This Is Not the Original Timeline”: A Case Report of an ExtendedDissociative Episode in a Healthy Young Male Accompanied withSevere Decline in Mental State

Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. Dissociativedisorders can be described and understood using the combination offive core symptoms: amnesia, depersonalisation, derealisation,identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge indiagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures therelevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but nosignificant medical history was presented to the emergency department with increased anxiety, subsequently progressing toagitation, pacing, and becoming nonverbal. No significantfindings were uncovered on laboratory blood testing (other thanprolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to apsychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state ofconsciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with nosignificant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signsof improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, theCOVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patientreported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given.This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. Thereare no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefitsof a drug-free period of watchful waiting upon admission