Psychogenic fugue

A fugue state is a syndrome consisting of a sudden loss of all autobiographical memories and knowledge of personal identity, usually associated with a period of wandering, for which there is a subsequent amnesic gap on recovery. Characteristically, fugue states last a few hours or days, although there are descriptions of complaints of autobiographical memory loss lasting much longer. Whenever such complaints persist, the suspicion of simulation must arise. Fugue states differ from transient global amnesia or transient epileptic amnesia in that the subject does not know who he or she is, and repetitive questioning is not a characteristic feature in fugues.

As discussed elsewhere,(!6) fugue states are always preceded by a severe precipitating stress. Second, depressed mood is also an extremely common antecedent for a psychogenic fugue state, and may be associated with manifest suicidal ideas just before or following recovery from the fugue. Third, various authors have noted that there is often a past history of a previous transient neurological amnesia, such as epilepsy or head injury. In brief, it appears the patients who have experienced a previous transient organic amnesia, and who become depressed and/or suicidal, are particularly likely to go into a fugue in the face of a severe, precipitating stress. That stress may consist of marital or emotional discord, bereavement, financial problems, a criminal charge, or stress during wartime. Fugues have been described as a 'flight from suicide'.

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