Ganser syndrome with work-related onset in a patient with a background of immigration

Abstract

Introduction. A substantial proportion of the recently published cases of dissociative disorders have a background of immigration (Fujiwara et al., 2008). Among the dissociative disorders, Ganser syndrome is an uncommon form that has as central symptom the giving of approximate answers to questions (vorbeireden). The predisposing and triggering factors of Ganser syndrome are poorly defined. Furthermore, this condition might cooccur with other psychiatric disorders. Here we describe a patient with a background of immigration, who, after an objectively minor work-related head injury, developed severe and persistent psychiatric symptoms, with features of Ganser syndrome.

Methods. The patient was assessed medically, psychiatrically, and by neuropsychological testing.

Results. The patient is a man with no known previous psychiatric history, who lived in several countries and encountered a series of stressful experiences in the process of migration. Several years after immigrating to his current country of residency, he developed severe psychiatric symptoms of Major Depressive Disorder, with Psychotic Features and Ganser syndrome. The symptoms, which emerged after a mild head injury, have persisted for more than a year, despite treatment.

Conclusions. The similarity between this case and other reports suggests that psychosocial stresses accompanying immigration may have a catalytic effect in triggering and maintaining dissociative symptomatology.

Keywords:

• Dissociation
• Head injury
• Psychosocial stress
• Vorbeireden