Ganser syndrome
Encyclopedia
Ganser syndrome is a rare dissociative disorder previously classified as a factitious disorder
. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue
, amnesia
or conversion disorder
, often with visual pseudohallucination
s and a decreased state of consciousness. It is also sometimes called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, pseudodementia, hysterical pseudodementia or prison psychosis. This last name, prison psychosis, is sometimes used because the syndrome occurs most frequently in prison inmates, where it may represent an attempt to gain leniency from prison or court officials.
Ganser is an extremely rare variation of dissociative disorder. It is a reaction to extreme stress and the patient thereby suffers from approximation or giving absurd answers to simple questions. The syndrome can sometimes be diagnosed as merely malingering, however, it is more often defined as dissociative disorder.
Symptoms include a clouding of consciousness, somatic conversion
symptoms, confusion, stress, loss of personal identity, echolalia
, and echopraxia
. The psychological symptoms generally resemble the patient's sense of mental illness rather than any recognized category. Individuals also give approximate answers to simple questions. For example, "How many legs are on a cat?", to which the subject may respond '3?'.
The syndrome may occur in persons with other mental disorders such as schizophrenia
, depressive disorders, toxic states, paresis
, alcohol use disorders
and factitious disorders. EEG
data does not suggest any specific organic cause.
in 1898 pointed out their hysterical twilight state. They may also describe hallucination
s which are usually more florid than those in schizophrenia
. They may also have disorders of sensation similar to those in conversion disorder
. They may be inattentive or drowsy.
Some workers believe there is a genuine psychosis
underlying this, others believe it is a dissociative disorder, while still others believe it is the result of malingering
. Over the years, opinions have seemed to move from the last view more towards the first.
Ganser syndrome is currently classified under dissociative disorders, to which it moved in the DSM IV from the factitious disorders.
Diagnosing Ganser syndrome is very challenging, not only because some measure of dishonesty is involved but also because it is very rare.
Usually when giving wrong answers, they are only slightly off, showing that the individual understood the question. For instance, when asked how many legs a horse has they might say, "five." Also, although subjects appear confused in their answers, in other respects they appear to understand their surroundings.
The disorder is apparently most common in men and prisoners although prevalence data and familial patterns are not established.
Factitious disorder
Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their...
. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue
Fugue state
A fugue state, formally dissociative fugue or psychogenic fugue , is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality...
, amnesia
Amnesia
Amnesia is a condition in which one's memory is lost. The causes of amnesia have traditionally been divided into categories. Memory appears to be stored in several parts of the limbic system of the brain, and any condition that interferes with the function of this system can cause amnesia...
or conversion disorder
Conversion disorder
Conversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life, and conversion is considered a psychiatric...
, often with visual pseudohallucination
Pseudohallucination
A pseudohallucination is an involuntary sensory experience vivid enough to be regarded as a hallucination, but recognised by the patient not to be the result of external stimuli. In other words, it is a hallucination that is recognized as a hallucination, as opposed to a "normal" hallucination...
s and a decreased state of consciousness. It is also sometimes called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, pseudodementia, hysterical pseudodementia or prison psychosis. This last name, prison psychosis, is sometimes used because the syndrome occurs most frequently in prison inmates, where it may represent an attempt to gain leniency from prison or court officials.
Ganser is an extremely rare variation of dissociative disorder. It is a reaction to extreme stress and the patient thereby suffers from approximation or giving absurd answers to simple questions. The syndrome can sometimes be diagnosed as merely malingering, however, it is more often defined as dissociative disorder.
Symptoms include a clouding of consciousness, somatic conversion
Conversion disorder
Conversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life, and conversion is considered a psychiatric...
symptoms, confusion, stress, loss of personal identity, echolalia
Echolalia
Echolalia is the automatic repetition of vocalizations made by another person. It is closely related to echopraxia, the automatic repetition of movements made by another person....
, and echopraxia
Echopraxia
Echopraxia is the involuntary repetition or imitation of the observed movements of another. It is closely related to echolalia, the involuntary repetition of another's speech. The etymology of the term is from Ancient Greek: "ἠχώ from ἠχή " and "πρᾶξις "...
. The psychological symptoms generally resemble the patient's sense of mental illness rather than any recognized category. Individuals also give approximate answers to simple questions. For example, "How many legs are on a cat?", to which the subject may respond '3?'.
The syndrome may occur in persons with other mental disorders such as schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, depressive disorders, toxic states, paresis
Paresis
Paresis is a condition typified by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it also can be used to describe the muscles of the eyes , the stomach , and also the vocal cords...
, alcohol use disorders
Alcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...
and factitious disorders. EEG
EEG
EEG commonly refers to electroencephalography, a measurement of the electrical activity of the brain.EEG may also refer to:* Emperor Entertainment Group, a Hong Kong-based entertainment company...
data does not suggest any specific organic cause.
Overview
The original description by Sigbert Josef Maria GanserSigbert Josef Maria Ganser
Sigbert Josef Maria Ganser was a German psychiatrist born in Rhaunen. He earned his medical doctorate in 1876 from the University of Munich. Afterwards he worked briefly at a psychiatric clinic in Würzburg, and later as an assistant to neuroanatomist Bernhard von Gudden in Munich...
in 1898 pointed out their hysterical twilight state. They may also describe hallucination
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s which are usually more florid than those in schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
. They may also have disorders of sensation similar to those in conversion disorder
Conversion disorder
Conversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life, and conversion is considered a psychiatric...
. They may be inattentive or drowsy.
Some workers believe there is a genuine psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
underlying this, others believe it is a dissociative disorder, while still others believe it is the result of malingering
Malingering
Malingering is a medical term that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation ; avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences;...
. Over the years, opinions have seemed to move from the last view more towards the first.
Ganser syndrome is currently classified under dissociative disorders, to which it moved in the DSM IV from the factitious disorders.
Diagnosis
According to the DSM-IV-TR, which classifies Ganser syndrome as a dissociative disorder, it is "the giving of approximate answers to questions (e.g. '2 plus 2 equals 5' when not associated with dissociative amnesia or dissociative fugue)."Diagnosing Ganser syndrome is very challenging, not only because some measure of dishonesty is involved but also because it is very rare.
Usually when giving wrong answers, they are only slightly off, showing that the individual understood the question. For instance, when asked how many legs a horse has they might say, "five." Also, although subjects appear confused in their answers, in other respects they appear to understand their surroundings.
Treatment
Hospitalization may be necessary during the acute phase of symptoms, and psychiatric care if the patient is a danger to self or others. A neurological consult is advised to rule out any organic cause.Prevalence
The disorder is extraordinarily rare with fewer than 100 recorded cases. While individuals of all backgrounds have been reported with the disorder, there is a higher inclination towards males (75% or more). The average age of those with Ganser syndrome is 32 and it stretches from ages 15–62 years old. It has been reported in children.The disorder is apparently most common in men and prisoners although prevalence data and familial patterns are not established.