Fugue
Dr.Balan Stephen
Definition
Fugue is a rare status of mind which represents a severe form of dissociative disorder
It is a functional state of amnesia
Aetiology
Caused by traumatic events such as a war, abuse, accidents, disasters, extreme violence.
Abuse of of alcohol (alcohol induced "blackouts".
Features
During a fugue the person's outward behaviour appears normal
Patient may travel away from home
Loss of awareness or confusion of his own identity
Patient feels temporarily distant (cut off) from one's own emotional or physical state (depersonalization)
He feels dissociated from what is going on around him (derealisation).
He is unable to recall the past
Or he may assume a new identity
Usually it is an abrupt psychological reaction to stressful circumstances
The patient physically removes himself from the reality of the stressful circumstances
The dissociative fugue state spontaneously resolves after hours or days
May be recurrent
It may represent an individual's ability to dissociate as a way of managing emotional diffuculties
Investigations
CT, MRI of the brain
EEG
Routine blood tests
Treatment
The goal is to help the person come to terms with the stress or trauma that triggered the fugue
To develop new coping methods to prevent further episodes
A combination of the following methods may be of use :
Psychotherapy - a type of counselling - uses techniques designed to encourage communication of conflicts and increase insight into problems
Cognitive therapy : focuses on changing dysfunctional thinking patterns and resulting feelings and behaviours
Medication
If at all needed it is for depression or anxiety - antidepresants and anxiolytics
Family therapy : the family is taught about the disease and its recognition
Creative therapies ( art therapy, music therapy) help the patient to explore his thoughts and express them in a safe and creative way
Clinical Hypnosis : uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness (awareness)
Prognosis
Most dissociative fugues are brief, lasting from less than a day to several months. Often, the disorder goes awa on its own. The outlook is quite good.
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