Case Reports in Psychiatry / 2020 / Article / Tab 1

Case Report

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.

DurationPsychopathology and main lab findingsTherapeutic interventionsRemark

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 effectsDx: 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 activitiesSlight 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/dayEngagement 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 activitiesImproving
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-EMDRClose 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 activitiesSlight improvement (behaviorally)
Thirteenth weekNo 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 constipationBisacodyl 5 mg PO BID added-Hypnosis continued-Encouragement of engagement in routine daily activitiesFollow 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 activitiesImproving
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 activitiesImproving
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.

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