6.3 Dissociative Fugue

Question 1

What is ‘dissociative fugue’?

Answer 1

Dissociative fugue is a subset of dissociative amnesia, it is characterised by:

1. Purposeful and sudden unexpected travel from home, or bewildered wandering.
2. Amnesia with identity or other important autobiographical information.
3. Assume an entirely new identity upon arriving in the new location.
4. Patients are unaware of their new identity and location, and will not recall details of their dissociative fugue.

Question 2

What are predisposing factors to dissociative fugue?

Answer 2

1. Heavy alcohol use.
2. Major depression.
3. Head trauma or epilepsy.
4. Stressful life event.

Question 3

What is your clinical approach to a patient presenting with ‘dissociative fugue’?

Answer 3

1. Medically stabilise patient.
2. Psychiatric assessment.
   
   • Medical Hx
   • Psychiatric Hx
   • Collateral Hx
3. Mental status examination & Cognitive assessment.
   
   • Affect - bewildered.
   • Cognitive questions.
4. Labs and Brain studies
   
   • Baseline labs, e.g. bloods, urine.
   • Head imaging, EEG if focal neurological findings.

Question 4

What are 7 questions to ask a patient with dissociative fugue?

Answer 4

1. Do you have gaps in your memory?
2. Are you missing parts of memory?
3. Are you missing important events in life?
4. Do you remember some parts of life better than others?
5. Do you lose periods of time?
6. Do you have blackouts or blank spells?
7. Do you feel safe?

Question 5

Name a key difference and a key similarity between dissociative amnesia and dissociative fugue.

Answer 5

1. Similarity: Neither are bothered by their memory loss.
2. Difference: Those with dissociative amnesia are aware that they have forgotten something, where as those with dissociative fugue are not aware.

Question 6

How long does dissociative fugue last?

Answer 6

Minutes, hours to days. Can sometimes last for 1-2 years.

Question 7

How is dissociative fugue treated?

Answer 7

1. Spontaneous recovery.
2. Lorazepam is the most useful option, readily available and effective.
3. Psychotherapy is ongoing and directed to help the patient recover their lost memories.
4. In some circumstances, administration of sodium amobarbital or hypnosis may help patient to speak more freely.

After the episode, the patient will resume normal identity without ever remembering the time of the fugue.

Deciding on a management option:

• Inpatient vs. outpatient management