Ganser's syndrome

Ganser's syndrome is one of the variants of mental pseudo-disorder, when the patient behaves as if he is suffering from some kind of physical or mental illness. Patients with Ganser's syndrome are often compared to individuals with schizophrenia.

To this syndrome, the term "prison psychosis" is sometimes used, because for the first time the violation was described on the basis of observations of the behavior of convicts.

[1], [2], [3],

Epidemiology

Ganser's syndrome in everyday life is much less common than in the prison environment. With this syndrome, young people 16-18 years old are more likely to suffer.

Cases of disease in older age is much less. Illness is more susceptible to patients suffering from megalomania.

Various types of reactive psychoses are known, and among them Ganser's syndrome, as a hysterical twilight confusion of consciousness, happens most rarely.

[4], [5], [6],

Causes of the ganser's syndrome

The exact causes of the development of Ganser's syndrome are still unknown. However, there are suggestions that the syndrome, in the first place, can be associated with severe stress.

There are other risk factors: for example, it is a certain behavioral feature in which a person at all costs tries to avoid an uncomfortable situation or responsibility for something. Often the cause of the syndrome.

[7], [8], [9], [10], [11],

Risk factors

Additional factors contributing to the development of Ganzer's syndrome are:

• chronic alcohol abuse;
• head trauma;
• a sudden psychological shock.

[12], [13], [14], [15]

Pathogenesis

As we have already mentioned above, the main etiological factors in the development of Ganzer's syndrome are strong nervous shock, fright, stress, etc. In one expression, this provoking factor is called the "state of transcendental stress".

The second pathogenetic link can be called the desire of a sick person to create around him a situation of impunity - moreover, the patient wants to achieve from others compassion, pity, participation. In order to achieve the desired effect, a person can go against any social and ethical norms of behavior, without being afraid to seem strange, or even aggressive.

To prove the veracity of their nervous pseudo-disorder, patients with Ganzer's syndrome agree to undergo any diagnostic procedures, even if they involve risk or are accompanied by pain. At the same time, the goal of such behavior is never to receive material assistance or status, but only to recognize a person as truly sick.

[16], [17],

Symptoms of the ganser's syndrome

The most vivid symptoms of Ganzer's syndrome are spoken and effective disorientation - a person speaks and acts "out of place", illogically and unpredictably.

The so-called "mimicking" conversational, or verbal disorientation - is manifested in absurd statements, implausible answers and absurd conclusions. For example, the patient is not able to count the number of his fingers.

Another symptom is the "spillover" of movements and actions "out of place": the patient literally tries to put pants over his head, socks on his hands, etc.

It is noteworthy that a person who is in an acute period of Ganzer's syndrome does not pass the test for skin sensitivity: there is no reaction to thermal and mechanical stimuli.

Among the additional violations observed:

• disorientation in space;
• limitation of communication with the outside world;
• distorted perception of reality.

At the moment of exacerbation the patient sharply focuses only on his own feelings and problems.

The first signs of Ganzer's syndrome can be manifested in affective disorders, mood swings and states (sadness is replaced by a state of happiness, and a joyful mood is caused by anxiety). In some cases, visual hallucinations are observed, which are the consequence of various phobias and fears. Such hallucinogenic moments are accompanied by scenic performances, which can take the form of a court session, reading out the verdict, etc.

The patient periodically falls into imitating seizures, reminiscent of any of the severe mental illnesses - for example, schizophrenia. The main signs of this imitation can be:

• confusion;
• attempts to prove their high status and position in society;
• pseudoamnesis and pseudo-hallucinations.

The clinical picture of Ganser's syndrome usually persists for several days, after which the patient's condition is normalized. The patient usually does not remember what happened to him during the attack.

Stages

For psychopathological manifestations, Ganser's syndrome is more complex and diverse than the usual shock reaction. As a result of exposure to a psychogenic traumatic situation, the patient experiences stress for a while, and the syndrome develops gradually. However, in most cases, it is possible to determine at first the acute stage, which later passes into a neurotic and subacute stage. Such a separation in diagnosis is rarely used, since it is not possible to clearly define the boundaries of the stages.

[18], [19],

Complications and consequences

A person who once suffered an attack of Ganzer's syndrome, has every chance to survive a repeated exacerbation of the disease.

As such, complications of Ganser's syndrome do not exist. However, it is necessary to monitor the patient's condition during an attack, since he can not control himself. There are cases when patients with Ganzer's syndrome, being in a disoriented state, caused harm either to themselves or to surrounding people.

[20], [21], [22], [23], [24], [25], [26], [27]

Diagnostics of the ganser's syndrome

Diagnosis of Ganser's syndrome can sometimes present certain difficulties, since the patient by his behavior is able to deceive even the doctor.

Diagnostic sign of the syndrome is the presence of a characteristic cause of the disease - a traumatic situation (stress).

Sometimes you may need the help of a neuropathologist, a psychotherapist.

Analyzes may be needed only to determine the presence of concomitant diseases in the patient. For the diagnosis of Ganser's syndrome, laboratory tests are not informative.

Instrumental diagnostics allows to exclude organic pathology of the brain. If such disorders are suspected, the doctor may order a radiographic examination of the skull, magnetic resonance imaging of the brain, encephalography.

[28], [29], [30], [31]

Differential diagnosis

Differential diagnosis is carried out with such diseases:

• Pseudodegmentation is the so-called false dementia syndrome, which is characterized by only a small twilight state, or even its absence. Patients under pseudodementia experience an imaginary loss of the simplest skills and abilities. The patient is indifferent, looks at one point, answers questions "past the topic," and the mood often and dramatically changes.
• Puerilism is a kind of simulation of foolish behavior, which is usually inherent in children. The patient can play toys, use children's expressions, cry and pinch his legs. However, some actions reveal a conscious adult and sensible person.
• Hysterical stupor is a condition in which the patient is actually motionless, but at the same time there are various emotional reactions on his face.
• Schizophrenia is a polymorphic group of mental disorders.

Treatment of the ganser's syndrome

The main point in the treatment of Ganzer's syndrome is the elimination of the initial traumatic situation of the psyche, as well as the patient's belief that he will be helped. The doctor's task is to reduce the effects of stress and calm the patient.

Usually, for an early arrest of the attack, use aminazine. Other drugs can be used only if there are co-occurring psychoses, neuroses, depressive conditions.

	Dosing and Administration	Side effects	Special instructions
Aminazine	Usually, during an attack, they are administered intramuscularly or intravenously at an initial dose of 25-50 mg.	Loss of vision clarity, lowering of blood pressure, allergic reactions.	Caution is prescribed to elderly patients.

	Dosing and Administration	Side effects	Special instructions
Amitriptyline	Ingest with food, 25 mg 2-3 times a day, with a possible further increase in dosage.	Deterioration of vision clarity, increased intraocular pressure, difficulty with defecation, headaches, anuria, subfebrile temperature.	The drug is not compatible with alcohol.

	Dosing and Administration	Side effects	Special instructions
Paroxetine	Take inside, in the morning, with food. Dosage is set individually.	Drowsiness, trembling in the hands, convulsions, dizziness.	When there is a seizure, the drug is stopped.

	Dosing and Administration	Side effects	Special instructions
Mykalit	Take inside, for 3-4 reception, from 0.6 to 1.2 grams per day.	Dyspepsia, trembling in the hands, dry mouth, drowsiness, worsening of appetite.	The drug should be taken with a sufficient amount of liquid.

Vitamins

Vitamins in the treatment of Ganser's syndrome can be prescribed for the normalization of oxidation-reduction processes and the work of the nervous system, as well as for the elimination of hypovitaminosis - in the first place, vitamins of group B.

Vitamins	Daily requirement	Therapeutic doses	Food Sources
Vitamin B1	1-1.5 mg	Intramuscularly for 2-3 ml of 6% of r-ra	Cereals, nuts, beans, pork
Vitamin B2	1-3 mg	2 mg up to 3 times a day	Eggs, dairy products, liver, fish and meat, vegetables
Vitamin B6	2-3 mg	Intramuscularly 1 ml of 5% solution	Beans, eggs, cereals, nuts, liver
Vitamin B9	200-400 μg	At 200-400 mcg per day orally	Greens, yeast, liver
Vitamin B12	3 μg	In 1 ml of 0.02-0.05% of r-intramuscularly	By-products, eggs, cheese, fish
Vitamin B15	2 mg	50 mg three times a day	Buckwheat, beans, liver

Physiotherapeutic treatment

In the treatment of Ganser's syndrome, various physiotherapeutic procedures can be used - for example, electrosleep, exercise therapy, sanatorium treatment, acupuncture (reflexotherapy), occupational therapy, etc.

Physiotherapeutic methods allow to remove emotional overstrain and fatigue, and also to raise working capacity and qualitatively improve metabolic processes in the body.

Alternative treatment

At home, prescriptions for alternative medicine can be used to treat Ganser's syndrome. They are allowed to use at the end of the stage of exacerbation of the disease, when the dangerous symptoms are left behind.

It is very useful for nervous disorders, including with Ganzer's syndrome, to take soothing baths - with the addition of decoction of rhizome of valerian, cones of hops, sprigs of needles. This therapeutic bath should be taken 2-3 times a week for 15-20 minutes.

Instead of tea daily, several times a day, it is necessary to drink tea from the leaves of mint or lemon balm. To improve the effect, you can add flowers of chamomile, sage and a little honey.

Very well calms the nervous system of the compress, which is prepared from a warm infusion of mint leaves. Should 20 g of mint pour 0.5 liters of boiling water, insist 15-20 minutes, moisten with a soft towel and apply to the frontal part of the head. So it is recommended to lie down about half an hour, periodically wetting the towel again.

It is also useful to consider such an unconventional method of treatment as the use of essential oils. If in the room where the patient is sleeping, spray a little of the fragrant oil of lavender or needles, then the dream will be more prolonged and calm. And, as is known, it is in a dream that the recovery of the organism and the nervous system occurs most intensively.

[32],

Herbal Treatment

• To relieve the condition with Ganser's syndrome, it is recommended to use lemon balm leaves, preparing an infusion of 10 g of the plant and 0.5 L of boiling water. Infusion take 150 ml three times a day.
• It is useful to take a decoction of marshweed. To prepare the broth take 3 tbsp. L. Plants and 0.5 liters of boiling water, insist 45-60 minutes. Take 200 ml three times a day.
• Infusion of oregano is prepared by pouring 3 tbsp. L. Plants 0.5 liters of boiling water. Take three times a day with honey.
• Reduces the symptoms of exacerbation of Ganser's syndrome with cyanosis infusion. At 2 tbsp. L. The root of the cyanosis is taken 200 ml of boiling water, insist 2 hours. Take 50 ml three times a day.

Homeopathy

Homeopathy can come to the rescue in the period of remission and even during the episode of Ganser's syndrome. If the patient is in an excited state, it seems to him that he is very sick and even will die soon - the drug Aconitum will help. However, if the psycho-traumatic situation was so severe for the patient that, from his words, he does not understand what is happening - prescribe the drug Opium.

With hysterical events, if the emotional state is not completely controlled by the patient, Ignatia is prescribed.

With physical discomfort, you can use Arnica.

In case the patient needs participation and consolation, and this condition is prolonged for a long time - the drug Acidum phosphoricum is shown.

Homeopathic medicines listed above are used only in strictly individual dosage, which is determined by a homeopathic doctor. Before applying this or that remedy, it is necessary to make sure that there is no allergy to the components of the chosen product.

Operative treatment

Operative treatment for Ganzer's syndrome is not practiced. The disease is considered a mental pseudo-disorder with a distortion of reality, and requires observation from a neurologist and a psychotherapist. Psychotherapy helps to save the patient from fixing attention on the traumatic situation, and also to work out the protective reaction mechanisms.

Prevention

In order to avoid the re-development of Ganzer's syndrome, it is recommended to adhere to several preventive rules:

• periodically take a course of preventive treatment from a neurologist, taking medications according to the symptoms;
• observe the regime of the day, go to bed in time, eat at about the same time;
• Do not ignore communication, do not shut yourself in;
• to engage in physical education, to actively rest;
• Avoid alcohol and do not abuse beverages that contain caffeine;
• avoid conflicts and possible stressful situations.

If the doctor suggests to take a course of preventive treatment, then one should not refuse: prescribed medications will help support the nervous system and strengthen the body.

[33], [34], [35], [36], [37], [38], [39]

Forecast

The prognosis for patients with Ganser's syndrome is considered favorable, as recovery is usually expected for several days. Changes in thinking, intellectual activity and the sphere of emotions Ganser's syndrome does not cause, even in the distant future.

[40], [41], [42], [43]