The Ganser Syndrome

Abstract

In 1897 Ganser delivered a paper entitled “Concerning an Unusual Hysterical Confusional State” in which he described three prisoners who developed transitory symptoms of mental illness. The main features were disturbances of consciousness with subsequent amnesia for the episode, prominent hallucinations, sensory changes of an hysterical kind and, on questioning, peculiar verbal responses which have come to be regarded as the hallmark of the Ganser state. The illness terminated abruptly with full restoration of normal mental function. Despite Ganser's designation of the condition as hysterical, controversy over its precise nosological status has persisted over the past sixty-odd years. Is it in fact a form of hysteria, or is it a psychotic illness of brief duration? Is the hysterical pseudo-dementia described by Wernicke (1906) identical with or distinct from the Ganser syndrome? What is the relationship, if any, of the symptomatology of the Ganser state—the often-described “vorbeireden” and “approximate answers”—to the disordered thought of the schizophrenic and the dysphasia of the patient suffering from organic brain disease? Is it a fact that the Ganser syndrome occurs most frequently in patients in military or civil prisons and is rare in the non-delinquent population? To these and other problems the standard textbooks of psychiatry return conflicting answers.

Ganser syndrome and lesion in the temporoparietal region

“…Ganser syndrome in organic states has mainly been reported in patients with head injury and stroke, mostly those involving the frontal lobes 7–10. It has also been reported in alcoholism with Korsakoff psychosis,1 neurosyphilis,4 dementia11 and AIDS 12. The present case of Ganser syndrome had features of hysterical dissociation but was found to have intracerebral haemorrhage in the temporoparietal region of the dominant hemisphere.…”

“…Hence, it was referred to as prison psychosis. Later, such cases were reported more frequently in non-forensic settings 1. The syndrome has found a place in both the ICD-10 and DSM-IV, despite controversy about its existence and distinctiveness.…”

A Case of Ganser’s State Presenting as a Dementia Syndrome

“…Ganser himself initially described it as a syndrome manifested by clouded consciousness, hallucinations, hysterical con version symptoms, approximate answers and amnesia for the episode of illness 11 ]. Whitlock [2] points out that most investigators consider the presence of 'vorbeireden' as the essential symptom for making this diagnosis. Because contemporary cases only rarely exhibit all of the outlined features.…”

A Review of the EEG Literature on Ganser's Syndrome

“…s case three reportedly "had an abnormal EEG due to apparent cortical and subcortical disturbances" [15] . Whitlock presented six cases of Ganser's syndrome [5]. Case one showed diffuse slow activity which gradually improved during the hospitalization.…”