Ganser syndrome is a rare dissociative disorder characterized by nonsensical or wrong answers to questions and other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. The syndrome has also been called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, hysterical pseudodementia or prison psychosis. The term prison psychosis is sometimes used because the syndrome occurs most frequently in prison inmates, where it may be seen as an attempt to gain leniency from prison or court officials. Psychological symptoms generally resemble the patients sense of mental illness rather than any recognized category. The syndrome may occur in persons with other mental disorders such as schizophrenia, depressive disorders, toxic states, paresis, alcohol use disorders and factitious disorders. Ganser syndrome can sometimes be diagnosed as merely malingering, but it is more often defined as dissociative disorder.The identification of Ganser syndrome is attributed to German psychiatrist Sigbert Ganser (1853–1931). In 1898, he described the disorder in prisoners awaiting trial in a penal institution in Halle, Germany. He named impaired consciousness and distorted communication, namely in the form of approximate answers (also referred to as Vorbeireden in the literature), as the defining symptoms of the syndrome. Vorbeireden involves the inability to answer questions precisely, although the content of the questions is understood.Ganser syndrome is described as a dissociative disorder not otherwise specified (NOS) in the DSM-IV, and is not currently listed in the DSM-5. It is a rare and an often overlooked clinical phenomenon.
Treatment
In many cases, the symptoms seem to dwindle after a few days, and patients are often left with amnesia for the period of psychosis. 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. Psychotherapy may also recommended for ensuring and maintaining safety. Ganser patients typically recover quickly and completely. Since Ganser syndrome can be a response to psychic deterioration, its resolution may be followed by other psychiatric symptoms, such as schizophrenia and depression, hence the rationale behind the recommendation of psychotherapy. Medication is usually not required. Epidemiology
With about 100 case studies, the incidence of the disorder is not precisely known. Individuals of multiple backgrounds have been reported as having the disorder. The syndrome was historically thought to be more common in men. However, Whitlock speculates that the higher reported rate of Ganser in men might be due to the greater proportion of men who are incarcerated. It has been most frequently seen in individuals ages 15 to 40 and has also been observed in children. This wide age range is derived from case studies, and therefore may not be an accurate estimate. Ganser syndrome has also been observed in groups other than prison populations. Controversy
There is controversy regarding whether Ganser syndrome is a valid clinical entity.