Senile squalor: Plyushkin's not Diogenes' syndrome

Some names appear to stick to syndromes or diseases like a proverbial glue, regardless of their total inappropriateness. Gross self-neglect in old age characterised by domestic squalor, social withdrawal, apathy, tendency to hoard rubbish (syllogomania) and a lack of shame was originally reported by Macmillan & Shaw in 1966 and subsequently ‘christened’ by Clark et al as Diogenes∗ syndrome in 1975. Post (1982) preferred the term ‘senile recluse’ and argued that this is not a syndrome but merely an end stage of personality disorder. It was usually extremely difficult to help these patients, as one's care and goodwill often met with hostility and blunt refusal to cooperate (Cybulska & Rucinski, 1986). More recent studies, however, have shown a strong association of this condition with frontal lobe dysfunction (Orrell & Sahakian, 1991), thus giving a psychiatrist of old age a somewhat firmer basis for action.

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Personality in later life: personality disorder and the effects of illness on personality

10.1093/med/9780199644957.003.0053 ◽

2013 ◽

Author(s):

Catherine Oppenheimer

Keyword(s):

Personality Disorder ◽

Old Age ◽

Later Life ◽

Good Care ◽

Major Life ◽

Cultural Contexts ◽

Personality Changes ◽

Diogenes Syndrome ◽

Dsm Iv ◽

The Life Course

This chapter covers disorders of personality in later life, including personality changes caused by dementia. There is little agreement on how best to measure personality in old age. Nevertheless, it is clear that specific changes in personality accompany dementia, particularly fronto-temporal dementia. Personality disorder (PD) in older people has been little studied and is beset by problems of definition. The current (DSM-IV) categories of PD need modification to take account of the biological and cultural contexts of old age before valid studies of the epidemiology and the life course of PDs can be made. An older person’s personality style will profoundly influence their adjustment to major life-stresses, and good care depends on clinicians’ understanding of this. Long-standing personality traits are probably important in the development of the Diogenes syndrome (extreme self-neglect) in later life.

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Diogenes' syndrome: review and case history

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700003256 ◽

1997 ◽

Vol 14 (3) ◽

pp. 115-116 ◽

Cited By ~ 4

Author(s):

Brian O'Shea ◽

Jane Falvey

Keyword(s):

Risk Assessment ◽

Personality Disorder ◽

The Elderly ◽

Frontal Lobe Dysfunction ◽

Helping Professions ◽

Common Pathway ◽

Multidisciplinary Assessment ◽

Original Case ◽

Diogenes Syndrome

AbstractOur objective in writing this paper was to present a case of Diogenes' syndrome and to examine the evolution of thinking about the phenomenon. To do this we looked at original case material and then carried out a literature review, the results of this showed the syndrome has been reported most often in the elderly and in higher socio-economic groups. It represents a non-specific final common pathway for many interacting variables.In our conclusion we found that a detailed multidisciplinary assessment is indicated in all cases. Further work is required to estimate the role of personality disorder and organic frontal lobe dysfunction in the aetiology of this syndrome. A multiaxial approach to diagnosis should be employed. Intervention should be based on objective findings and risk-assessment, rather than on ideological grounds. Irish law does not allow a large variety of options to the helping professions.

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Diogenes Syndrome and Pathological Hoarding Behaviour: A Case Report

European Psychiatry ◽

10.1016/s0924-9338(09)71324-0 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

L.C. Castro ◽

O. Ribeiro

Keyword(s):

Social Withdrawal ◽

Future Research ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Somatic Disorders ◽

Diogenes Syndrome ◽

End Stage ◽

The Impact

Background:Diogenes syndrome is the combination of severe self-neglect, domestic squalor, social withdrawal, a tendency to hoard excessively, and refusal of help, in elderly patients.Aim:To report a case of Diogenes’ syndrome underlying the impact of pathological hoarding behaviour in the quality of life of the patient. to discuss the pathological hoarding behaviour (syllogomania) in the context of this specific behavioural disorder.Methods:Case study and review of the literature.Results:The subject of this case study is a 78-year-old man with Diogenes syndrome. Hoarding behaviour is the major presentation symptom in this case, along with domestic squalor and social withdrawal. He has marked obsessive personality traits, no insight for his morbid condition and an attitude of refusal of treatment.Discussion:The literature reveals high comorbidity of Diogenes syndrome with psychiatric and somatic disorders. Some authors raise the possibility that obsessive-compulsive disorder may be the cause of hoarding rubbish in those cases of Diogenes syndrome in which hoarding exists and cannot be better explained by other psychopathology. other authors hypothesise Diogenes syndrome as a reaction to stress in elderly people with certain personality characteristics or as the end stage of a personality disorder. the ethiopathogeny of Diogenes syndrome remains unclear and there is no consensus about diagnostic criteria. It is a relevant area for future research, contributing for a better comprehension of the differential diagnosis of pathological hoarding behaviour and late life psychopathology.

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Diogenes Syndrome

Unusual and Rare Psychological Disorders ◽

10.1093/med:psych/9780190245863.003.0020 ◽

2016 ◽

pp. 306-318

Author(s):

Brian O’Shea

Keyword(s):

Mental Health ◽

Social Withdrawal ◽

Health Professions ◽

Compulsive Hoarding ◽

Scientific Interest ◽

Strong Focus ◽

Diogenes Syndrome ◽

The Media ◽

Senile Squalor ◽

Physical Morbidity

Diogenes syndrome, also termed senile squalor syndrome, was named after the Greek Cynic philosopher Diogenes. Although symptoms of Diogenes syndrome are not currently a strong focus of scientific interest, the syndrome has received considerable coverage in the media. Symptoms include extreme self-neglect, a dirty appearance, domestic squalor, lying in excrement, social withdrawal, and compulsive hoarding of garbage. Diogenes syndrome appears to be associated with a high physical morbidity and mortality rate. As discussed in this chapter, the particular nature of Diogenes syndrome represents a particular dilemma for the mental health professions and society. The chapter also discusses hoarding disorder, a separate but overlapping concept.

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Differences in Frontal Lobe Dysfunction in Patients with Episodic and Chronic Migraine

Journal of Clinical Medicine ◽

10.3390/jcm10132779 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2779

Author(s):

Sang-Hwa Lee ◽

Yeonkyeong Lee ◽

Minji Song ◽

Jae Jun Lee ◽

Jong-Hee Sohn

Keyword(s):

Chronic Migraine ◽

Frontal Lobe ◽

Iowa Gambling Task ◽

Medication Overuse Headache ◽

Wisconsin Card Sorting Test ◽

Episodic Migraine ◽

Frontal Lobe Dysfunction ◽

Card Sorting ◽

Cross Sectional ◽

Frontal Lobe Function

Neuroimaging and neuropsychological investigations have indicated that migraineurs exhibit frontal lobe-related cognitive impairment. We investigated whether orbitofrontal and dorsolateral functioning differed between individuals with episodic migraine (EM) and chronic migraine (CM), focusing on orbitofrontal dysfunction because it is implicated in migraine chronification and medication overuse headache (MOH) in migraineurs. This cross-sectional study recruited women with CM with/without MOH (CM + MOH, CM − MOH), EM, and control participants who were matched in terms of age and education. We conducted neuropsychological assessments of frontal lobe function via the Trail Making Test (TMT) A and B, the Wisconsin Card Sorting Test (WCST), and the Iowa Gambling Task (IGT). We enrolled 36 CM (19 CM + MOH, 17 CM–MOH), 30 EM, and 30 control participants. The CM patients performed significantly (p < 0.01) worse on the TMT A and B than the EM patients and the control participants. The WCST also revealed significant differences, with poorer performance in the CM patients versus the EM patients and the control participants. However, the net scores on the IGT did not significantly differ among the three groups. Our findings suggest that the CM patients exhibited frontal lobe dysfunction, and, particularly, dorsolateral dysfunction. However, we found no differences in frontal lobe function according to the presence or absence of MOH.

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Frailty and Autonomy among the Oldest Old: Evidence from the Multicenter Prospective AgeCoDe-AgeQualiDe Study

Gerontology ◽

10.1159/000514170 ◽

2021 ◽

pp. 1-8

Author(s):

André Hajek ◽

Christian Brettschneider ◽

Tina Mallon ◽

Hanna Kaduszkiewicz ◽

Birgitt Wiese ◽

...

Keyword(s):

Old Age ◽

Service Use ◽

Oldest Old ◽

Strong Association ◽

Total Sample ◽

Sociodemographic Factors ◽

Related Factors ◽

Clinical Frailty Scale ◽

Related Quality ◽

Health Related

Introduction: There is a lack of studies examining the link between perceived autonomy and frailty among the oldest old. Therefore, our objective was to fill this gap. Methods: Data were used from the multicenter prospective cohort study “Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe; follow-up [FU] wave 9; n = 510 observations in the analytical sample). The average age was 90.3 years (SD: 2.7 years). The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to assess frailty. Socioeconomic and health-related covariates were included in our regression model. The autonomy scale developed by Schwarzer was used to assess perceived autonomy in old age. Results: Adjusting for various confounders, multiple linear regressions showed that lower perceived autonomy was associated with increased levels of frailty (total sample: β = −0.13, p < 0.001; women: β = −0.14, p < 0.001; and men: β = −0.12, p < 0.001). Furthermore, lower perceived autonomy was associated with more depressive symptoms, higher cognitive impairment, and being institutionalized (except for men) in the total sample and in both sexes, but it was not significantly associated with age, sex, marital status, educational level, and social support. Conclusion: Findings indicate that frailty is associated with lower autonomy among the oldest old. More generally, while health-related factors were consistently associated with autonomy, sociodemographic factors (except for being institutionalized) were not associated with autonomy among the oldest old. We should be aware of the strong association between autonomy and physical as well as mental health in very old age.

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The Antisocial Personality Questionnaire: An Inventory for Assessing Personality Deviation in Offender Populations1 * An earlier version of this paper was presented at the Fifth European Conference on Law and Psychology, Budapest, Hungary, August 1995.

European Journal of Psychological Assessment ◽

10.1027//1015-5759.15.1.14 ◽

1999 ◽

Vol 15 (1) ◽

pp. 14-24 ◽

Cited By ~ 35

Author(s):

Ronald Blackburn ◽

Diane Fawcett

Keyword(s):

Personality Disorder ◽

Social Withdrawal ◽

Self Control ◽

Self Report ◽

Criminal Career ◽

Big Five Personality ◽

Personality Questionnaire ◽

Antisocial Personality ◽

Mentally Disordered Offenders ◽

Mentally Disordered

Summary: The development is described of the Antisocial Personality Questionnaire (APQ), a short multitrait, self-report inventory that measures intrapersonal and interpersonal dispositions of relevance to antisocial populations. Scales were generated through factor analysis of an item pool adapted from the MMPI, Buss-Durkee Hostility Inventory, and a self-report scale of Psychopathy, using samples of male mentally disordered offenders (N = 499) and male volunteer nonoffenders (N = 238). Eight factors extracted were identified as Self-Control, Self-Esteem, Avoidance, Paranoid Suspicion, Resentment, Aggression, Deviance, and Extraversion. Short scales constructed to measure these have satisfactory reliability (α), and correlations with measures of personality disorder, observer ratings of interpersonal style, and criminal career data support their construct validity. Scale intercorrelations yield two higher-order dimensions of hostile impulsivity and social withdrawal that reflect orientations towards others and the self, respectively. The APQ provides comprehensive coverage of the deviant traits implicated in personality disorder and antisocial behavior, and appears to tap three of the Big Five personality dimensions (Neuroticism, Extraversion and Agreeableness). The questionnaire has satisfactory psychometric properties and can aid research and intervention with offenders.

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