1

Ganser Syndrome

In 1898, German psychiatrist Sigbert Ganser first described Ganser syndrome

while studying 3 prisoners. Ganser originally described the syndrome as short-lived,
florid, psychotic episodes with subsequent retrograde amnesia. He believed the
syndrome to be hysterical in nature.

The term Ganser syndrome has subsequently been used to describe

behaviors in which psychotic illness is simulated or dissociative disorders occur in
forensic settings. The following are the 4 most commonly described constituent
symptoms:

1. The first, approximate answers (vorbeireden, literally meaning "talking

past the point"), can be illustrated by the patient answering "3" when asked, "How
many legs has a horse?" Such answers are approximate and may appear
somewhat absurd in nature. However, they usually reveal an understanding of the
question posed.
2. The second, clouding of consciousness, usually manifests as
inattentiveness or drowsiness.
3. The third is somatic conversion symptoms, such as hysterical paralysis.
4. The fourth is hallucinations.

Most patients have a comorbid personality disorder, particularly antisocial and

histrionic types. Because of the disruption between the usually integrated functions
of consciousness, memory, identity, and perception of the environment, the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)
classifies Ganser syndrome as a dissociative disorder; although, in the past, it has
been regarded as a factitious disorder, hysterical symptom, actual psychosis, or
malingering.

The full syndrome is considered very rare. Fewer than 100 cases have been
described and documented in the literature.
 2

Sex: Approximately 80% of patients with Ganser syndrome are male.

Age: Although described in all age groups, it is most common in adolescence and
early adulthood.

Ganser syndrome is observed most often in a forensic setting or where marked

psychosocial stress is present. Typically, the duration of symptoms is brief. The 4
main symptoms are as follows:

o Approximate answers (vorbeireden)

o Clouding of consciousness

o Somatic conversion symptoms (eg, hysterical paralysis)

o Hallucinations

Commonly observed features include the following:

o A dreamy or perplexed appearance

o Memory or personal identity loss

o No recollection of the syndromal state upon recovery

o Perseveration

o Echolalia

o Echopraxia

Common symptoms observed in Ganser syndrome include the following:

o Approximate answers

o Amnesia after illness

 3
o Confusion

o Functional somatic symptoms

o Hallucinations

o Precipitating stress

o Loss of personal identity

o Preservation
o Echolalia and echopraxia

Medical Care:

• Inpatient treatment may be needed during the acute phase.

• 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.

• Recovery usually is within days for most cases, especially if precipitating

stress resolves.

Medication rarely is necessary and may be contraindicated in medically ill

patients. Low-dose benzodiazepines and antipsychotic medications have been used
with limited success. Employ psychopharmacological interventions with caution
because they could result in masking an underlying organic disease.

Prognosis:

• Amnesia for events during the syndrome is the most common sequela.