Experience | News | Products | Other
This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Ganser Syndrome (Pseudodementia)
Post your experienceSynonyms: Prison psychosis, pseudodementia, hysterical pseudodementia.
This is a rare condition of uncertain or variable aetiology. It was first described by the psychiatrist Sigbert Ganser in 1898.1 Ganser described the syndrome after studying the behaviour of three inmates of a prison and thus it has acquired the synonym "prison psychosis". He was of the opinion that the condition was hysterical or malingering in origin.
It is thought that people develop Ganser's syndrome, either consciously or unconsciously, to avoid an unpleasant situation. There has been much debate over the years as to whether it is psychotic, hysterical or factitious in origin. Association with serious illness may suggest an aetiology similar to delirium. It is fairly common to find it associated with head injury.2 There may be no one cause in all cases.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) currently classifies Ganser syndrome as a dissociative disorder. It is often classified as a factitious disorder.
Ganser syndrome is said to be very rare with fewer than 100 cases in the literature. The precise incidence is not known as most of the recorded cases in the literature describe only individual patients and criteria are lax. Ganser syndrome is more common in men, with a probable male to female ratio of 3 or 4:1. It is most frequently described in individuals between the ages of 15 and 40 but a wide range of ages have been reported. It has been described in children.3 Ganser syndrome is thought to be precipitated by episodes of severe stress but has also been described in association with head injury.
The condition tends to occur against a background of head injury, serious illness or severe psycho-social stress. The 4 principle features are:
- Approximate answers
- Clouding of consciousness
- Somatic conversion symptoms such as hysterical paralysis
- Hallucinations, visual or auditory
The term approximate answers needs explanation. It is the most characteristic feature of the condition and German terms such as vorbeireden meaning talking past and vorbeigehen meaning to pass by or danebenreden meaning talking next to are used in the literature. The essential feature of approximate answers is that whilst the patient gives an incorrect response, the nature of the response suggests that he understands the question. Thus he may say that grass is blue and that a dog has 3 legs. When asked the day of the week or month of the year he will give a day of the week or month of the year but the wrong one. This is in direct contrast to answers that are simply nonsensical, perseverative or otherwise inappropriate.
Diagnostic criteria are not well established. Most authorities would want approximate answers and at least one other principle feature to make the diagnosis.
Other features include:
- A dreamy or perplexed appearance
- Memory or personal identity loss
- No recollection of the condition upon recovery
- Perseveration
- Echolalia
- Echopraxia
- Confusion
- Precipitating stress
- Loss of personal identity
There is no typical finding on examination. A full neurological examination should be performed and a mental state examination. There are now more sophisticated tests to assess exaggerated or fabricated cognitive dysfunction.4 Look for signs of self-inflicted injury.
- Acute psychotic illness such as schizophrenia
- Temporal lobe epilepsy
- Wernicke's encephalopathy
- Head injury
- Encephalitis
- Meningitis
- Münchhausen's syndrome
- Drug intoxication
- Malingering
No investigation is diagnostic but a number may be performed to exclude other pathology. It is important to exclude an underlying organic cause.
- Mental state examination should be performed
- FBC
- Urea and electrolytes
- Liver function tests
- Vitamin B12 levels
- Thyroid function tests
- Urine drug screen
- CT scan or MRI scan to exclude structural pathology
- Lumbar puncture may be performed to exclude meningitis or encephalitis
- EEG does not usually show any specific disorder5
One study reported that a man pursuing an insurance claim presented with Ganser syndrome-like symptoms. Simple memory tests and the existence of symptoms not typical of the syndrome were used to exclude the syndrome.6
Admission to a psychiatric unit is required for assessment and to prevent self-harm that is common in this condition.
Drug therapy is of limited value and not usually required. Evidence of benefit from benzodiazepines, antipsychotic medication or other treatments such as psychotherapy and ECT is very limited.
If the precipitating stress has been withdrawn, symptoms usually resolve spontaneously within days but there is usually no recollection of the illness. Sometimes severe depression follows.
Mortality and morbidity are related to the underlying cause, especially if organic.
Document references
- whonamedit.com; Sigbert Josef Maria Ganser; Brief biography
- Dalfen AK, Anthony F; Head injury, dissociation and the Ganser syndrome. Brain Inj. 2000 Dec;14(12):1101-5. [abstract]
- Miller P, Bramble D, Buxton N; Case study: Ganser syndrome in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1997 Jan;36(1):112-5. [abstract]
- Slick DJ, Sherman EM, Iverson GL; Diagnostic criteria for malingered neurocognitive dysfunction: proposed standards for clinical practice and research. Clin Neuropsychol. 1999 Nov;13(4):545-61. [abstract]
- Cocores JA, Schlesinger LB, Gold MS; A review of the EEG literature on Ganser's syndrome. Int J Psychiatry Med. 1986-1987;16(1):59-65. [abstract]
- Merckelbach H, Peters M, Jelicic M, et al; Detecting malingering of Ganser-like symptoms with tests: a case study. Psychiatry Clin Neurosci. 2006 Oct;60(5):636-8. [abstract]
Internet and further reading
- Schneider D; Ganser syndrome; emedicine January 2009.
Document ID: 2177
Document Version: 21
Document Reference: bgp1381
Last Updated: 3 Apr 2009
Planned Review: 3 Apr 2011
The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.
Experience | News | Products | Other
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicinePatient UK Newspaper (^ top of page)
Latest Health News
Related Products (^ top of page)
Medical equipment
Books
Other - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
UK Guidelines
Online Videos
Medline
Other good health sites
Want to search some more? Use the Google Search box below to search our site.
Disclaimer: Patient UK has no control over the content of any external links above. Inclusion does not imply endorsement by Patient UK.
Want to advertise on this site? Find out how >>
Here you can follow a link to view existing patient experiences on this subject, or to add your own
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Note: this will open in a new window
Note: this will open in a new window
Here you can follow a link to view existing patient experiences on this subject, or to add your own
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Note: this will open in a new window
Note: this will open in a new window



