A 15-year-old, female high school student was referred to our child and adolescent psychiatric department for sudden loss of memory during a high-school extracurricular activity. She did not have any previous psychiatric problems. There were no abnormalities in her laboratory results, including a chest X-ray, brain magnetic resonance imaging scan, HIV test, liver function test, vitamin B12 assay, and electrolyte level test. She did not have abnormal behavior or psychotic symptoms, including hallucinations and delusions. She did not exhibit cognitive problems on a mini-mental status examination, except she could not recall the other participants of her extracurricular activity, even after looking at their pictures and phone numbers. She was embarrassed at the memory loss, but she was neither worried nor agonized. She reported that she had not experienced physical or emotional trauma or severe stress. Through the interviews with her family and friends, we determined that she had experienced difficult social relationships for the previous month. According to her family, she was usually timid and extremely vulnerable, and such characteristics prevented her from getting along with more than a few close friends. Nevertheless, her interest in musical instruments led her to join a brass band and to enjoy playing alto saxophone in the band. According to the band members, the vice-chief wind player assigned to the baritone saxophone had complimented her performance. However, the patient felt left out and had started playing louder and trying harder in the band. The vice-chief was displeased with her behavior, and began to disparage the patient to other people. She cowered before the vice-chief and avoided confronting him. The vice-chief, however, kept disparaging her, and the patient had to endure hardships as the practice hours became longer and more frequent during a break. When the patient broke her commitment to meet the vice-chief, the vice-chief bawled at her on the phone. The patient experienced headaches afterwards, which became more severe and frequent. After 3 days, however, the patient claimed that she no longer suffered from any headaches. Moreover, when her friends in the brass band called her for practice, the patient was embarrassed and could not recall anything about the band activity or the members of the band.
Her initial diagnosis was dissociative amnesia. The patient became anxious and tried to avoid conversations regarding the band activities when a supportive interview for memory retrieval was administered. She was educated about her disorder, and it was suggested that her memory could return. However, her memory did not recover. Therefore, we decided to use drug-assisted interview for treatment of her amnesia.
After 3 days of hospitalization, a lorazepam-assisted interview was planned, and the patient gave her consent. The interview with lorazepam was conducted according to a previously described protocol[10-11, 15], described in Table 1.
Before obtaining informed consent, the procedure was prepared, with a brief explanation of the means by which the procedure could help her memory recover. The patient was maintained on an intravenous drip of 500 mL of 5% dextrose. We dissolved 4 mg of lorazepam (Ildong pharmaceutical Co., Ltd., Seoul) in 30 mL of normal saline. Monitoring of her vital signs, including her blood oxygen saturation, was conducted.
After 10 mL of diluted lorazepam (1.25 mg of lorazepam) solution was intravenously injected, the patient became relaxed and sleepy. She was kept awake by gently calling her name and asking her simple questions. The interview was started with ordinary questions that gradually transitioned to the topics of her memory loss. A few minutes later, she started to report having been bullied by members of the band. She recalled that she had been insulted by a member on a phone call. When she became infuriated and tearful, an additional 5 mL of lorazepam solution (0.625 mg of lorazepam) was administered. As she was too unstable emotionally to continue the interview and could not recall the details of the phone call even after half an hour, the interview was halted. The next day, the patient could recall that she had cried during the lorazepam-assisted interview. However, she could not remember any experiences with other members of the band, and she reported anxiety regarding recall of such experiences. An additional 0.25 mg of lorazepam was administered in the next interview. Supportive psychotherapy to provide reassurance and suggestions was performed until the second lorazepam-assisted interview. After she had been hospitalized for 10 days, the second lorazepam-assisted interview was conducted. The same procedures were used. During the second interview, she successfully recalled a phone conversation with three friends in which she blamed herself for not reporting the bullying. The day after, she could recall that her relationships with peers and more senior members of the band had been stressful. As soon as she remembered that her best friend had blamed her, she was disappointed and angry because she could not resolve the misunderstanding. She then recalled most of the events related to her memory loss and decided to accept further psychotherapy.
A final diagnosis of dissociative amnesia[3] was made, and she was discharged after 14 days of hospitalization. One week later, she was getting along well without any memory or cognitive problems.
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