Patient was hospitalized for detailed history and evaluation. He was traced thrice with help of police. Once he was found from a famous temple 80 km far from home begging outside. Once he was found in a fair doing religious rituals with a group of people 1-month after leaving home.
Patient reported that he had twice experience that he found himself away from home at another place and he could not tell why and recall how he reached there. There was no history suggestive of suspiciousness, unusual perceptual experiences, grossly disorganized behavior, high talk or increased goal-directed activity.
No history suggestive of alcohol, cannabis or any other substance use, episodes of fall, convulsion, sleep walking, head injury. No past history is suggestive of trance states or possession symptoms. In first isolation interview patient did not revealed any stressor or recent stressful events preceding last fugue. Mother reported that they are a farmer by occupation since many years but lost major part of land due to fraud made by his uncle in documents of property ownership.
Dissociative fugue: Recurrent episodes in a young adult
The patient was probed about this issue during subsequent interviews, he opened up his concerns about loss of land. He told that their land was the only source of earning a livelihood for them. They suffer extreme financial crisis after the incidence. He also reported about poor social support from his other uncles.
He had occasional suicidal thoughts but avoids doing so, when he thinks about his elderly mother. He lived with mother in nuclear family. Father passed away 7 years back by snake bite. He was the only child.
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Paternal grandfather had some psychiatric illness episodic nature having symptoms of headache, sleep disturbance and withdrawn behavior. No further details were recalled by patient's mother. He left studies after fifth class and started labor work at their farm with his father because of the poor economical situation of family. According to mother, her son was quiet and responsible before the onset of illness.
Dissociative Fugue - Mental Health Disorders - MSD Manual Consumer Version
No unusual personality traits were reported. Physical examination, neurological assessment, and blood investigation tests were normal. The head computed tomography scan could not be done because of non-affordability. The mental state examination revealed a young male with poor hygiene, unkempt appearance, and poor eye contact.
His mood was depressed and effect was restricted which was appropriate to his mood. No thought or perceptual disturbance was found.
He was oriented to time, place, and person, but had poor attention and concentration. No abnormality found in immediate, short-term, and remote memory, but the recall of events during fugue episode was patchy. Judgment and insight were intact. The patient was diagnosed of dissociative fugue with major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision.
He was treated with fluoxetine supportive and insight-oriented psychotherapy. Psychoeducation was given both to patient and family. He responded well after 1-month and during subsequent visits after discharge, he was encouraged to find new work to earn. Efforts were made to enhance coping with stressors to prevent another fugue episode.
He comes for regular follow-up since last 2 months and no fugue episode occurred. In this case, the patient is young adult male.
History of the fugue
Most cases in the literature describe men with a dissociative fugue, primarily in military samples. However, no adequate data exist to demonstrate a gender bias to this disorder. Dissociative fugue is usually described in adults. The striking feature in this case is recurrence of fugue episodes.
Dissociative fugues have been described to last from minutes to months. Some patients report multiple fugues. However, in most cases of recurrent fugues, a more chronic dissociative disorder, such as dissociative identity disorder, was not ruled out.
In this patient, there was no history suggestive of switching to altered self-states or identities. No such behavior was observed during an examination or during follow-up visits. The patient was found bagging roadside during one fugue and doing some religious rituals during another fugue. Literature reveals that some individuals may display overtly bizarre, disorganized or dangerous behavior during the fugue. Depression has been described associated with a dissociative fugue in the literature.
Dissociative fugue can present with recurrent fugue episodes and episodes may last for days to months. Lightbulb Joke. Family Business. The Value of Failure. Bedtime Story. Red Hat Unveils Ansible Platform. Deadline Extended! The Bedrock of Digital Transformation.
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