Diogenes syndrome

Last updated
Diogenes syndrome
Other namesSenile squalor syndrome
Syllogomanie-Puteaux.jpg
Room crammed with garbage
Specialty Psychology, psychiatry   OOjs UI icon edit-ltr-progressive.svg

Diogenes syndrome, also known as senile squalor syndrome, is a disorder characterized by extreme self-neglect, domestic squalor, social withdrawal, apathy, compulsive hoarding of garbage or animals, and a lack of shame. Affected people may also display symptoms of catatonia. [1] [2]

Contents

The condition was first recognized in 1966 [3] and designated Diogenes syndrome by Clark et al. [4] The name derives from Diogenes of Sinope, an ancient Greek philosopher, a Cynic and an ultimate minimalist, who allegedly lived in a large jar in Athens. Not only did he not hoard, but he actually sought human company by venturing daily to the Agora. Therefore, this eponym is considered to be a misnomer. [5] [6] [7] Other possible terms are senile breakdown, Plyushkin's Syndrome (after the Gogol character), [5] social breakdown and senile squalor syndrome. [8] Frontal lobe impairment may play a part in the causation (Orrell et al., 1989). [9]

Presentation

Diogenes syndrome is a disorder that involves hoarding of rubbish and severe self-neglect. In addition, the syndrome is characterized by domestic squalor, syllogomania, social alienation, and refusal of help. It has been shown that the syndrome is caused as a reaction to stress that was experienced by the patient. The time span in which the syndrome develops is undefined, though it is most accurately distinguished as a reaction to stress that occurs late in life. [10] [11]

In most instances, patients were observed to have an abnormal possessiveness and patterns of compilation in a disordered manner. These symptoms suggest damage to the prefrontal areas of the brain, due to its relation to decision making. In contrast, there have also been cases where the hoarded objects were arranged in a methodical manner, which may suggest a cause other than brain damage.

Although most patients have been observed to come from homes with poor conditions, and many had been faced with poverty for a long period of time, these similarities are not considered a definite cause to the syndrome. Research showed that some of the participants with the condition had solid family backgrounds as well as successful professional lives. Half of the patients were of higher intelligence level. [12] This indicates the Diogenes syndrome does not exclusively affect those experiencing poverty or those who had traumatic childhood experiences.

The severe neglect that they bring on themselves usually results in physical collapse or mental breakdown. Most individuals with the syndrome do not get identified until they face this stage of collapse, due to their predilection to refuse help from others. [4]

Personality traits that can be seen frequently in patients diagnosed with Diogenes syndrome are aggressiveness, stubbornness, suspicion of others, unpredictable mood swings, emotional instability and deformed perception of reality. [11] Secondary DS is related to mental disorders. [11] The direct relation of the patients' personalities to the syndrome is unclear, though the similarities in character suggest potential avenues for investigation. [11]

Diagnosis

Individuals with Diogenes syndrome generally display signs of collectionism, hoarding, or compulsive disorder. Individuals who have had damage to the brain, particularly the frontal lobe, may be at more risk to developing the syndrome. The frontal lobes are of particular interest, because they are known to be involved in higher order cognitive processes, such as reasoning, decision-making and conflict monitoring. Diogenes syndrome tends to occur among the elderly. People with this disorder tend to have significant functional problems correlated with morbidity and mortality. [13]

Management

It is ethically difficult when it comes to dealing with diagnosed patients, for many of them deny their poor conditions and refuse to accept treatment. The main objectives of the doctors are to help improve the patient's lifestyle and wellbeing, so health care professionals must decide whether or not to force treatment onto their patient.

In some cases, especially those including the inability to move, patients have to consent to help, since they cannot manage to look after themselves. Hospitals or nursing homes are often considered the best treatment under those conditions.

When under care, patients must be treated in a way in which they can learn to trust the health care professionals. In order to do this, the patients should be restricted in the number of visitors they are allowed, and be limited to one nurse or social worker. Some patients respond better to psychotherapy, while others to behavioral treatment or terminal care. [11]

Results after hospitalization tend to be poor. Research on the mortality rate during hospitalization has shown that approximately half the patients die while in the hospital. A quarter of the patients are sent back home, while the other quarter are placed in long-term residential care. Patients under care in hospitals and nursing homes often slide back into relapse or face death.

There are other approaches to improve the patient's condition. Day care facilities have often been successful with maturing the patient's physical and emotional state, as well as helping them with socialization. Other methods include services inside the patient's home, such as the delivery of food. [11]

History

The origin of the syndrome is unknown, although the term “Diogenes” was coined by A. N. G. Clarke et al. in the mid‑1970s and has been commonly used since then. Diogenes syndrome was acknowledged more prominently as a media phenomenon in popular media rather than medical literature. The primary description of this syndrome has only been mentioned recently by geriatricians and psychiatrists. [3] [4]

See also

Related Research Articles

Schizophrenia Mental disorder characterized by psychosis

Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations, delusions, paranoia, and disorganized thinking. Other symptoms include social withdrawal, decreased emotional expression, and apathy. Symptoms typically develop gradually, begin during young adulthood, and in many cases never become resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a history that includes the person's reported experiences, and reports of others familiar with the person. To be diagnosed with schizophrenia, symptoms and functional impairment need to be present for six months (DSM-5) or one month (ICD-11). Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.

Dementia Long-term brain disorders causing impaired memory, thinking and behavior

Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively impact a person's ability to function and carry out everyday activities. Aside from memory impairment and a disruption in thought patterns, the most common symptoms include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Consciousness is not affected. Dementia ultimately has a significant effect on the individual, caregivers, and on social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning, and a greater cognitive decline than what is caused by normal aging. Several diseases and injuries to the brain, such as a stroke, can give rise to dementia. However, the most common cause is Alzheimer's disease, a neurodegenerative disorder.

Factitious disorder imposed on self, also known as Munchausen syndrome, is a factitious disorder where those affected feign or induce disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to themselves. Munchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but patients also have a history of recurrent hospitalization, travelling, and dramatic, extremely improbable tales of their past experiences. The condition derives its name from the fictional character Baron Munchausen.

The Fregoli delusion is a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise. The syndrome may be related to a brain lesion and is often of a paranoid nature, with the delusional person believing themselves persecuted by the person they believe is in disguise.

Body dysmorphic disorder (BDD), occasionally still called dysmorphophobia, is a mental disorder characterized by the obsessive idea that some aspect of one's own body part or appearance is severely flawed and therefore warrants exceptional measures to hide or fix it. In BDD's delusional variant, the flaw is imagined. If the flaw is actual, its importance is severely exaggerated. Either way, thoughts about it are pervasive and intrusive, and may occupy several hours a day, causing severe distress and impairing one's otherwise normal activities. BDD is classified as a somatoform disorder, and the DSM-5 categorizes BDD in the obsessive–compulsive spectrum, and distinguishes it from anorexia nervosa.

Compulsive hoarding Behavioral pattern

Compulsive hoarding, also known as hoarding disorder, is a mental disorder characterised by accumulation of possessions due to excessive acquisition of or difficulty discarding them, regardless of their actual value, leading to clinically significant distress or impairment in personal, family, social, educational, occupational or other important areas of functioning. Excessive acquisition is characterized by repetitive urges or behaviours related to amassing or buying items. Difficulty discarding possessions is characterized by a perceived need to save items and distress associated with discarding them. Accumulation of possessions results in living spaces becoming cluttered to the point that their use or safety is compromised. It is recognised by the eleventh revision of the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Hoarding Intentional accumulation of items for later use

Hoarding is a behavior where people or animals accumulate food or other items.

Pemberton's sign was named after Hugh Pemberton, who characterized it in 1946.

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 patient's 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.

Derek Summerfield is an honorary senior lecturer at London's Institute of Psychiatry and a member of the Executive Committee of Transcultural Special Interest Group at the Royal College of Psychiatry. He is also an Honorary Fellow of the Egyptian Psychiatric Association. He has published around 150 papers and has made other contributions in medical and social sciences literature.

Jim van Os

Jim van Os is a Dutch professor of Psychiatric Epidemiology and Public Mental Health at Utrecht University Medical Centre, the Netherlands.

Zotepine Chemical compound

Zotepine is an atypical antipsychotic drug indicated for acute and chronic schizophrenia. It has been used in Germany since 1990 and Japan since 1982.

Hypocholesterolemia Medical condition

Hypocholesterolemia is the presence of abnormally low (hypo-) levels of cholesterol in the blood (-emia). A defect in the body's production of cholesterol can lead to adverse consequences as well. Cholesterol is an essential component of mammalian cell membranes and is required to establish proper membrane permeability and fluidity. It is not clear if a lower than average cholesterol level is directly harmful; however, it is often encountered in particular illnesses.

The obsessive–compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive–compulsive disorder (OCD). "The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks." OCD is a mental disorder characterized by obsessions and/or compulsions. An obsession is defined as "a recurring thought, image, or urge that the individual cannot control". Compulsion can be described as a "ritualistic behavior that the person feels compelled to perform". The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive–compulsive spectrum disorders.

Nosophobia, also known as disease phobia or illness anxiety disorder, is the irrational fear of contracting a disease, a type of specific phobia. Primary fears of this kind are fear of contracting HIV infection, pulmonary tuberculosis (phthisiophobia), venereal diseases, cancer (carcinophobia), heart diseases (cardiophobia), and catching the common cold or flu.

A paraneoplastic syndrome is a syndrome that is the consequence of a tumor in the body, specifically due to the production of chemical signaling molecules by tumor cells or by an immune response against the tumor. Unlike a mass effect, it is not due to the local presence of cancer cells.

Grandiose delusions Subtype of delusion

Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, are a subtype of delusion that occur in patients with a wide range of psychiatric diseases, including two-thirds of patients in manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, frequently in narcissistic personality disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. Around 10% of healthy people experience grandiose thoughts at some point in their lives but do not meet full criteria for a diagnosis of GD.

Treatment of chronic fatigue syndrome (CFS) is variable and uncertain, and the condition is primarily managed rather than cured.

Squalor refers to filthiness and degradation, as from neglect or poverty.

Iatrogenesis Causation of harm by any medical activity

Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. First used in this sense in 1924, the term was introduced to sociology in 1976 by Ivan Illich, alleging that industrialized societies impair quality of life by overmedicalizing life. Iatrogenesis may thus include mental suffering via medical beliefs or a practitioner's statements. Some iatrogenic events are obvious, like amputation of the wrong limb, whereas others, like drug interactions, can evade recognition. In a 2013 estimate, about 20 million negative effects from treatment had occurred globally. In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990.

References

  1. ↑ Cybulska, E; Rucinski, J (1986). "Gross Self-neglect in Old Age". Br J Hosp Med. 36 (1): 21–23. PMID   3535960.
  2. ↑ Rosenthal, M; Stelian, J; Wagner, J; Berkman, P (1999). "Diogenes syndrome and hoarding in the elderly: case reports". The Israel Journal of Psychiatry and Related Sciences. 36 (1): 29–34. PMID   10389361.
  3. 1 2 Macmillan, D; Shaw, P. (1966). "Senile breakdown in standards of personal and environmental cleanliness". BMJ. 2 (5521): 1032–7. doi:10.1136/bmj.2.5521.1032. PMC   1944569 . PMID   5919035.
  4. 1 2 3 Clark, AN; Mankikar, GD; Gray, I (1975). "Diogenes syndrome A clinical study of gross neglect in old age". Lancet. 1 (7903): 366–368. doi:10.1016/S0140-6736(75)91280-5. PMID   46514. S2CID   44838574.
  5. 1 2 Cybulska, E (1998). "Senile Squalor: Plyushkin's not Diogenes Syndrome". Psychiatric Bulletin. 22 (5): 319–320. doi: 10.1192/pb.22.5.319 .
  6. ↑ (01-28-2006) by Alicia M. Canto, in: "Uso y abuso de Diógenes"
  7. ↑ Marcos, M; Gomez-Pellin, MC. (2008). "A tale of a misnamed eponym: Diogenes syndrome". Int J Geriatr Psychiatry. 23 (9): 990–1. doi:10.1002/gps.2005. PMID   18752218. S2CID   45209151.
  8. ↑ Cooney, C; Hamid, W (1995). "Review: diogenes syndrome". Age and Ageing. 24 (5): 451–3. doi:10.1093/ageing/24.5.451. PMID   8669353.
  9. ↑ Orrell, M; Sahakian, B. (1991). "Dementia of frontal type". Psychol Med. 21 (3): 553–6. doi: 10.1017/S0033291700022170 . PMID   1946843.
  10. ↑ Hanon C, P. C. (2004). Diogenes Syndrome: A Transnosographic Approach. Encephale, 30 (4), 315-322.
  11. 1 2 3 4 5 6 Reyes-Ortiz, C (2001). "Diogenes syndrome: The self-neglect elderly". Comprehensive Therapy. 27 (2): 117–121. doi:10.1007/s12019-996-0005-6. PMID   11430258. S2CID   41954393.
  12. ↑ Clark, AN; Mannikar (February 15, 1975). "Diogenes syndrome. A clinical study of gross neglect in old age". The Lancet. 1 (7903): 366–8. doi:10.1016/S0140-6736(75)91280-5. PMID   46514. S2CID   44838574.
  13. ↑ Cipriani, Gabriele; Claudio Lucetti; Marcella Vedovello; Angelo Nuti (14 December 2012). "Diogenes syndrome in patients with dementia". Dialogues in Clinical Neuroscience. 14 (4): 455–460. doi:10.31887/DCNS.2012.14.4/gcipriani. PMC   3553571 . PMID   23393422.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.