What is Ganser Syndrome?
Ganser syndrome is a rare psychiatric condition, named after Sigbert Ganser the German
psychiatrist who first conceptualized it. It is sometimes called Prison Psychosis because it was
first described by Ganser in prisoners awaiting trial. In this condition, the person deliberately,
behaves like they have a mental illness, often mimicking behavior of serious mental illness like
schizophrenia.
Symptoms of Ganser Syndrome
Classically, people with this illness are known to deliberately give wrong answers to simple
questions (qualitative) when asked (e.g., “how many hands does a human have?”: “10 “).
This is known concisely as approximate answers
Other symptoms include:
Causes of Ganser Syndrome
Uncovering the causes of this phenomenon still remains a challenge for modern science.
Nevertheless, various conditions both physical and mental have been strongly linked to people
with Ganser syndrome.
These risk factors include:
Also, Ganser syndrome can co-exist with some mental illness like depression, and schizophrenia.
Diagnosis
Although a diagnosis of Gasner syndrome is particularly difficult, care providers apply a set of
criteria, which involves the exclusion of organic/physical causes such as stroke. The presence
of psychological symptoms is also explored and correlated with any organic findings if any.
Treatment
Ganser syndrome is treated by psychiatrists and psychologists, often concurrently.
Psychotherapy is usually subscribed, and in the presence of comorbid mental illness
medications are prescribed. When physical illness is an antecedent, then the relevant illness is
treated to see if symptoms resolve.
Gambling Addiction
What is Gambling Addiction?
It is known also as pathological gambling or compulsive gambling; it is an impulse-control
disorder. Here there is an uncontrollable urge to keep gambling despite the negative
consequences on one’s life like financial loss, and loss of relationships for instance.
How does the brain get addicted to gambling?
Gambling has been shown to trigger the brain’s reward system thus causing an addiction. It
leads to a release of 10 times the normal dopamine just like meth and cocaine. Gambling
addiction can exist in different forms such as gambling as a means to financial gain which
almost leads to financial loss and the cycle perpetuates. Also, this addiction can present as
someone who relishes engaging in high-risk bets just for the trill of it and occasional wins.
Gambling is not restricted to slot machines, cards, casinos but has also become popular in
football with the emergence of sports betting agencies.
What causes Gambling addiction?
The causes of gambling addiction are numerous and include:
Signs of Gambling addiction
Psychological symptoms of excessive gambling include anxiety, depression, suicidal thoughts.
Physical health symptoms present in gambling addiction are acne, insomnia, headaches,
overeating or loss of appetite.
Long and short-term impact of Gambling Addiction
Gambling addiction often spirals into the development of other addictions to cope with
financial challenges and unstable relationships that emerge because of this habit. Many
gamblers turn to drugs, alcohol, and other psychoactive substances to alleviate anxiety, and
stress of their lifestyle. Thus, a new addiction to psychoactive substances develops which might
be difficult to quit even after quitting gambling.
Gamblers often ends up in massive debt over time.
Diagnosis and Treatment
Gambling disorder is differentiated using criteria which includes symptoms mentioned earlier.
The duration of symptoms such be over 12 months.
It is often challenging to quit gambling but with the help of support groups such as Gamblers
Anonymous, and psychotherapy one can thread the path of recovery.
Often the co-existing symptoms of anxiety, or depression are also treated to oral medication.
Gender Dysphoria
What is Gender Dysphoria also known as gender identity disorder?
This term describes the sense of unease experienced by people due to a mismatch between their
biological sex and their gender identity. Gender identity refers to our sense of who we are and
how we see and describe ourselves. This is mostly described as male or female (binary
identity). Nevertheless, some people feel a dichotomy between their gender identity and their
biological sex, assigned at birth. For instance, despite having facial hair, and male genitals, one
might still feel masculine or identify as male. Also, they might use terms such as gender
diverse, agender, or gender-nonconforming.
Gender dysphoria is not a mental illness but some people experiencing it might develop mental health challenges.
What causes Gender Dysphoria?
There is no known cause of gender dysphoria. Certainly, one’s sexual orientation has no
bearing in the matter. Whether, gay, bi-or heterosexual, one can still have gender dysphoria.
Signs of Gender Dysphoria
There might be drastic changes in appearance, behavior or interests in people with gender
dysphoria.
The following signs can also appear:
Diagnosis
Beyond a strong feeling of incongruence between one’s psychological sense of gender and
gender assigned at birth, there should be a presence of clinically significant distress, or
impairment of social and occupational functioning owing to this mismatch.
Furthermore, the following can be considered:
Treatment
When a diagnosis of gender dysphoria is made the mental health care professionals will decide
the appropriate mode of treatment suitable for the person concerned. This might include
acceptance and affirmation of their identity or hormone treatment or surgery.
Affirmation might be a change in one’s legal name, and pronouns.
If one is assessed and noted not to have gender dysphoria then family and group support is
recommended.
Generalized Anxiety Disorder
What is Generalized Anxiety Disorder?
This is one of the commonest mental disorders. It is a mental health challenge that presents as
excessive, persistent and unrealistic worry about everyday things. This excessive worry is often
difficult to control and accompanied by non-specific psychological and physical symptoms.
What causes Generalized Anxiety Disorder?
The causes include:
Signs and symptoms
Often people with generalized anxiety disorder can experience a myriad of vague physical
symptoms such as:
Diagnosis
Initial assessment begins with addressing behavioral or somatic symptoms and subsequently
evaluating psychosocial difficulties. It could also include undertaking several rating
scales/questionnaires to determine severity of anxiety. One should expect to undergo test to
exclude organic causes such ass thyroid function test, blood glucose level, echocardiography,
and toxicology. This is necessary because physical ailments such as Goiter could mimic
generalized anxiety disorder.
Treatment
There are two treatment modalities for generalized anxiety disorder and they are cognitive
behavioral therapy and medications. Usually both are combined. It is advised to see a
psychiatrist as soon as one notices symptoms as stated earlier because generalized anxiety
disorder can lead to, or worsen other mental or physical conditions like insomnia, drug or
alcohol disorder, and suicide potential etc.
General Adaptation Syndrome (GAS)
What is General Adaptation Syndrome?
This describes the physiological processes the body goes through as it responds to stress. This
process has three stages: alarm reaction, resistance phase and period exhaustion.
The alarm reaction stage is the body’s initial reaction to stress and is better known as fight -orflight
where the nervous system is triggered to release of hormones called adrenaline and
noradrenaline. These hormones stimulate various organs thus causing physical symptoms like
increased heart rate, rise in blood pressure, dilated pupils, rapid breathing etc.
The resistance stage of general adaptation syndrome is where the body tries to repair itself after
the initial shock of stress. This action leads to reduction in blood pressure and sweating for
instance. However, this process can be impaired leading to constantly elevated blood pressures,
headaches, and sleeplessness. This prolonged period of stress has negative organ-wide effects.
The exhaustion stage happens due to prolonged stress. Enduring stressors without relief
ultimately drains ones physical, emotional and mental resources to the point where they can
barely cope. This stage is generally marked by fatigue, burnout, and decreased stress tolerance.
What causes General Adaptation Syndrome (GAS)?
Any kind of stressor can trigger GAS, be it pleasant or unpleasant. It is now understood that
psychological stress is more likely to cause GAS than physical stress. Stressors at home, work,
or traumatic experiences like abuse can all play a part.
How can one manage stress?
Various stress mitigation techniques help people cope with GAS such diaphragmatic breathing,
muscle relaxation techniques, mindfulness and physical activity like going to the gym.
It is important to seek help when you feel overwhelmed or notice a loved one going through
chronic stress or burnout.
Grief and Loss
What is Grief?
Grief is the acute pain that accompanies a loss. Grief is a normal part of coping with loss, but
for some people, it can be far more serious. When grief impedes personal life for long periods
then it becomes a disorder for which professional help is needed.
What are the stages of Grief?
Psychiatrist Elisabeth Kübler-Ross, first identified 5 stages of grief.
They are Denial, Anger, Bargaining, Depression, and acceptance.
What are the types of Grief?
Anticipatory grief occurs or begins before a significant loss happens. Examples include when
a loved one is terminally ill, or retirement is imminent.
Disenfranchised grief occurs when the loss of something significant is devalued and thus one
cannot mourn properly. Here one is stigmatized for grieving, and in turn causes a vicious cycle.
Complicated Grief arises usually due to the death of a loved one, and one remains in a constant
state of bereavement without the emotions fading. It is also known as prolonged grief.
What is prolonged/complicated Grief?
Although recently recognized as a clinical phenomenon in the Diagnostic and Statistical
Manual V, prolonged grief has often afflicted thousands as the anguish of a loss as remained
fresh even as months and years have gone by.
Prolonged grief disorder is more common, and then tends to be prevalent in women. It is usually
diagnosed 6 months post the antecedent traumatic event.
What are the symptoms of Grief?
There are many ways in which people grief and these can manifest as emotional or physical
symptoms.
The emotional symptoms of grieving are:
Increased irritability, numbness, bitterness, detachment, preoccupation with loss.
The physical symptoms of grief are:
Digestive problems, headache, fatigue, chest pain, sore muscles.
There can also be a manifestation of long and short-term effects of grief such as loss of interest
in school, work or social gatherings
Also, there might be the presence of suicidal ideation, depression, and substance abuse as
coping mechanisms.
Can prolonged /poorly managed grief be treated?
It is important to seek help as soon as possible for yourself or a loved one as soon as you suspect
that grief might be prolonged. Individual therapy is often prescribed by a psychotherapist, as
well as family centered therapy. Also, moderating social media use, and maintain hobbies can
be helpful. Often there might be comorbid depression, insomnia for which a psychiatrist would
prescribe medication to help improve symptoms.
Gilles de la Tourette Syndrome
What is Gilles de la Tourette Syndrome (GTS)?
It is a childhood-onset neurodevelopmental disorder that is characterized by several motor and
phonic tics. Tics usually develop at age 10, and typically improve with increasing age.
What causes Gilles de la Tourette Syndrome (GTS)?
The etiology is multifactorial and complex. This condition is polygenic, involving multiple
common risk variants. However, the non-genetic risk factors include: perinatal infection,
autoimmune dysfunction. Nonetheless, no definite cause is known.
What are the symptoms?
GTS can coexist with attention-deficit/hyperactivity disorder, obsessive compulsive disorder.
Common symptoms include Motor tics like:
Also, involuntary vocalizations:
How is Gilles de la Tourette Syndrome (GTS) diagnosed?
Beyond accounting for symptoms, a psychiatrist would aim to exclude drug induced tics or the
presence of other medical conditions like Huntington’s disease)
How is Gilles de la Tourette Syndrome (GTS) managed?
Treatment options for GTS include behavioral interventions, drug treatment, and rarely
surgery. It is important to seek expert help once symptoms are noted.
Geriatric Depression
What is Geriatric Depression?
It is a form of depression that is common among the elderly especially those with chronic
illness, hospitalized, in nursing homes or living in geriatric psychiatry wards. It is relatively
harder to spot than depression in the young and is often not accompanied by sadness.
What are causes of Geriatric Depression?
Social factors such as:
What are the signs and symptoms of Geriatric Depression??
How is it diagnosed?
The presence of medical conditions which can predispose one to depression/mimic its
symptoms are often excluded such as stroke, brain tumor, Cushing’s disease.
Also, the psychiatrist will ensure that the presentation is not a side effect of medications such as
benzodiazepines, steroids. Subsequently, the patient is screened with psychometric
assessments and the severity of depression determined.
What is the treatment for Geriatric Depression??
Effective treatment of geriatric depression would usually involve at least two of the three
modalities: antidepressants, psychotherapy, and electroconvulsive therapy. It is important to
see a psychiatrist once you or loved one is suspected of having symptoms of geriatric
depression. Reaching out and staying connected to the world by volunteering time, taking care
of a pet, joining a class or support group, learning a new skill and writing memoirs have been
shown to help in geriatric depression.
Compiled by: Dr. Emelda Edem Asem - Ahiablee, Dr. Ramata Seidu, Dr. E. A. Azusong,
Dr. Akosua Dickson, Dr. Matilda Asiedu, Dr. Wendy Muonibeh Bebobru, Dr. Chukwuebuka Emmanuel Ohakpougwu