Factitious disorder Health Article

Ganser syndrome

Ganser syndrome is a rare disorder (about a 100 documented cases worldwide) that has been variously categorized as a factitious disorder or a dissociative disorder. It is named for a German psychiatrist named Sigbert Ganser, who first described it in 1898 from an examination of male prisoners who were thought to be psychotic. Ganser syndrome is used to describe dissociative symptoms and the pretending of psychosisthat occur in forensic settings.

There are four symptoms regarded as diagnostic of Ganser syndrome:

• Vorbeireden: A German word that means "talking beside the point," it refers to a type of approximate answer to an examiner's questions that may appear silly but usually indicates that the patient understands the question. If examiner asks how many legs a dog has, the patient may answer, "Five."
• Clouding of consciousness: The patient is drowsy or inattentive.
• Conversion symptoms: These are physical symptoms produced by unconscious psychological issues rather than diagnosable medical causes. A common conversion symptom is temporary paralysis of an arm or leg.
• Hallucinations.

Virtual FD

Although virtual factitious disorder does not appear as a heading in any present diagnostic manual, it is a phenomenon that has appeared with increasing frequency with the spread of the Internet. The growing use of the personal computer has affected presentations of factitious disorder in two important ways. First, computers allow people with sufficient technical skills to access medical records from hospital databases and cut-and-paste changes into their own records in order to falsify their medical histories. Second, computers allow people to enter Internet chat rooms for persons with serious illnesses and pretend to be a patient with that illness in order to obtain attention and sympathy. "Munchausen by Internet" can have devastating effects on chat groups, destroying trust when the hoax is exposed.

Causes

The causes of factitious disorder, whether physical or psychiatric, are difficult to determine because these patients are often lost to follow-up when they sign out of the hospital. Magnetic resonance imaging(MRI) has detected abnormalities in the brainstructure of some patients with chronic FD, suggesting that there may be biological or genetic factors in the disorder. PET scans of patients diagnosed with Ganser syndrome have also revealed brain abnormalities. The results of EEG (electroencephalography) studies of these patients are nonspecific.

Several different psychodynamic explanations have been proposed for factitious disorder. These include:

• Patients with FD are trying to re-enact unresolved childhood issues with parents.
• They have underlying problems with masochism.
• They need to be the center of attention and feel important.
• They need to receive care and nurturance.
• They are bothered by feelings of vulnerability.
• Deceiving a physician allows them to feel superior to an authority figure.

There are several known risk factors for factitious disorder, including:

• The presence of other mental or physical disorders in childhood that resulted in the patient's getting considerable medical attention.
• A history of significant past relationships with doctors, or of grudges against them.
• Present diagnosisof borderline, narcissistic, or antisocial personality disorder.

Symptoms

SYMPTOMS OF FACTITIOUS DISORDER IN ADULTS OR ADOLESCENTS.Reasons for suspecting factitious disorder include:

• The individual's history is vague and inconsistent; or the individual has a long medical record with many admissions at different hospitals in different cities.
• The patient has an unusual knowledge of medical terminology or describes the illness as if they are reciting a textbook description of it.
• The patient is employed in a medical or hospital-related occupation.
• Pseudologia fantastica, a Latin phrase for "uncontrollable lying," is a condition in which the individual provides fantastic descriptions of events that never took place.
• The patient visits emergency rooms at times such as holidays or late Friday afternoons when experienced staff are not usually present and obtaining old medical records is difficult.
• The patient has few visitors even though he or she claims to be an important person.
• The patient is unusually accepting of surgery or uncomfortable diagnostic procedures.
• The patient's behavior is controlling, attention-seeking, hostile, or disruptive.
• The symptoms are present only when the patient thinks he or she is being watched.
• The patient is abusing substances, particularly prescription pain-killers or tranquilizers.
• The course of the "illness" fluctuates, or complications develop with unusual speed.
• The patient has multiple surgical scars, a so-called "gridiron abdomen," or evidence of self-inflicted wounds or injuries.

SYMPTOMS OF MUNCHAUSEN SYNDROME BY PROXY.Factors that suggest MSBP include:

• The victim is a young child; the average age of MSBP victims is 40 months.
• There is a history of long hospitalizations and frequent emergency room visits.
• Siblings have histories of MSBP, failure to thrive, or death in early childhood from an unexplained illness.
• The mother is employed in a health care profession.
• The mother has been diagnosed with depression or histrionic or borderline personality disorder.
• There is significant dysfunction in the family.