Ganser's syndrome in a man with AIDS

Received Nov. 18, 2002; accepted Dec. 13, 2002. From the Temple University School of Medicine, Philadelphia. Address reprint requests to Dr. Lamdan, Temple University Health Sciences Center and Department of Psychiatry, 1316 West Ontario St., Jones Hall, 7th Floor, Philadelphia, PA 19140. Copyright 2003 The Academy of Psychosomatic Medicine. In 1898, German psychiatrist Siegbert Ganser first recognized the syndrome that would bear his name as a presentation of Vorbeireden, or “approximate answers.” Central features of Ganser’s syndrome include 1) approximate answers, 2) somatic conversion symptoms, 3) clouding of consciousness, and 4) hallucinations. Although it has been regarded as a psychotic disorder, it is currently classified among disorders of dissociation. The syndrome is uncommon, and rates of incidence and prevalence remain unclear. There appears to be a higher incidence of the condition in male subjects who belong to an ethnic minority. According to a review of 41 cases of Ganser’s syndrome, symptoms may span a wide range and include conversion features such as paralysis, anesthesias, paresthesias, and hysterical seizures (seen in 33% of the cases); psychogenic fugue (seen in 33%); disorientation to time and place (seen in 56%); perceptual disturbances such as auditory hallucinations, visual hallucinations, and olfactory hallucinations (seen in 51%); and amnesia, including localized, selective, and continuous types (seen in 93% of the cases). Approximate answers and amnesia were highly correlated at 93%, suggesting a dissociative mechanism. Onset of the syndrome is frequently associated with a stressful life event, which is most often of a domestic, sexual, or financial nature. Most cases are transient and resolve suddenly with an inability to recall the event. Ganser’s syndrome has been reported in a variety of patients, including those who have suffered trauma (per Ganser), organic brain disease, alcoholism with Korsakov’s psychosis, schizophrenia, depression, and neurosyphillis, although it has been most commonly reported in forensic settings. The condition is thought to unconsciously occur in response to a psychologically intolerable event. Further, it has been suggested that individuals presenting with Ganser’s syndrome frequently have underlying axis II psychopathology. Presented here is a description of an HIV-positive male patient who came into an outpatient psychiatry clinic exhibiting Ganser’s syndrome.