Diogenes Syndrome

What is Diogenes Syndrome?

Diogenes Syndrome Is In medical literature, Diogenes syndrome (DS) is described as a behavioral disorder mainly affected elderly people. The characteristic features of this condition are severe neglected physical condition, isolation from social activity, familial squalor and syllogomania or severe hoarding disorder¹.

Incidence

It has been estimated that the incidence of DS is up to 0.5 per 1000 population per year. The predominance of this disease usually occurs at the age of 60 or more, who are living home for prolonged period of time, though in some cases younger individuals also affected.

The reorganization of DS is difficult as the symptoms are similar to other behavioral or cognitive disorders. It has been also noticed that females are more affected than male, especially those who live alone at home. The disease incidence rate also showed that widows are more affected^1,2.

Causes

The affected individuals have a history of loneliness usually due to stay alone for a prolonged period of time at home. They unable to explode emotional distress. Different case history showed that certain factors trigger Diogenes Syndrome.

• Mental disorder illness
• History of abuse
• Introvert characteristics is one of the characteristic features of the Diogenes Syndrome
• Suspicious and unfriendly personality trait.

Apart from the above-mentioned factors, complex etiology of the behavioral conditions associated with Diogenes Syndrome due to psychiatric and/or neurological co-morbidities. However, it is not necessary the presence of these co-morbidities in every case.

In certain cases, schizoid and paranoid traits are observed. Other health conditions also aggravated Diogenes Syndrome, which includes:

• Stroke
• Arthritis or bone fracture related immobility
• Congestive cardiac failure
• Dementia
• Vision impairment
• Chronic weakness
• Depression^1,3,4

Symptoms

Symptoms are gradually developed and occur. At the early stage of the Diogenes Syndrome, affected individual withdrawing herself from the social situation and avoiding others. Diogenes Syndrome affected individuals may also have poor judgment, personality alteration, and improper behaviors.

These symptoms appear long before the Diogenes Syndrome identified. The cause of these symptoms is due to intense isolation. The alarming symptoms associated with an undiagnosed individual may include:

• Poor hygiene leads to skin rashes, fleas or lice in the body.
• Uncombed, knotted hair
• Nails are overgrown
• Body odor
• Untidy appearance
• Inexplicable injuries
• Dehydration
• Malnutrition

The included personality traits in DS affected individuals are as follows:

• Unfriendliness
• Stubbornness
• Aggressiveness
• Independence
• Eccentricity
• Paranoia
• Aloofness
• Detachedness
• Compulsivity
• Narcissism
• Lack of insight
• Indirect self-destructive behavior, even suicidal tendency
• The arrangement of the house, where affected person stay also exhibit signs of negligence and putrefy, which include
• Presence of huge number of rodent
• The distressing quantity of waste in and around the home
• Horrible smell in the house
• Diogenes syndrome affected individuals have some typical symptoms, which include
• Self negligence
• Unhygienic surroundings
• severe hoarding disorder
• Sleep-wake rhythm disorders
• Not accepting their situation
• Irresponsive about personal and surrounding unhygienic condition
• Unwillingness to take other’s help and support
• It has been noticed some medical and psychiatric co-morbidities are associated with Diogenes syndrome:
• Dementia
• Depression Contributory factors1,3,4
• Obsessive-compulsive disorder

Diagnosis

• Comprehensive medical history assessment including behavioral disturbances history is important. Other included diagnostic process include a physical examination.
• In blood test iron, calcium, potassium vitamin B12, folate, serum proteins, and albumin need to screen to identify Diogenes Syndrome affected the individual.
• In general for testing baseline parameters liver function tests, renal function, and thyroid status need to check.
• Identification of underlying cause requires neuro-imaging tests like MRI or PET scan require to perform^1,4.

Management

Management of Diogenes Syndrome affected an individual is difficult. There are no clear guidelines available. Different pharmacological or non-pharmacological therapeutic approaches are applied to provide best possible management of Diogenes Syndrome affected individuals.

• Self-management of Diogenes Syndrome affected an individual is not possible, even hospital admission also not appropriate for Diogenes Syndrome affected the individual. Day care and community care are the main lines of management.
• Safety and showing respect towards patient are very important.
• Different case history showed certain medical therapy like risperidone, sodium valproate and quetiapine provide an effective result.
• Serotonin reuptake inhibitors are prescribed to manage the compulsive hoarding behaviors.
• Care giver plays an important role in the management of Diogenes Syndrome affected individual^1,4.

References

1. Gabriele Cipriani, Claudio Lucetti, Marcella Vedovello, Angelo Nuti. Diogenes syndrome in patients suffering from dementia. Dialogues Clin Neurosci. 2012 Dec; 14(4): 455–460. Online available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553571/
2.  Berlyne N., Twomey J., Henderson S. mith SL. Diogenes syndrome. Lancet. 1975;1:515.
3. Jeffrey DC Irvine, Kingsley Nwachukwu; Recognizing Diogenes syndrome: a case report; BMC Res Notes. 2014; 7: 276. Published online 2014 May 2. doi: 10.1186/1756-0500-7-276. Online available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016666/
4. Corey Whelan, (2016). Understanding Diogenes Syndrome. healthline. Online available at http://www.healthline.com/health/diogenes-syndrome#treatment5