EpistemisAutopsychic disorientation
Specialty: Psychiatry.
Why it occurs
- Dementia in terminal phase (destruction of autognostic associative neural networks)
- Severe dissociative amnesia or dissociative fugue
- Severe head injury with diffuse cortical damage
- Extreme catatonic or disorganized schizophrenia
- Hyperacute metabolic or toxic encephalopathy
- Severe intoxication due to dissociative anesthetics (ketamine, PCP) or hallucinogens
Initial workup
High resolution brain MRI; panel of onconeuronal and autoimmune antibodies in blood and CSF; electroencephalogram; specific cognitive assessments; toxic screening.
red flags
Sudden appearance of loss of identity in a young patient with no neurodegenerative history, which indicates a severe dissociative condition due to trauma, or a hyperacute autoimmune encephalitis.
Standard management
- Treat the underlying cause. If the condition is dissociative of psychosocial origin, supportive psychotherapy and Lorazepam if there is severe distress. If organic/neurodegenerative, optimize reality orientation measures and low-dose Haloperidol if agitation occurs.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 6
- Treatment options
- 1