Lesson 2: Cognitive Disorders

Description

Evan, an 18 year-old male, was brought to a hospital for psychiatric consultation. The US Coast Guard had found him adrift in a sailboat off the coast of Florida, and the local police had taken him to the hospital. Despite having been overexposed to the sun and being exhausted, Evan was physically fine. He showed no evidence of head injury or dehydration. His psychological health, however, was poor. When asked what day it was, Evan gave the wrong date, he was incorrect by five days. He also found difficulty concentrating on specific questions. He was, however, able to tell the physician that he had gone sailing off the coast of Florida with some friends and they had encountered bad weather.

Because of his confusion (he had to be reminded that he was in a hospital) and his exhaustion, Evan was permitted to sleep for six hours. Upon awakening he was more alert, but he was still unable to account for his companions. In fact, he had no recollection of what happened after the bad weather fell upon the group. He did, however, remember the conversation he had with the physician upon arrival at the hospital. He was also able to recall that he was a student at a local college, that he had a group of close friends, and that he had a caring family. In addition, it was learned that Evan did not abuse alcohol or other drugs, and that he had no history of previous mental illness.

Evan then underwent a “lie-detector test.” During his interview he admitted that neither he nor his friends were experienced sailors and that no one in the group was capable of dealing with the storm they encountered. Unlike his friends, Evan had attached himself to the boat with a life jacket and tie line. He believed that it was a combination of luck and the tie line that saved him from being swept into the sea like his friends. Evan had survived on a small supply of food for the next three days – up to the time he was rescued by the Coast Guard.

Diagnosis

Evan had acute memory loss. He did not display signs of head trauma, cerebrovascular accident, drug use, dementia, or delirium. Because of this and the fact that the amnesic period developed after a traumatic experience, the diagnosis of psychogenic amnesia is made. Evan’s DSM diagnosis for Axis I is psychogenic amnesia.