She was discharged from the hospital after 3 weeks with a diagnosis of generalized dissociative amnesia. She stabilized with intact cognition over the next few days. She stated that because of these issues, she traveled to Canada as an asylum seeker. She alleged that members of a religious group in the United States harassed her. She reported a history of being in an abusive relationship. During her admission, she was able to remember more details about her past. She was started on a low dose of antipsychotic (ie, risperidone 1 mg/d that was gradually increased to 2 mg/d). The initial differential diagnosis included dissociative amnesia, malingering, or disorganized schizophrenia. The patient was admitted to the psychiatry unit for further assessment and diagnostic clarification. Collateral history from her neighbor suggested that the patient had been behaving unusually for a while with bizarre behaviors such as laughing to herself. Following the patient’s conversation with her roommate, she was able to identify herself and recall parts of her autobiographical memory. Her roommate was able to make contact with her. We involved the local police department, and they were able to rapidly identify the patient and establish her address.
Her electroencephalogram (EEG) revealed some abnormal activities in the left temporal region, mostly the anterior area, and a sleep-deprived EEG was pending. She underwent a lumbar puncture, which revealed normal cell counts and chemistry. Neuroimaging scans including computed tomography and magnetic resonance imaging with gadolinium were normal. Her initial neurologic examination, drug screening test, complete blood count, sepsis screening, complete metabolic panel, and kidney, liver, and thyroid function tests were all unremarkable. With a tentative diagnosis of transient global amnesia, she underwent a complete medical and neurologic workup to rule out the differential diagnosis including transient ischemic attack/stroke, seizure, or transient global amnesia. She was seen by the neurology department for a headache, neck pain, and memory loss. Cognitively, we completed a Mini-Mental State Examination, 4 and she scored 0/10 on temporal and spatial orientation and 20/20 on the rest of the examination. She denied any delusions or hallucinations. She appeared to have linear and organized thought processes. Her affect was congruent, reactive, and euthymic. Her speech was normal in tone, rate, and volume. She was well kempt and appropriately dressed for the weather. She remained pleasant, calm, and cooperative throughout the interview. In terms of her psychiatric assessment, she did not appear to be very concerned about her memory loss. She had autobiographical memory loss and loss of memory for global events prior to police contact.
The police, who had found the patient purposelessly wandering the streets, brought her to the emergency department. This is the case of a woman in her 40s with no previous history of medical disorders. The differential diagnosis of dissociative amnesia involves substance use disorder, malingering, cognitive disorder, and neurologic conditions such as seizure disorders and transient global amnesia. 3 Depending on the magnitude of memory loss, dissociative amnesia can be classified as localized (lack of memory for a period of time or an event), selective (lack of memory for specific parts/aspects of an event), or generalized (lack of memory for the life history and identity).
In support of this connection, previous research showed that the majority of patients who presented with this condition had a history of traumatic experience. Although the etiology is still unclear, current evidence 1 suggests a strong connection between history of psychological trauma and dissociative amnesia. 1 A previous study 2 in a population-based sample from Canada reported a lifetime prevalence of 6% for this condition. Dissociative amnesia, a type of dissociative disorder, is characterized by autobiographical memory loss.
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