A 42-year-old married man with two children, living in Trabzon, presented with memory loss. He had been working in iron and aluminum joinery before his symptoms appeared. He struggled to recognize loved ones and remember much of his past. Prior to the onset of amnesia, the patient experienced fever, abdominal pain, and nausea, but these symptoms resolved quickly. The next day, while at work, he was unable to perform familiar tasks and had to ask his child for help. He remembered his family, but details like his wedding day, the birth of his children, and other significant life events were lost. He knew that his parents had passed away, but he could not remember why, where, or when. He remembered some of his close relatives but did not recognize others. For example, of his three uncles, he only remembered the one who had died; the others seemed as if he was seeing them for the first time in his life. Of the five friends he had been close to before the incident, he could only remember two. His memory was selective, recalling some relatives but not others, and he could only remember a car accident in 2012.
Following the onset of memory loss, he temporarily forgot how to drive and struggled with basic tasks. Over time, he relearned how to drive, but occasionally forgot he could. The patient also left his job and took up lumberjack work, which he had never done before. His wife had to monitor him closely, as he often forgot daily events. In the evening, he would forget what he had talked about in the morning and what he had done throughout the day. The patient would either tell his wife what he planned to do in the near future or write it down on small pieces of paper. Because he would forget to take his insulin and his meal times, he kept track of them by making daily notes. He could remember and complete most of the work on his own, but he kept forgetting to change the machine's program There was no family history of dementia, and he had no history of substance abuse or childhood trauma. He had recently experienced a significant decrease in sales in his business and had frequent arguments with his wife due to economic problems. In fact, he had been experiencing difficulties in his interpersonal relationships for a long time. The patient had a history of intensive care and splenectomy following a traffic accident in 2012. He was driving the car at the time of the accident, and besides himself, his wife and children were also present. The others sustained injuries that could be treated with simple medical intervention. After the accident, he began experiencing flashback episodes, sensitivity to reminders of the event, irritability, mood changes, recurrent nightmares about the accident, and accompanying insomnia. Initially, he was prescribed mirtazapine 15 mg/day, but he spontaneously discontinued the treatment and neglected follow-up care. After a while, he started experiencing additional outbursts of anger and fluctuations in affect. His tolerance threshold towards those around him seemed to have decreased. His attitude towards his wife and children changed. He stopped seeing his close friends, felt insecure around people, and was unable to establish intimacy with them. He blamed himself for not being able to rebuild his life after the accident and thought he was a burden to his loved ones. In 2013, the patient attempted suicide by hanging twice, two months apart. In 2014, a combined treatment with sertraline and mirtazapine was started with the diagnoses of PTSD and depressive disorder for his ongoing symptoms. In trauma-focused supportive psychotherapy, the focus was on making the relationship between his current complaints and past traumatic experiences more visible, and on addressing the negative effects of these experiences on him. The aim was for the patient to gain awareness of his current situation, make sense of his experiences, and pave the way for the construction of a new, non-stigmatized identity. After the treatment, there was a significant decrease in trauma-related flashback episodes, sensitivity to trauma reminders, and recurrent nightmares with an accident theme. However, irritability, mood changes, sleep problems, negative self-perception, and emotional dysregulation persisted. The patient continued to attend follow-up visits for a short period before discontinuing them. He did not seek medical support again until the most recent period of complaints. During this time, there was a significant decline in his social and occupational functioning.
Audiovisual Number Sequence Test, Stroop Test, Clock Drawing, Proverb Interpretation and Binary Similarities Subtests were administered to evaluate attention and executive functions; Auditory Verbal Learning Test, Benton Test, Bender Gestalt Test were administered to evaluate memory; MMPI was administered to evaluate personality traits and psychopathology. According to the results of neuropsychological tests, mental flexibility, abstract thinking, semantic and phonemic fluency were intact, while focused attention, attention maintenance and response inhibition skills were impaired. According to the MMPI test, the patient was severely depressed with anxiety and agitation and may have borderline personality traits. No significant pathological findings were found in neuroimaging studies(Fig. 1,2) (brain CT, brain MRI and brain PET CT), dementia markers (HIV, syphilis, hepatitis, CBC, biochemistry, urine tests), toxicity markers and rheumatologic markers, which were performed with the recommendations of the neurology department to exclude organic etiology. The patient with known comorbidities of hypertension and diabetes mellitus was consulted to cardiology and endocrinology departments. As a result of the follow-up and treatment process in both departments, it was concluded that no pathology was detected that could explain the patient's current picture.