Ganser syndrome - a dissociative disorder or a factitious disorder? A case report. / Zespól Gansera ­ zaburzenie dysocjacyjne czy zaburzenie pozorowane? Opis przypadku.

Ganser syndrome (GS) is one of afew eponyms that have survived in psychiatry until the present day. GS is a little-known and rare disorder. It is most often described as a response to a stressor (e.g. incarceration), that is why it is an important issue in forensic psychiatry. Organic causes are taken into consideration. The basic symptoms of the syndrome are: approximate answers, visual and auditory hallucinations, clouding of consciousness and conversion symptoms. Additionally, patients may perform activities in an awry manner and suffer from insensitivity to painful stimuli.GS is usually acute and subsides spontaneously. Usually patients do not remember they had an episode of the disease. Diagnostic criteria of GS are imprecise and its classification has been changed over the years. GS was not listed in the DSM-5 classification, although in the DSM-IV it was classified as a dissociative disorder. Currently some authors tend to classify it rather as a factitious disorder. WHO (ICD-10 and ICD-11) classifies GS as a dissociative and conversion disorder, which seems to be appropriate in the light of current knowledge. The presented case report describes apatient with a nearly identical pattern of full-blown GS, which occurred twice. The symptoms appeared shortly after the patient was incarcerated. The course of the disorder was chronic and recurrent. The patient was insensitive to pain stimuli. Somatic causes were excluded in the diagnostic process.

Electrodermal activity and suicide risk assessment in patients with affective disorders. / Aktywnosc elektrodermalna a ocena ryzyka samobójstwa u osób z zaburzeniami afektywnymi.

There are questionnaires and scales, including self-assessment scales, used to evaluate suicide risk. Additionally, suicide risk factors (i.a., prior suicide attempts, willingness to commit suicide, somatic diseases, male gender) are also known. Their application, however, does not provide a sufficient guarantee for properly distinguishing persons with high and low suicide risk. In 1986, Gunnar Edman observed that there is an association between low electrodermal activity and suicidal tendencies, which was confirmed in other studies and meta-analyses. Electrodermal activity (EDA) is commonly considered to be a very good indicator of orienting reflex, which is a response to the information linked with a stimulus and, in a way, a physiological mechanism that helps an organism to survive. This phenomenon is related to habituation, the rate of which is a measure of EDA reactivity. Hyporeactivity consists in very rapid habituation of a stimulus, even after first exposure. According to Lars Håkan Thorell, hyporeactivity may be understood as a specific deficit of attention, which is associated with inability to arouse curiosity with ordinary, everyday events at the physiological level. This results in a greater tendency to attempt suicide shown by persons with mood disorders, and lower fear of hurting oneself. The goal of this paper is to present history of studies on electrodermal activity, relationship between EDA and suicide tendencies in persons with affective disorders and to discuss EDOR System that identifies persons at particularly high risk of committing suicide.