eMedicine Specialties > Psychiatry > Emergency

Ganser Syndrome: Treatment & Medication

Author: Daniel Schneider, MD, MA, Chief Resident, Departments of Psychiatry and Neurology, University of Massachusetts
Coauthor(s): Brian R Szetela, MD, Assistant Professor, Department of Psychiatry, University of Massachusetts Medical School; Consulting Psychiatrist, Psychiatric Consultation - Liaison Service, University of Massachusetts Memorial Medical Center; Robert C Daly, MB, ChB, MPH, BCh, Senior Fellow, Department of Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health
Contributor Information and Disclosures

Updated: Jan 22, 2009

Treatment

Medical Care

  • Inpatient treatment may be needed during the acute phase. This is often necessary to protect the patient from himself or herself considering his or her dissociation. Treat any underlying medical conditions.
  • Admit the patient to a psychiatric facility if the patient is a danger to self or others.
  • Simple supportive psychotherapy and monitoring for safety are the chief components of treatment. Limited evidence exists that hypnosis or ECT may be useful.
  • Recovery usually is within days for most patients, especially if precipitating stress resolves.

Consultations

  • Consultation with a neurologist is advisable to rule out neurologic etiologic factors.
  • Consultation with a psychiatrist is recommended initially and in follow-up.

Activity

  • Restrict general activity to allow close observation during the acute phase of the syndrome.
  • Upon recovery, regular activities may be resumed.

Medication

Medication rarely is necessary and may be contraindicated in medically ill patients. Low-dose benzodiazepines and antipsychotic medications have been used with limited success. Psychopharmacological interventions should be used with caution because they could result in masking an underlying organic disease.

More on Ganser Syndrome

Overview: Ganser Syndrome
Differential Diagnoses & Workup: Ganser Syndrome
Treatment & Medication: Ganser Syndrome
Follow-up: Ganser Syndrome
References
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References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.

  2. Ruggles AH. Observations on Ganser's Syndrome. American Journal of Insanity. 1905;62:307-311.

  3. Enoch MD, Trethowan WH. The Ganser syndrome. Uncommon Psychiatric Syndromes. 1979;50-62.

  4. Snyder SL, Buchsbaum MS, Krishna RC. Unusual visual symptoms and Ganser-like state due to cerebral injury: a case study using (18)F-deoxyglucose positron emission tomography. Behav Neurol. 1998;11(1):51-54. [Medline].

  5. Merckelbach H, Peters M, Jelicic M, Brands I, Smeets T. Detecting malingering of Ganser-like symptoms with tests: a case study. Psychiatry Clin Neurosci. Oct 2006;60(5):636-8. [Medline].

  6. Andersen HS, Sestoft D, Lillebaek T. Ganser syndrome after solitary confinement in prison: a short review and a case report. Nord J Psychiatry. 2001;55(3):199-201. [Medline].

  7. Carney MW, Chary TK, Robotis P. Ganser syndrome and its management. Br J Psychiatry. Nov 1987;151:697-700. [Medline].

  8. Dalfen AK, Anthony F. Head injury, dissociation and the Ganser syndrome. Brain Inj. Dec 2000;14(12):1101-5. [Medline].

  9. Epstein RS. Ganser syndrome, trance logic, and the question of malingering. Psychiatric Annals. Apr 1991;21(4):238-44.

  10. Ladowsky-Brooks RL, Fischer CE. Ganser symptoms in a case of frontal-temporal lobe dementia: is there a common neural substrate?. J Clin Exp Neuropsychol. Sep 2003;25(6):761-8. [Medline].

  11. Lee HB, Koenig T. A case of Ganser syndrome: organic or hysterical?. Gen Hosp Psychiatry. Jul-Aug 2001;23(4):230-1. [Medline].

  12. McEvoy, Campbell T. Ganser-like signs in carbon monoxide encephalopathy. Am J Psychiatry. Dec 1977;134(12):1448-9. [Medline].

  13. Miller P, Bramble D, Buxton N. Case study: Ganser syndrome in children and adolescents. J Am Acad Child Adolesc Psychiatry. Jan 1997;36(1):112-5. [Medline].

  14. Shorer CE. The Ganser Syndrome. British Journal of Criminology. Apr 1965;5:120-131.

  15. Sigal M, Altmark D, Alfici S. Ganser syndrome: a review of 15 cases. Compr Psychiatry. Mar-Apr 1992;33(2):134-8. [Medline].

  16. Tost H, Wendt CS, Schmitt A, Heinz A, Braus DF. Huntington's disease: phenomenological diversity of a neuropsychiatric condition that challenges traditional concepts in neurology and psychiatry. Am J Psychiatry. Jan 2004;161(1):28-34. [Medline].

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Further Reading

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Keywords

Ganser syndrome, Ganser's syndrome, psychotic episodes, psychotic illness, psychosis, clouding of consciousness, inattentiveness, drowsiness, hysterical paralysis, hallucinations, hysteria, malingering, alcoholism, head injury, epilepsy, stroke, cerebral infection, dissociative disorder, factitious disorder, amnesia, psychosocial stress, vorbeireden, echolalia, echopraxia, confusion

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Contributor Information and Disclosures

Author

Daniel Schneider, MD, MA, Chief Resident, Departments of Psychiatry and Neurology, University of Massachusetts
Disclosure: Nothing to disclose.

Coauthor(s)

Brian R Szetela, MD, Assistant Professor, Department of Psychiatry, University of Massachusetts Medical School; Consulting Psychiatrist, Psychiatric Consultation - Liaison Service, University of Massachusetts Memorial Medical Center
Brian R Szetela, MD is a member of the following medical societies: American Psychiatric Association, American Society of Addiction Medicine, and Association for Convulsive Therapy
Disclosure: Nothing to disclose.

Robert C Daly, MB, ChB, MPH, BCh, Senior Fellow, Department of Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health
Disclosure: Nothing to disclose.

Medical Editor

Alan D Schmetzer, MD, Professor, Vice-Chair for Education, and Director of Residency Training, Department of Psychiatry, Indiana University School of Medicine
Alan D Schmetzer, MD is a member of the following medical societies: American Medical Association and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories
Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other; Pfizer Honoraria Speaking and teaching

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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