Ganser's syndrome

Ganser syndrome is a type of mental pseudo-disorder in which the patient behaves as if he or she suffers from some physical or mental illness. Patients with Ganser syndrome are often compared to people with schizophrenia.

The term "prison psychosis" is sometimes used for this syndrome, because the disorder was first described based on observations of the behavior of prisoners.

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Epidemiology

Ganser syndrome is much less common in everyday life than in prisons. The syndrome most often affects young people aged 16-18.

Cases of the disease in older age are much less common. Patients suffering from delusions of grandeur are more susceptible to the disease.

There are various types of reactive psychoses, and among them, Ganser's syndrome, as a hysterical twilight clouding of consciousness, occurs most rarely.

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Causes Ganser syndrome

The exact causes of Ganser syndrome are still unknown. However, there are suggestions that the syndrome may be primarily associated with severe stress.

There are other risk factors: for example, this 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.

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Risk factors

Additional factors that contribute to the development of Ganser syndrome are:

• chronic alcohol abuse;
• head injuries;
• sudden psychological shock.

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Pathogenesis

As we have already indicated above, the main etiological factors in the development of Ganser syndrome are severe nervous shocks, fear, stress, etc. In one expression, such a provoking factor is called a “state of extreme stress.”

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

In order to prove the truth of their nervous pseudo-disorder, patients with Ganser syndrome agree to undergo any diagnostic procedures, even if they are associated with risk or accompanied by pain. At the same time, the goal of such behavior is never to receive material assistance or status, but only to recognize the person as truly sick.

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Symptoms Ganser syndrome

The most striking symptoms of Ganser syndrome are considered to be conversational and active disorientation - a person speaks and acts “out of place”, illogically and unpredictably.

The so-called "mistalk" - conversational or speech disorientation - manifests itself in absurd statements, implausible answers and absurd conclusions. For example, the patient is unable to count the number of his own fingers.

Another symptom is “passive action” - these are movements and actions that are “out of place”: the patient literally tries to put his pants on over his head, socks on his hands, etc.

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

Additional violations include:

• 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 Ganser syndrome may manifest themselves in affective disorders, mood swings and conditions (despondency is replaced by happiness, and a joyful mood is replaced by anxiety). In some cases, visual hallucinations are observed, which are a consequence of various phobias and fears. Such hallucinogenic moments are accompanied by stage productions, which may take the form of a court hearing, reading a sentence, etc.

The patient periodically falls into imitative attacks, reminiscent of some serious mental illness, such as schizophrenia. The main signs of such imitation may be:

• confusion;
• attempts to prove one's high status and position in society;
• pseudo-amnesia and pseudo-hallucinations.

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

Stages

In terms of psychopathological manifestations, Ganser syndrome is more complex and diverse than a normal shock reaction. As a result of exposure to a psychogenic traumatic situation, the patient experiences stress for some time, and the syndrome develops gradually. However, in most cases, it is possible to initially determine an acute stage, which over time turns into a neurotic and subacute stage. Such a division is rarely used in diagnostics, since it is not possible to clearly define the boundaries of the stages.

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Complications and consequences

A person who has once suffered an attack of Ganser syndrome has every chance of surviving a repeated exacerbation of the disease.

There are no complications of Ganser syndrome as such. However, it is necessary to monitor the patient's condition during an attack, since he cannot control himself. There are known cases when patients with Ganser syndrome, being in a disoriented state, caused harm either to themselves or to people around them.

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Diagnostics Ganser syndrome

Diagnosis of Ganser syndrome can sometimes be difficult, as the patient's behavior can mislead even the doctor.

The diagnostic sign of the syndrome is the presence of a characteristic cause of the disease – a traumatic situation for the psyche (stress).

Sometimes you may need the help of a neurologist or psychotherapist.

Tests may be needed only to determine the presence of concomitant diseases in the patient. Laboratory tests are not informative for diagnosing Ganser syndrome.

Instrumental diagnostics allows to exclude organic pathology of the brain. If such disorders are suspected, the doctor may prescribe an X-ray examination of the skull, magnetic resonance imaging of the brain, and encephalography.

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Differential diagnosis

Differential diagnostics are carried out with the following diseases:

• Pseudodementia is the so-called false dementia syndrome, which is characterized by only a slight twilight state, or even its absence. Patients with pseudodementia experience an imaginary loss of the simplest skills and abilities. The patient is indifferent, stares at one point, answers questions "off topic", and the mood often and dramatically changes.
• Puerilism is a kind of simulation of silly behavior that is usually characteristic of children. The patient may play with toys, use childish expressions, cry and kick his legs. However, some actions reveal a conscious adult and sensible person.
• Hysterical stupor is a condition in which the patient is virtually motionless, but at the same time his face displays a variety of alternating emotional reactions.
• Schizophrenia is a polymorphic group of mental disorders.

Treatment Ganser syndrome

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

Usually, aminazine is used to quickly stop an attack. Other medications can be used only if concomitant psychoses, neuroses, or depressive states are detected.

	Method of administration and dosage	Side effects	Special instructions
Aminazine	Usually, during an attack, it is administered intramuscularly or intravenously at an initial dose of 25-50 mg.	Loss of visual acuity, low blood pressure, allergic reactions.	The drug should be prescribed with caution to elderly patients.

	Method of administration and dosage	Side effects	Special instructions
Amitriptyline	Take orally with food, 25 mg 2-3 times a day, with possible further increase in dosage.	Deterioration of visual acuity, increased intraocular pressure, difficulty with defecation, headaches, anuria, subfebrile temperature.	The drug is incompatible with alcohol.

	Method of administration and dosage	Side effects	Special instructions
Paroxetine	Taken orally, in the morning, with food. The dosage is determined individually.	Drowsiness, hand tremors, convulsions, dizziness.	If convulsions occur, stop taking the drug.

	Method of administration and dosage	Side effects	Special instructions
Micalite	Take orally, in 3-4 doses, from 0.6 to 1.2 g per day.	Dyspepsia, hand tremors, dry mouth, drowsiness, loss of appetite.	Taking the drug should be combined with drinking a sufficient amount of liquid.

Vitamins

Vitamins in the treatment of Ganser syndrome can be prescribed to normalize oxidation-reduction processes and the functioning of the nervous system, as well as to eliminate hypovitaminosis - primarily of B vitamins.

Vitamins	Daily requirement	Therapeutic doses	Food sources
Vitamin B1	1-1.5 mg	Intramuscularly 2-3 ml of 6% solution	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 mcg	200-400 mcg per day orally	Greens, yeast, liver
Vitamin B12	3 mcg	1 ml of 0.02-0.05% solution intramuscularly	Offal, eggs, cheese, fish
Vitamin B15	2 mg	50 mg three times a day	Buckwheat, beans, liver

Physiotherapy treatment

Various physiotherapeutic procedures can also be used in the treatment of Ganser syndrome, such as electrosleep, exercise therapy, spa treatment, acupuncture (reflexology), occupational therapy, etc.

Physiotherapeutic methods help relieve emotional stress and fatigue, as well as increase efficiency and qualitatively improve metabolic processes in the body.

Folk remedies

At home, you can use traditional medicine recipes to treat Ganser syndrome. They are allowed to be used after the acute stage of the disease, when the dangerous symptoms are left behind.

It is very useful for nervous disorders, including Ganser syndrome, to take soothing baths - with the addition of a decoction of valerian rhizome, hop cones, pine branches. Such a medicinal bath should be taken 2-3 times a week for 15-20 minutes.

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

A compress made from a warm infusion of mint leaves is very good for calming the nervous system. You should pour 20 g of mint with 0.5 l of boiling water, leave for 15-20 minutes, soak a soft towel in the infusion and apply to the forehead. It is recommended to lie like this for about half an hour, periodically wetting the towel again.

An alternative method of treatment such as using essential oils is also considered useful. If you spray a little aromatic lavender or pine oil in the room where the patient sleeps, the sleep will become longer and calmer. And, as is known, it is during sleep that the restoration of the body and nervous system occurs most intensively.

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Herbal treatment

• To alleviate the condition of Ganser 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. Take 150 ml of the infusion three times a day.
• It is useful to take a decoction of marsh cudweed. To prepare the decoction, take 3 tbsp. of the plant and 0.5 l of boiling water, leave for 45-60 minutes. Take 200 ml three times a day.
• An infusion of oregano is prepared by pouring 3 tablespoons of the plant into 0.5 liters of boiling water. Take three times a day with honey.
• Reduces symptoms of exacerbation of Ganser's syndrome infusion of Polemonium. For 2 tbsp. of Polemonium root take 200 ml of boiling water, leave for 2 hours. Take 50 ml three times a day.

Homeopathy

During remission and even during an attack of Ganser syndrome, homeopathy can come to the rescue. If the patient is in an excited state, it seems to him that he is very sick and will even die soon - Aconitum will help. However, if the psychotraumatic situation was so strong for the patient that, according to him, he does not understand what is happening - Opium is prescribed.

In hysterical phenomena, if the emotional state is absolutely not controlled by the patient, Ignatia is prescribed.

If physical discomfort occurs, Arnica can be used.

If the patient needs participation and consolation, and this condition lasts for a long time, the drug Acidum phosphoricum is indicated.

The homeopathic preparations listed above are used only in a strictly individual dosage, which is determined by a homeopathic doctor. Before using any remedy, it is necessary to make sure that there is no allergy to the components of the selected remedy.

Surgical treatment

Surgical treatment for Ganser syndrome is not practiced. The disease is considered a mental pseudo-disorder with a distortion of reality, and requires observation by a neurologist and psychotherapist. Psychotherapy helps to relieve the patient from focusing on a psychotraumatic situation, as well as to work out the protective mechanisms of the reaction.

Prevention

In order to avoid the recurrence of Ganser syndrome, it is recommended to follow several preventive rules:

• periodically undergo a course of preventive treatment with a neurologist, taking medications according to the symptoms;
• stick to a daily routine, go to bed on time, and eat at approximately the same time;
• do not ignore communication, do not withdraw into yourself;
• do physical exercise, have active rest;
• avoid drinking alcohol and do not abuse drinks containing caffeine;
• avoid conflicts and possible stressful situations.

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

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Forecast

The prognosis for patients with Ganser syndrome is considered favorable, as recovery is usually expected within a few days. Ganser syndrome does not cause changes in thinking, intellectual activity and the emotional sphere, even in the distant future.

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