25-Year-Old Ethiopian Woman

Table 1

Summary of the patient’s progress in the inpatient unit.

Duration	Psychopathology and main lab findings	Therapeutic interventions		Remark
		Pharmacological	Psychosocial
First and the second week	-The patient was hostile, disturbed, and had frequent shouting She did not know where she was and where she was brought from-Lab investigations like CBC, TSH, RFT, and LFT were normal-HCG, negative-Dissociative experiences scale: 66	-Risperidone 2 mg PO BID; -Diazepam 10 mg PO noct In the second week, fluoxetine 20 mg PO in the morning was added	Rapport building and empathic understanding Psychoeducation on drug adherence and side effects	Dx: dissociative amnesia with dissociative fugue comorbid with schizophrenia
Third week	-Abdominal U/S was done and confirmed, as she is not pregnant.-The patient becomes more engaging but very irritable when asked about the trauma-Dissociative experiences scale: 66	-Risperidone titrated to 6 mg/day-Diazepam was tapered and discontinued-Artane 2 mg PO morning	-Engaging the patient in scheduled routine daily activities	Slight improvement(behaviorally) but a present of neuroleptic-induced Parkinson
Fourth week	-Reported suicidal ideation and tried to strangulate herself--Had wrist rigidity and drooling of saliva	-Risperidone titrated to 8 mg/day then to 10 mg/day-Fluoxetine titrated to 40 mg/day	-emphatic understanding and encouragement of social relationships with other patients and attendants	-Worsening-24 hours under close follow-up
Fifth and sixth week	-Very irritable-Frequent shouting-Hostile towards her mother-Drug side effects observed-Dissociative experiences scale: 66	-Risperidone tapered slowly until 4 mg/day diazepam 10 mg PO BID reinitiated-Fluoxetine tapered to 20 mg/day	Engagement in routine daily activities-hypnosis	-An additional diagnosis of neuroleptic-induced pseudo-Parkinson
Seventh week			-Simpson Angus	-Antipsychotic discontinued-Diazepam 10 mg PO BID-Fluoxetine 20 mg/day	-Hypnosis-Engagement in routine daily activities like washing clothes, and making coffee	-Dx: dissociative amnesia with dissociative fugue, comorbid with schizophrenia-Neuroleptic-induced Pseudo parkinsonism
Eighth and ninth week	-More engaging	-Additionally, phenobarbitone was initiated for drug-assisted hypnosis and titrated to 100 mg PO BID	-Drug-assisted hypnosis-She was let to engage more in daily activities	Improving
Tenth week	-Head and neck CT was done and normal finding-Abdominal U/S confirmed no pregnancy-Hostile-Suicidal and homicidal towards her mother-crying-	The same	-Hypnosis continued every day-EMDR	Close follow-up for possible suicidality and homicide
Eleventh week	-Sleeplessness-Shouting-Physical and verbal aggression-Severe paranoia towards everybody	-Risperidone 2 mg PO BID reinitiated-Haloperidol 5 mg IM Prn-Phenobarbitone tapered and discontinued-Fluoxetine and diazepam continued	-Engagement in social activities	-Worsening-Close follow-up
Twelfth week	-Acute dystonia torticollis)	-Risperidone changed to olanzapine 5 mg PO BID due to unavailability	-hypnosis continued-Encouragement of engagement in routine daily activities	Slight improvement (behaviorally)
Thirteenth week	No new finding	-Fluoxetine was changed to amitriptyline due to unavailability	-Hypnosis continued-Encouragement of engagement in routine daily activities
Fourteenth week and fifteenth	-refusal to take medication	-Modicate 12.5 IM testing dose-Amitriptyline was titrated to 100 mg PO noct-Olanzapine titrated to 20 mg PO/day	-Hypnosis continued-encouragement of engagement in routine daily activities
Sixteenth week	-A frequent complaint of constipation	Bisacodyl 5 mg PO BID added	-Hypnosis continued-Encouragement of engagement in routine daily activities	Follow for possible drug side effect
Seventeenth week	-Constipation continued despite treatment	-Enema was done-Modicate 25 mg IM given	-Hypnosis continued-Encouragement of engagement in routine daily activities
Eighteenth week	-Good social interaction	-Amitriptyline was changed to sertraline through cross tapering	-Hypnosis continued-Encouragement of engagement in routine daily activities	Improving
Nineteenth week	-Good social interaction-Good interaction with her mother but not accepted as her true mother	-Sertraline 100 mg PO morning-Diazepam 10 mg PO BID-Olanzapine 5 mg PO BID-Engage in routine daily activities	-Hypnosis continued-Encouragement of engagement in routine daily activities	Improving
Twentieth week	-Improved engagement in social activities like helping other patients-She said her mother is no more her enemy	-Diazepam tapered-Sertraline was discontinued-Discharge considered	-Encouragement of engagement in routine daily activities	-Improving

Follow-up and outcomes.