Neurobiological basis of ganser syndrome.

Ganser syndrome continues to be a rare and widely misunderstood condition. While DSM-IV classifies Ganser syndrome as a dissociative disorder, its etiology continues to be debated. There are episodic reports in the literature of Ganser syndrome in patients with head trauma or strokes. However, the mechanisms by which these cerebral insults lead to Ganser syndrome or other dissociative states are largely unknown.A case of a patient with Ganser syndrome with a prior history of stroke and bifrontal infarcts is described. This case demonstrates how organic pathology may predispose a patient to dissociative states, such as Ganser syndrome. We review the relationship between hyperglutamatergic states, caused by stroke and stress, and dissociative symptoms.Ganser syndrome continues to be a rare and widely misunderstood condition. While DSM-IV classifies Ganser syndrome as a dissociative disorder, its etiology continues to be debated. There are episodic reports in the literature of Ganser syndrome in patients with head trauma or strokes. However, the mechanisms by which these cerebral insults lead to Ganser syndrome or other dissociative states are largely unknown.A case of a patient with Ganser syndrome with a prior history of stroke and bifrontal infarcts is described. This case demonstrates how organic pathology may predispose a patient to dissociative states, such as Ganser syndrome. We review the relationship between hyperglutamatergic states, caused by stroke and stress, and dissociative symptoms.

Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients.

OBJECTIVE: Until recently, conventional antipsychotics were the standard pharmacotherapy for psychosis and behavioral disturbances associated with dementia. This double-blind, placebo-controlled study compared the acute efficacy of the selective serotonin reuptake inhibitor citalopram and the neuroleptic perphenazine with placebo for the treatment of psychosis and behavioral disturbances in nondepressed patients with dementia. METHOD: Eighty-five hospitalized patients with at least one moderate to severe target symptom (aggression, agitation, hostility, suspiciousness, hallucinations, or delusions) were randomly assigned to receive either citalopram, perphenazine, or placebo under double-blind conditions for up to 17 days. RESULTS: Patients treated with citalopram or perphenazine showed statistically significant improvement on several Neurobehavioral Rating Scale factor scores. Compared to those receiving placebo, only patients treated with citalopram showed significantly greater improvement in their total Neurobehavioral Rating Scale score as well as in the scores for the agitation/aggression and lability/tension factors. Side effect scores were similar among the three treatment groups. CONCLUSIONS: Citalopram was found to be more efficacious than placebo in the short-term hospital treatment of psychotic symptoms and behavioral disturbances in nondepressed, demented patients.