- this is a psychopathological symptom complex, manifested by an extremely dismissive attitude towards one's own appearance and health, social isolation, apathy, a tendency to accumulate rubbish, and a lack of shame. Patients are slovenly, do not follow the rules of hygiene and the daily routine, are indifferent to the assessment of others, do not care about cleanliness in their home, strive for an isolated existence, react negatively to attempts to interfere in their lives. Identification of the syndrome is carried out in the complex for diagnosing the underlying disease, includes a clinical conversation, psychological testing, and instrumental studies of the brain. Medical treatment.

ICD-10

F60.9 Personality disorder, unspecified

General information

Diogenes is an ancient Greek philosopher, a supporter of extreme minimalism, who lived in a large earthen vessel. Diogenes syndrome was isolated in 1966 and received its original name after 9 years. Prior to this, manifestations of pathological hoarding and slovenliness in the elderly were attributed to obsessive-compulsive disorder. Synonyms of the Diogenes syndrome are the syndrome of senile squalor, senile disorder, Plyushkin's syndrome, social decay. In the International Classification of Diseases 10th revision, it is not singled out as a separate disease, traditionally considered within the framework of organic pathologies of the brain. The syndrome is most common among the elderly and old people who have had social recognition and professional success.

The reasons

The syndrome is based on an organic disease of the brain, but its content is determined not only physiological changes, but also emotional and personal characteristics, social skills that have been formed throughout life. Researchers have identified a number of factors that predispose to the development of senile squalor syndrome:

• Traumatic lesions of the brain. The disorder develops in the remote period of TBI. In addition, brain surgery may be the cause.
• Intoxication. The formation of senile disorder occurs with toxic encephalopathy. The most common option is alcohol neurointoxication.
• Neuroinfections. Cases of a syndrome that arose on the basis of a viral infection were identified nervous system. Patients with encephalitis are at risk.
• Degenerative diseases of the CNS. In old age, the progressive loss of neurons causes cognitive decline and personality changes. Sloppiness, indifference to appearance, syllogomania are most often observed in Pick's disease.
• Propensity to hoard. Patients in the premorbid period had certain personality tendencies, in particular, a passion for collecting and pathological hoarding.

Pathogenesis

Experimental studies have confirmed the presence of the pathophysiological basis of the syndrome. In subjects with established diagnosis there is abnormal activity in two areas of the cerebral cortex: the insular lobe and the anterior cingulate gyrus. These areas are involved in the decision-making process, the processing of sensations, the formation of aversion to the sight and smell of dirt. They participate in the analysis of information about the norms of behavior, social emotional reactions. Violation of the functions of the insula and the cingular cortex is manifested by indifference to sewage, non-compliance with the rules of behavior. The desire to collect everything in a row and carry it to the dwelling comes from an ancient deep need for replenishment of stocks. The centers that provide such rudimentary behavior are located in the subcortical regions. With pathological changes in the higher cortical structures, the process of realizing the necessity and usefulness of things is disrupted.

Symptoms

The main signs of the disorder are the desire to accumulate things, aggressiveness and negativism towards others, slovenliness, stinginess, lack of disgust and shame, a reclusive lifestyle, inability to critically assess one's condition. At the initial stage, changes in character are noted: patients become emotionally unstable, irritable, quick-tempered. Gradually, the degree of adequacy of behavior decreases more and more, isolation, alertness, and suspicion increase.

Because of the collection of old unusable things, the dwelling is completely littered. The rooms are littered with broken, dilapidated furniture and household items, broken household appliances, clothes, books, newspapers and magazines. A small part of the room remains for life, patients sleep on the floor, organizing a bed from rags that come to hand. Attempts by relatives and friends to put the room in order provoke aggression, increase isolation and the desire for isolation. Persuasions are useless. According to patients, all items are useful, useful in the future.

The rubbish starts to exude bad smell. Cockroaches, rats start up in a house or apartment, homeless cats and dogs settle. The presence of animals increases the risk of infection. Patients completely fence themselves off from contact with people: they do not open doors to visitors, they do not answer phone calls. refuse to accept the help of relatives who are able to arrange a life. Money savings are not realized or invested, but they constantly worry about the possible theft, waste of funds. Preserving and increasing property becomes the main occupation.

Not enough attention is paid to nutrition and hygiene. Hypertrophied thrift is manifested by the fact that patients do not buy quality products, but buy expired food or eat leftovers found in garbage cans. They do not use the bathroom: they do not take a shower, they do not wash, they do not brush their teeth, they do not comb their hair, they do not do laundry, they do not change their linen. The bathroom is often littered with things. The symptoms of Plushkin's syndrome include a lack of shame. Patients appear asocial: wear soiled torn clothes, have tangled dirty hair, do not worry about bad body odor, festering wounds, lice. They can undress in public, defecate, which becomes the basis for arrest by the police for disturbing the peace.

Complications

The lack of care for the sick and the necessary treatment for Diogenes syndrome leads to sad consequences. The main causes of complications are social isolation, neglect of health and appearance. Eating spoiled food, the presence of homeless animals and their excrement, failure to comply with hygiene procedures contributes to the development infectious diseases(gastrointestinal, respiratory, skin). Pathological stinginess of patients is manifested by savings on medicines and visits to doctors. Protracted infections and exacerbations of diseases of internal organs in isolation are fatal.

Diagnostics

Examination of patients is carried out by a psychiatrist, a clinical psychologist and a neurologist. The task of the diagnostic stage is to detect the characteristic symptoms of the disorder and their physiological substrate, differentiation with other mental illnesses that manifest themselves in a similar way (antisocial behavior, slovenliness, hoarding). The main research methods are:

• Conversation. Since patients are not critical to their own disease, the examination takes place in the presence of relatives. The main complaints are the craving for collecting and storing unnecessary things, the rejection of hygiene, extreme social isolation, and the lack of a sense of shame. According to the results of the conversation, the doctor differentiates the syndrome with pathological hoarding with obsessive behavior, with schizophrenia.
• observation. Patients behave cautiously, refuse to answer questions, and have a negative attitude towards doctors and other medical personnel. Outwardly untidy, do not keep a distance when communicating, show tactlessness.
• CT scan of the brain. Instrumental diagnostics allows you to detect changes in specific areas of the brain, determine the degree of damage. Computed tomography can be replaced by other studies, such as MRI.
• Psychodiagnostics of the cognitive sphere. The study of cognitive processes is necessary to detect dementia and schizophrenia. In these diseases, the primary is a decrease in intellectual abilities or a distortion of perception and thinking, and not emotional and personal deviations, which is typical for the Diogenes syndrome.

Treatment of Diogenes Syndrome

Requires therapy for the disease that provoked the syndrome. On the initial stages treatment can be done on an outpatient basis. With persistent social isolation, a threat to the life of the patient or others, hospitalization is necessary even in the absence of voluntary consent. Comprehensive medical and psychological assistance includes:

• Pharmacotherapy. Vascular and nootropic drugs with a calming effect are used. Medicines of these groups contribute to the restoration of blood supply and nerve transmission in the brain, alleviate the symptoms of the disorder. Combinations of neuroleptics, tranquilizers, antidepressants are selected individually. Their reception is necessary to restore emotional stability, stop behavioral disorders (aggressiveness).
• Psychological counseling. The help of a psychologist may be required by relatives. The specialist talks about the peculiarities of the behavior of patients, the expected results drug treatment, gives recommendations on how to care for and communicate with the patient. The main task is to convince them of the need to live together, maintain order and personal hygiene.
• Rehabilitation. The basis for the restoration of social activity is the love and support of close relatives. Elderly people should feel their need, usefulness for society. Rehabilitation begins with involvement in daily family affairs, celebrations. You should gradually expand the circle of acquaintances, allow the patient to show independence.

Forecast and prevention

The effectiveness of the treatment of Diogenes syndrome depends on the nature of the course of the underlying disease and the timeliness medical care. With an early appeal to a psychiatrist, the prognosis is most favorable, the improvement of the patient's condition can be achieved with minimal medication correction and increased control by relatives. Specific preventive measures have not been developed. The main task of preventing emotional and personal organic disorders in old age is involvement in family discussions and household chores, periodic monitoring of behavior and emotional state, contacting a doctor at the first sign of a deviation from the norm.

Diogenes syndrome (syndrome of senile squalor) is a mental disorder that manifests itself mainly in older people. Those suffering from this disorder are characterized by an obsessive desire to collect unnecessary, worthless, old things, neglect the rules of hygiene and have no sense of shame. Diogenes syndrome is diagnosed in approximately 3% of people aged.

Symptoms

Patients are not able to be critical of their condition, so they rarely seek special help, considering their “hobby” to be absolutely normal. You can suspect Diogenes syndrome by the following signs:

• pathological passion for hoarding;
• negative and aggressive reaction to condemnation, inability to self-criticism;
• neglect of hygiene rules;
• greed;
• attempts to isolate themselves from society;
• indifference to others;
• lack of shame.

Patients with Diogenes syndrome carry absolutely everything into the house: glass, broken furniture, even rotten vegetables and fruits. Often these accumulations smell unpleasant, rats and cockroaches start up in the house. Suffer from a person with Diogenes syndrome, besides himself, relatives and neighbors. Attempts on the "collector's" collection, attempts to get rid of it, are met with a tough rebuff, up to family quarrels. Patients become secretive, taciturn, may not go out for a long time, considering communication with people meaningless. Due to neglect of hygiene, they often suffer from various ailments, but do not seek medical help. The consequences of such an attitude towards yourself and others can be very sad.

Distinguishes those suffering from Diogenes syndrome and complete absence feelings of shame: they can look like homeless people, defecate where they want, do whatever comes to their mind. Sometimes this becomes a reason for detaining a person by the police.

A characteristic sign of the disorder may also be the fact that patients, even with a stable financial situation, consider every penny spent, they are very upset due to the high, in their opinion, spending. There are cases when people moved to the garbage heap, so as not to spend money on the maintenance of the apartment.

Any of these symptoms should alert relatives and neighbors and serve as a reason to call a specialized medical team.

The reasons

The frontal lobes of the brain are responsible for the love of gathering. If they are damaged, Diogenes syndrome can develop.

Accordingly, it can be caused by:

• unsuccessful operation;
• head injury;
• diseases that affect the brain (for example, encephalitis);
• alcoholism.

Also, people who have been prone to it throughout their lives are at risk of suffering from Diogenes syndrome in old age: misers, collectors, thrifty, closed. In Russia, another factor in the prevalence of the syndrome may be the difficult economic conditions in which many patients grew up.

Sometimes this disorder accompanies other mental illnesses, such as, for example, senile dementia.

Treatment

People with Diogenes syndrome do not realize what they need medical treatment so they don't ask for help. Recognizing this disease and directing a person to treatment is the task of others.

First of all, such a person should help relatives. In the early stages of the disorder, you can try to negotiate with the patient, directing his pathology in a safe direction. For example, to convince him to bring into the house not everything in a row, but only a certain category of things: magazines or books, for example. Such "collections" will not litter the house much and can really be useful. It is necessary to help the patient with cleaning, to convince him of its necessity, arguing that the person has nowhere to sit down or it is dangerous to move around the room. It is necessary to surround the sick person with family care and love, since Diogenes syndrome often manifests itself in people who lack the attention of relatives. If all "peaceful" methods do not help or the person has no close relatives, then such a patient needs treatment in a psychiatric hospital. If it is proved that he is mentally ill and incompetent, then his consent is not required for hospitalization.

In medicine, sedatives, antidepressants and antipsychotics are used to stabilize the condition of a patient with Diogenes syndrome. It is not advisable to treat it with the help of psychotherapy, since the nature of the disease is organic. Computed tomography is used to determine the degree of brain damage.

Probably, many had to deal with people who have some kind of special passion for hoarding. At first glance, they resemble vagabonds or those trying to drag with them as much as possible of various rubbish.

In fact, this condition is a manifestation of a fairly common mental illness - Diogenes syndrome. About 5% of the elderly suffer from this disease, although it also occurs among young people.

Diogenes is an ancient Greek philosopher, who would now be called the main lover of shocking. It is known that the thinker lived in an earthenware jar - a pithos in the very center of Athens, used a cloak instead of a bed, and Diogenes often ate right on the square, which in ancient Greece was considered bad manners.

But there is no information that the philosopher dragged rubbish from all Athens to his monastery in any source. And even on the contrary, it is known that the thinker's property consisted only of a bag and a staff. Through such a way of life, the philosopher tried to act for complete freedom and independence. It is even known that Diogenes wanted only one thing from Alexander the Great: that he should not block his sun.

What it is?

Diogenes syndrome or old age syndrome- a mental disorder, the characteristic features of which are an extremely dismissive attitude towards oneself, social isolation, apathy, a tendency to accumulate and collect all sorts of things (pathological hoarding) and a lack of shame.

Such people are not adapted to life and experience certain difficulties. The main problem is their lack of understanding and unwillingness to correct the situation, since, in their opinion, there are no problems.

It was recognized as a separate syndrome in 1966. The name "Diogenes syndrome" was proposed by a number of researchers in honor of the ancient Greek philosopher Diogenes, a supporter of extreme minimalism, who, according to legend, lived in a pithos (large earthen vessel). However, there is no exact information that Diogenes was engaged in the accumulation of property, and at the same time he was looking for human communication, taking walks in the Agora every day.

Thus, a number of researchers consider this name to be incorrect and suggest using other names: senile disorder, Plyushkin's syndrome (a character from Gogol's poem "Dead Souls"), social decay, senile squalor syndrome.

Symptoms of Diogenes Syndrome

Psychologists say that Diogenes syndrome is known for the following symptoms:

• hoarding
• non-compliance with hygiene rules;
• hermitage;
• shamelessness;
• apathy;
• avarice;
• lack of self-criticism;
• aggressiveness towards criticism.

Some doctors suggest calling the disease the syndrome of senile squalor or Plyushkin's syndrome, who, as those who read Gogol remember, liked to bring everything and more into the house.

Patients with Diogenes syndrome, as a rule, live in poverty, although they often have a sufficient amount of money. Such people prefer not to touch their savings and keep them in their hiding places or in a bank account. Such people drag everything from the street: empty cardboard boxes, old furniture, strollers and other unnecessary things. The situation is aggravated by the bad smell. Each thing, in their opinion, is necessary and useful in everyday life, so the Plyushkins do not throw anything away.

For such people, order and cleanliness in the house, as well as their own appearance and hygiene, fade into the background. There is even an unusual type of pathological hoarding - pathological hoarding of animals. This is a situation in which a huge number of stray dogs or cats are kept in a dwelling, while not receiving proper care.

As a rule, the disease affects the elderly, but sometimes it occurs in young people. Scientists from the University of California, long time who studied this disease, came to the conclusion that the passion for collecting lies in the human brain. Many of us in childhood diligently collected stamps, postcards, badges, coins, ordinary candy wrappers. Doctors say that many collectors are gradually approaching this disease, so they advise monitoring the behavior of their loved ones. With age, this passion disappears in some, while in others it develops into a serious hobby.

A striking example

Kurt Degerman, a resident of the Swedish city of Skellefteo, lived for the last 30 years of his life in the garbage, eating leftovers. He died at the age of 60, that is, this syndrome began in him at about 30 and was not associated with old age. After his death, a fortune was found in his bank account - about one and a half million dollars.

In his youth, Kurt realized that food and clothes from the store were a waste, so he preferred to live in a garbage dump and wear dirty clothes instead of at home. Until his death, the man wore the same dirty blue jacket. Found food and clothes in a landfill. At the same time, all the money that he managed to get by alms or by handing over cans, Degerman invested in securities and gold. Relatives said that Degerman was an excellent financial analyst and well versed in the processes on the stock exchange. True, he could not use the fruits of the mind, and his wealth went to his relatives.

In this case, the object of pathological hoarding is financial resources.

The reasons

The cause of the disease is a malfunction of the frontal lobe of the brain. Experts say that this violation explains the strange behavior, since in this area there is a center that is responsible for making rational decisions.

The causes of an unusual illness can also be:

• Head injury.
• Strong stress.
• Alcoholism.
• Addiction.
• Mental disorders of old age.
• Pathological tendency to hoarding.

For a long time there was a version that the disease affects people who have been poor throughout their lives or those who are characterized by stinginess. However, this assumption is wrong.

How to treat

People suffering from this syndrome do not understand that they need specialist help, so they do not seek it. In this regard, the responsibility falls on the shoulders of loved ones. It is they who should be the first to see the manifested oddities and send them for treatment.

The most correct decision would be to send the patient for a consultation with a psychiatrist. In non-started cases, the doctor may prescribe special medications that will improve the patient's condition. With regular use of drugs, the symptoms of the disease weaken or disappear completely, the person returns to a normal lifestyle.

The ability to motivate the patient will be of great benefit. For example, cleanliness in the house is necessary so that the “collection” is kept in order and is pleasant to look at. The patient must understand that he himself needs to keep his room clean, even if the concept of order among the victims of the Diogenes syndrome is exceptional. Psychiatrists advise to influence the consciousness of patients by the fact that their room is uncomfortable and there is nowhere to sit.

It is very important, at least once a week, to be interested in his “collection” and communicate with him on his topic. It is necessary to remain a loving relative who is ready to help at any moment. This will not be easy, as people with Diogenes Syndrome tend to be isolated and sometimes very aggressive. Home psychotherapy will greatly help in treatment if you try to find contact with them and try to understand them.

If the disease is in an advanced stage, it is necessary to undergo treatment in a psychiatric clinic. But a patient can be placed there only with his consent or by recognizing him as incapacitated, that is, by a court decision. But since such behavior is still regarded as a lifestyle, doctors often recognize patients with this disease as adequate, which indicates that there is no need for compulsory medical care.

DIOGEN SYNDROME (PLYUSHKIN)

In the early 60s of the last century, many studies appeared in psychiatry on patients who had previously been diagnosed with senile dementia. In fact, they, first of all, drew attention to themselves only by strange behavior, living closed in their apartments and avoiding any contact with the outside world. Ultimately, this strange reclusiveness was isolated into a separate disease (and called the “Diogenes syndrome”), which affects mainly the elderly.

Diogenes Syndrome- this is a mental disorder, the characteristic features of which are: an extremely neglectful attitude towards oneself and internal squalor (extreme slovenliness, indifference to one's appearance and the appearance of one's own home, a complete refusal to comply with hygiene standards accepted in society), social isolation (closed living in his home), a tendency to accumulate and collect all sorts of things (pathological accumulation of unnecessary, obsolete things) and the absence of shame. In addition to the above, there is suspicion and an aggressively negative attitude towards others (especially towards those who allow themselves to express dissatisfaction with their favorite hobby - see).

Unlike people who purposefully engage in thematic collecting and organize their collection at home, patients with pathological hoarding collect many household items: old clothes, magazines, CDs, letters, pens, old records, checks, newspapers, recipes, cardboard boxes. , beds, cloth, pins, mats, old medicines. All of these items (most of them unusable) are piled up, indiscriminately and sorted, and are also kept by the patient, even if they are unlikely to be used again.

note! If we are talking about the hoarding of human body products (nails, hair, feces), used handkerchiefs, spoiled food, dead animals, then in this case, the patient should be suspected of a more severe mental disorder than pathological hoarding. These conditions include a severe form of obsessive-compulsive disorder, organic brain damage, dementia, schizophrenia, or problems with alcohol.

The prevalence of pathological hoarding among the adult population, according to the results of some studies, ranges from 2 to 6%, and among adolescents - within 2%. In another epidemiological study, the prevalence this disease was approximately 1.5% equally among both men and women. Symptoms typically begin during adolescence, and worsen gradually with age, causing impairment of the person's functioning in daily life (i.e., the course of the disease is usually chronic and progressive).

Scientists have found that people who previously led an active lifestyle, received a good education and were successful in society most often fall ill with Diogenes syndrome. It usually occurs in elderly people with some desire for loneliness (among people over 65 years of age, the prevalence of this syndrome in the world is about 3%). A factor provoking the development of Diogenes syndrome in psychiatry is considered to be severe stress in old age, such as sudden economic problems, death loved one and loneliness. The causes of pathological hoarding can be: emotional attachment (for example, a person feels safe when he owns a thing), identification with the object and the feeling that one day this thing will be needed.

The Diogenes syndrome was first named in medicine by such a term in 1975 and was described by Clark, Meinkikar and Gray (although, of course, cases of it in the form of "senile squalor syndrome" have been known in psychiatry since time immemorial). I must say that the decision to name the syndrome after the ancient Greek philosopher Diogenes does not look entirely logical. He preached the idea of ​​asceticism: according to legend, he lived in a wine barrel, neglected hygiene standards, demonstrating to the world his minimal necessities of life and abandoning all the amenities that existed at that time. Diogenes did not need property, he was looking for human fellowship.

Thus, a number of researchers consider this name incorrect and suggest using other names: senile disorder, Plyushkin's syndrome, social decay, senile squalor syndrome, in which mental disorders are associated with a violation in the frontal lobe of the brain (especially the right hemisphere, where the center that controls rationality of action).

Patients suffering from this disorder usually accumulate huge amounts of garbage in the house and live in complete poverty. At the same time, they do not follow their appearance and hygiene. To this they have complete indifference. Just as they are indifferent to the dirt and sewage that accumulates in the dwelling. Oddly enough, they can be owners of large fortunes, keeping large sums of money in the house or in the bank, without attaching the slightest importance to this. However, they consider themselves to be beggars, which makes them greedily accumulate and store any items without any need for them. They don't throw anything away, so their house is full of garbage that usually has no use in real life. Often, neighbors are the first to know about such patients, tired of repelling attacks on their apartments by hordes of cockroaches, mice and rats spreading from a sick neighbor, and “tasting” the aromas of decaying sewage coming from neighbors’ windows and doors. First of all, social authorities show interest in such patients after the appearance of complaints from neighbors. As a rule, these patients do not have relatives, or their relatives do not show any involvement in them. In this case, such patients are placed in nursing homes or psychiatric hospitals, where they are primarily provided with normal food and care, and also taken under control. possible diseases caused by this lifestyle. In more advanced cases, the intervention of a specialist in psychiatry for treatment and monitoring at home is possible. However, most often patients refuse any help. And if they are not declared incompetent due to severe dementia or other mental illness, they continue to live in the same conditions and in the same way.

Pathological hoarding as a separate disorder was relatively recently included in the chapter on obsessive-compulsive and related disorders in the 5th edition of the DSM. This mental disorder is also planned to be included in the 11th edition of the ICD, which, in turn, will help to simplify the diagnosis of this not fully understood condition in the future.

The main diagnostic criteria for pathological hoarding are:

[1 ] Constant difficulty to part with existing things.
[2 ] This difficulty is due to a palpable need to preserve objects and torment at the thought of parting with things.
[3 ] The difficulty of parting with household items leads to the accumulation of property, which clutters up the premises and significantly complicates their use. Cleaning of the premises is initiated by family members, special services or authorities.
[4 ] Pathological hoarding causes clinically significant distress or impairment in the patient's social, occupational, and other areas of functioning (including compromised home safety for self and others).
[5 ] Manifestations of pathological hoarding are not caused by other medical conditions (eg, craniocerebral
trauma, cerebrovascular disease, etc.).
[6 ] Manifestations of pathological hoarding cannot be explained by other mental disorders (obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia and other psychotic disorders, cognitive deficits in neurocognitive disorders, or limited interests in autism spectrum disorders).

Specifiers for this disorder include:

[1 ] The difficulty of parting with things is combined with the need to over-acquire items that are not needed or for which there is no free space in the room.
[2 ] The degree of insight (understanding and awareness of the severity of one's own condition):
[2.1 ] sufficient insight: the patient acknowledges that storage-related beliefs and behaviors (difficulty in parting with objects, disorder or overacquisition) cause many problems;
[2.2 ] Lack of insight: The patient is generally confident that the beliefs and behaviors associated with holding items are not problematic despite evidence to the contrary;
[2.3 ] lack of insight or delusional beliefs: the patient is fully convinced that his beliefs and behaviors related to the possession of objects are not problematic, despite evidence to the contrary. Often, this type of insight is most common among patients with pathological hoarding.

Differential diagnosis of pathological hoarding should be carried out with psychotic disorder, organic brain damage, neurocognitive impairment, autism spectrum disorders, major depressive disorder and obsessive-compulsive disorder (it should be noted that pathological hoarding can be a symptom of this condition).

Since pathological hoarding as a diagnosis was singled out relatively recently, to date, large-scale studies have not yet been carried out. clinical research to create guidelines for the treatment of this condition. As a rule, cognitive or behavioral therapy is used, in which the patient can: try to understand why he feels an overwhelming desire to collect everything; organize and categorize your treasures to make it easier to throw away; improve the way you make decisions; learn and begin to apply relaxation techniques; attend family or group therapy classes; accept the need for hospitalization; get help maintaining healthy habits. Also apply medicines stabilizing the patient's condition. The most commonly used antidepressants are serotonin reuptake inhibitors (however, data on the use of this treatment is limited and was obtained mainly from a small uncontrolled study; some study results indicate that serotonin reuptake inhibitors have demonstrated their effectiveness only [ !!! ] in patients with obsessive-compulsive disorder without symptoms of pathological hoarding).

Read more in the following sources:

article “Rare diseases: Diogenes syndrome” by E.G. Koroleva EE "Grodno State Medical University" (Journal of Grodno State Medical University, No. 2, 2012) [

The mental disorder known as Diogenes Syndrome is manifested by syllogomania - the desire to collect and accumulate a variety of unnecessary things. Such a deviation in behavior was named after the ancient Greek philosopher, who, according to legend, lived in a barrel and was distinguished by extreme unpretentiousness.

The term "Diogenes Syndrome" acquired official status in 1975. Domestic doctors also refer to this disorder as dementia, social decay, the syndrome of senile squalor or Plyushkin. The last name is generated by an association with one of the characters in N. Gogol's work "Dead Souls".

Brief description of the pathology

Diogenes Syndrome is a rare disease predominantly found in Europe. Pathology is detected in 3% of the elderly population (over 65 years). In some cases, the disease is diagnosed in younger patients.

The development of the deviation is indicated by the clutter of the room where the sick person lives, the presence of an abundance of unnecessary things in the house ( old clothes, waste paper, parts from various devices, furniture, spoiled products).

Most often, such "values" fall into the patient's home from landfills, from garbage cans. Sometimes patients begin to bring dead animals into the house.

The inevitable result of the accumulation of garbage is unsanitary conditions, from which both the person with Plushkin's Syndrome and his relatives and neighbors suffer. When trying to get rid of rubbish, most patients express a violent protest, they begin to come up with various pretexts and tricks to save the collected items.

Individuals with Diogenes Syndrome may appear miserable, poorly dressed, and half-starved. However, despite the unkempt appearance, these patients are often wealthy and have caring relatives.

Why Diogenes Syndrome Develops

The appearance of pathology may be preceded by severe stress, emotional upheaval. Statistics say that social disintegration is becoming a common violation among the inhabitants of countries that have survived wars, global catastrophes, genocide, famine.

If a person has Diogenes Syndrome, the causes of the pathology may also be as follows:

• birth, craniocerebral trauma;
• the presence of brain tumors (mainly in the frontal lobes);
• prolonged loneliness, lack of communication with other people.

Diogenes Plushkin syndrome can affect patients who have undergone complex operations, abusing alcohol and drugs, suffering from a pathological addiction to collecting. Sometimes a violation is found in people who have worked in hazardous industries for a long time, exposed to the adverse effects of the environment.

Typical symptoms

The first manifestations of dementia often do not cause suspicion and much excitement among others. Many patients neglect the elementary order in their room, explain the chaos reigning in it by the lack of time or energy for cleaning.

As Diogenes Syndrome progresses, the signs of a change in a person's personality become more pronounced. The disease is manifested by the following symptoms:

1. Reluctance to throw away old, unnecessary things.
2. Failure to keep the room clean.
3. Lack of personal hygiene.
4. Indifference to appearance.
5. Excessive greed.
6. Antisocial behavior, isolation.
7. The lack of shame.
8. Apathy.

If others are trying to change the situation for the better, they often have to deal with the patient's aggression. Against the background of lack of personal hygiene, patients can be exposed to various infections, skin diseases. The treatment of a person with Diogenes Syndrome is most often flatly refused.

The sad ending of the disease is alienation from the surrounding reality, degradation of the personality, complete indifference of the patient not only to others, but also to his own person.

Stages of Plushkin's Syndrome

Doctors distinguish at least five stages of the pathological condition:

First stage	The lack of order in the sick room is perceived as the norm. The room is not yet filled with rubbish, the patient's behavior does not arouse suspicion.
Second stage	Garbage accumulates in the house, tanks or buckets are often overflowing. The dwelling is filling up unpleasant odors, the first mold appears.
Third stage	The apartment has piles of rubbish blocking the aisles. Unsanitary conditions and stench reign everywhere.
Fourth stage	There are no normal living conditions. The state of plumbing and furniture is neglected, a large amount of mold is found.
Fifth stage	The patient's home is uninhabitable. The walls and ceiling are seriously damaged. Neighbors complain of discomfort and stench emanating from the patient's apartment.

A patient who has reached the final stage of the Diogenes Syndrome risks his own health and life. His home often poses a threat to people living nearby. The risk of reproduction of bedbugs, cockroaches, rats, fires, floods increases.

If the situation becomes critical, and a patient with Diogenes Syndrome does not enter into a constructive dialogue, forced hospitalization in a psychiatric hospital is carried out.

Diagnosis of violation

According to international classification diseases, dementia is not considered an independent disease. Pathology is able to accompany various diseases of the brain, accompanied by a change in the personality of a person, to act as one of their symptoms.

The main method for diagnosing Diogenes Syndrome is computed tomography, designed for a detailed examination of the brain. Thanks to the procedure, the degree of damage to certain brain areas, the presence of neoplasms is revealed. In addition to computed tomography, patients need to consult a psychiatrist.

Can Diogenes Syndrome be cured?

An effective therapeutic regimen that helps to completely cure patients with Plushkin's Syndrome has not been developed to date. It is possible to improve the situation and prevent complete degradation thanks to the joint efforts of the relatives of the patient and doctors.

Most often, pathology is associated with organic damage in the brain. That is why psychotherapeutic methods do not provide a pronounced effect. If Diogenes Syndrome is confirmed, treatment may consist of the use of antidepressants, antipsychotics, and other drugs that affect the adequacy of the patient.

It is possible to improve the patient's condition thanks to the patience and understanding of his relatives. Doctors do not recommend throwing away accumulated things without obtaining the consent of the patient. Such actions invariably lead to the manifestation of aggression and even greater apathy. It is much more effective to surround the patient with care and love, to try to build a constructive dialogue with him.

AT modern medicine and scientific circles, active work is constantly being carried out aimed at creating effective ways treatment of Diogenes Syndrome.

Forecast and prevention of dementia

The prognosis for senile squalor is most often unfavorable. Assistance provided to the patient on an outpatient basis or in a medical institution stabilizes the condition only for a while. In many cases, the achieved rehabilitation is gradually replaced by the former degrading state.

Doctors say - Diogenes Syndrome can be prevented due to timely preventive measures. Refusal of a passive lifestyle, moderate exercise, daily stay on fresh air. Mental activity brings benefits - regular reading, intellectual games, solving crossword puzzles, learning foreign languages. Elderly people are advised to eat well and get enough sleep, monitor the state of the heart, control indicators blood pressure, blood sugar levels, prevent weight gain.

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