Rare and Unusual Psychiatric Syndromes: A Primer

Christoph U. Correll, MD; Bret S. Stetka, MD; Ariel Harsinay

Disclosures

July 23, 2018

Dissociative Amnesia/Dissociative Fugue

Dissociative amnesia is a condition characterized by the inability to recall autobiographical information, especially that surrounding a specific, often traumatic event. Previously a stand-alone diagnosis, dissociative fugue is a subtype of dissociative amnesia characterized by unexpected travel and "bewildered wandering" associated with amnesia for one's identity.

Fugues are usually precipitated by a strong emotional or physical stressor or stressful episode and have been observed in the context of severe psychological or physical trauma; the ingestion of psychotropic substances; general medical conditions; and neuropsychiatric conditions, including bipolar disorder, depression, delirium, and dementia. Psychotherapeutic and supportive approaches should be used, and comorbid conditions should be identified and managed as appropriate.

Recent research in dissociative amnesia has found a correlation between the condition and chronic cannabis use. A case study details a 51-year-old man who was found by the police, unable to recall his name or any personal information. The man reported daily cannabis use since age 15, and was subsequently diagnosed with substance-induced psychotic disorder. Cannabis use was shown to independently cause dissociation and fugue-like states in patients who are chronic users and typically have a history of hallucinations or other psychological disturbances.[10]

Foreign Accent Syndrome

Foreign accent syndrome is a rare condition whereby someone speaks their native language as if they had a foreign accent. This syndrome usually follows a head injury, trauma, or stroke affecting the speech center of the brain.

Recent research in the syndrome has found a correlation with lesions in the language-dominant hemisphere of patients. This typically involves lesions in the insula, primary motor cortex, and the Broca area. The two recent occurrences of foreign accent syndrome that led to this correlation were found in individuals who had had strokes right before developing their speech disturbances.[11]

Stockholm Syndrome

Stockholm syndrome characterizes a psychological response that can be observed in a victim in which he or she shows signs of sympathy, loyalty, or even voluntary compliance with the victimizer, regardless of the risk to himself or herself. The syndrome is most often discussed in the context of hostage abduction but has also been described in relationship to rape, domestic abuse, and child abuse. It can be understood as a severe form of reaction formation that talks place under enormous physiologic and emotional stress.

Stockholm syndrome is named after a 1973 bank robbery in Stockholm, Sweden, in which the hostages became emotionally attached to their hostage-takers. The hostages even defended their captors after they were freed, refusing to testify against them. A famous example of Stockholm syndrome is Patty Hearst, a millionaire's daughter who was kidnapped in 1974 and later took part in a robbery organized by her and her kidnapper.

As in all cases of severe trauma, psychotherapeutic and supportive approaches should be used, and comorbid conditions should be identified and managed as appropriate.

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