Man of Mystery: A Case Report of Dissociative Amnesia in Schizophrenia

Abstract

This case report is unique in its rare presentation of dissociative amnesia with schizophrenia and CT presentation of involutionary prefrontal cortex change. In this case, the patient lost all autobiographical information and memories of his past. He mysteriously appeared in the public health system six months ago without a previous public record and with an alias. In addition, he presented with disorganized behavior, dissociative amnesia, and was internally preoccupied. We diagnosed the patient with schizophrenia and started pharmacological intervention. Unfortunately, the patient had no improvement of insight, and his memory problem persisted despite the treatment. Thus, this case brings attention to dissociative amnesia with comorbid schizophrenia. Moreover, the patient had improvement in mood, but his dissociative amnesia persisted despite medication.

Dissociative Amnesia: A Mist Over Psychosis

“…However, what’s worth discussing is the spectrum of mental illness that can co-exist alongside or linger beneath the haze of dissociative amnesia. It is well-known that dissociative amnesia occurs in a background history of patients with post-traumatic stress disorder, somatization, conversion disorder as well as personality disorders, but little discussion is made on the cohort of patients that are on the psychotic or the affective spectrum [ 8 ]. At times, this can bring professional doubt, as an unfamiliar occurrence in a setting of pattern recognition can, at times, make physicians think twice before donning the diagnosis and, thereby, the optimal treatment plan.…”

Long-Term Retrograde Global Amnesia Following Minor Trauma

“…A published study on immigration and dissociative amnesia [ 17 ] sums up previous theories on how “immigration posed a significant threat to feelings of identity and self-cohesiveness”, which could include our patient. The patient’s amnesia lasted a long time, but many patients retrieve most of their memories or relearn them within days, weeks, or months; however, examples of persistent amnesia are reported [ 6 , 8 ]. Retrograde amnesia due to malingering is seen with criminal offenders and reported in 1 case in a neuropsychological study, where the subject felt need for sanctuary at a hospital and feigned his amnesia [ 6 ].…”

“…Published case reports on memory loss vary from complete autobiographic and semantic memory to only memory loss of a few days or periods of life [ 5 – 7 ]. A large gap in memory without recognition of close family has been described in several case reports [ 5 , 7 ], as well as dissociative amnesia and psychotic symptoms, where the patient afterwards was diagnosed with schizophrenia [ 8 ]. The new classification in ICD-11 (not yet implemented) has generalized amnesia included in dissociative amnesia (ICD-11, 6B61) [ 9 ], and dissociative reactions and symptoms are included in the diagnosis complex post-traumatic stress syndrome (ICD-11, 6B41) [ 9 ].…”