Dissociative fugue of the patient of maternity ward - A case report

Abstract

IntroductionMothers after childbearing are vulnerable to many stress related disorders.Objectiveto emphasize the role of the past obstetric complications, as so present infant pathology as risk factors for the mother's post partum stress related disorders.MethodsThe case analysis.Case descriptionThe thirty-year-old, women left the maternity ward with her baby unnoticed on the fourth day after giving birth. She was referred to psychiatry ward, after finding her by the police. In the past history the patient had spontaneous miscarriage in the first pregnancy. She has waited with her husband 6 years long for the next baby. The second pregnancy was at risk, the labor was premature and the infant has palatoschisis. The mother had difficulties with feeding. She feared about baby's life, and had feeling of being neglected by the staff. In psychiatry ward she did not reveal any symptoms of mental illness. She was interested in her child, however the period of the flight was covered with memory gap. The predominance of immature defense mechanisms, as so mild cognitive dysfunctions were revealed in psychological testing. The dissociative fugue was diagnosed. The patient was discharged without any medication to ambulatory psychotherapy.CommentaryThe interaction of past and present traumatic experiences in the patient with cognitive dysfunctions and immature defense mechanisms could impair ability of post-partum coping with fear about the child and consequently led to the loss of conscious control over the memory. Early diagnosing and supporting problematic patients of the maternity ward is needed.

Modern faces of hysteria, or some of the dissociative disorders

“…According to contemporary literature, risk factors for developing a dissociative disorder , include genetic factors [6,7] and severe psychological trauma. Trauma is associated with difficult, unavoidable situations which cannot be resolved or opposed against.…”

“…Among the causative factors, there is also severe psychological trauma that may occur as a result of a direct threat to health or life [1]. The literature most frequently mentions traumatic experiences from early childhood [8], a dramatic loss of loved ones [9], violence [10], sexual abuse, catastrophes, war, natural disasters, traumatic experiences associated with pregnancy and the perinatal period [6], and protracted interpersonal and intrapsychic problems. [7,11,12,13,14,15].…”

“…[7,11,12,13,14,15]. According to Janet, overly strong emotions felt as a result of traumatic experiences lead to the detachment of these experiences and their transfer to the subconscious [6,16]. Torn from under the control of personality, psychological functions become autonomous.…”

“…This case is an example of a situation in which there is an interaction between psychological risk factors for perinatal stress disorders and cognitive dysfunction in the mother. The patient's immature defence mechanisms, previous traumatic experiences (perinatal loss, threatened pregnancy, a birth defect in the newborn child), and perinatal stress have all ultimately led to amnesia, loss of identity integration, perception and conscious control of behavior [6].…”

“…Do czynników sprzyjających występowaniu zaburzeń dysocjacyjnych, zgodnie ze współczesnym piśmiennictwem, można zaliczyć czynniki genetyczne [6,7] oraz poważne urazy psychiczne. Urazy wiążą się z sytuacjami trudnymi, niemożliwymi do uniknięcia, których nie da się rozwiązać, ani im się przeciwstawić.…”