Diogenes Syndrome: Identification and Distinction from Hoarding Disorder

“Severe domestic squalor” or Diogenes syndrome is characterised by extreme self-neglect of environment, health, and hygiene, excessive hoarding, squalor, social withdrawal, and a distinct lack of concern or shame regarding one’s living condition. This report presents a case of a 51-year-old male admitted to the hospital psychiatric ward following the police removing him from his home. Police officers attended the man’s home following the alarm being raised by his stepfather that he had not been seen or heard from in 3 weeks. His home was covered in several feet of rubbish, rotting food, and debris and smelled intensely of rotting mould, urine, and faeces. He was found lying nude on top of garbage with a rug over him. Diogenes syndrome is highly comorbid with psychiatric and somatic disorders, including depression, obsessive-compulsive disorder, personality disorder, and stress. This case report provides a rare opportunity to better understand the distinction of Diogenes syndrome from the closely related condition hoarding disorder. Furthermore, creating an agreed-upon constellation of symptoms representative of Diogenes is essential to creating a formal Diagnostic and Statistical Manual of Mental Disorders (DSM) entry, which would facilitate the much-needed development of assessment measures to enable accurate diagnosis and treatment.

Lethal giant basal cell carcinoma

Basal cell carcinomas are the most common malignancy in Caucasian populations with a very low predisposition to metastatic disease and an excellent prognosis if appropriately treated. Given the rarity of a lethal outcome two cases are reported. Case 1: A 61-year-old reclusive man who had an untreated facial basal cell carcinoma for 10 years died of hypothermia and sepsis complicating the extensively ulcerated and infected tumour. He also had underlying cardiomegaly, ischaemic heart disease and chronic obstructive pulmonary disease. Case 2: A 60-year-old man who had an untreated lower lumbar basal cell carcinoma for 14 years died of sepsis, inanition and pulmonary thromboembolism (due to a right-sided deep venous thrombosis) complicating the deeply ulcerated tumour. Untreated giant basal cell carcinoma may uncommonly present for medicolegal assessment with complex pathophysiological lethal mechanisms. The possibility of Diogenes syndrome should be considered.

Diogenes syndrome in dementia: a case report

Background Diogenes syndrome is a neurobehavioural syndrome characterised by domestic squalor, hoarding and lack of insight. It is an uncommon but high-mortality condition, often associated with dementia. Aims To describe the clinical features and treatment of Diogenes syndrome secondary to behavioural variant frontotemporal dementia (bvFTD). Method We describe a case of bvFTD in a 77-year-old man presenting with Diogenes syndrome. Results The patient's medical and psychiatric histories were unremarkable, but in recent years he had begun packing his flat with ‘art pieces’. Mental state examination revealed confabulation and more structured delusions. Neuropsychological evaluation outlined an impairment in selective attention and letter verbal fluency, but no semantic impairment, in the context of an overall preserved mental functioning. Brain magnetic resonance imaging and positron emission tomography (PET) with fluorodeoxyglucose showed mild bilateral temporo-insular atrophy and hypometabolism in the left-superior temporal gyrus respectively. An amyloid PET scan and genetic analysis covering the dementia spectrum were normal. A diagnosis of bvFTD was made. Conclusions The clinical framing of behavioural symptoms of dementia such as hoarding poses a diagnostic challenge. This case illustrates the importance of a deeper understanding of Diogenes syndrome, leading to timelier diagnosis and effective therapeutic strategies.