DIOGENES SYNDROME
Description
● Definition: Diogenes syndrome is a syndrome that may coexist with neurological or mental disorders, but it is not a separate psychiatric diagnostic in the DSM-5 or ICD-11. Behavioural symptoms of the syndrome include extreme self-neglect, compulsive hoarding of trash or animals, severe social disengagement, and apathy or lack of guilt over one's living circumstances.
● Epidemiology:
• It mostly affects older people, usually those over 60.
• Although some research indicate somewhat higher rates in women, there is no discernible gender difference.
Due to patients' propensity to shun social or medical assistance, they are frequently underdiagnosed.
● Causes and Dangers:
Although the precise aetiology is unknown, a number of elements are involved:
Neurocognitive disorders include frontal lobe dysfunction and dementia.
•Psychiatric illnesses include personality problems, depression, obsessive-compulsive disorder (OCD), and schizophrenia.
• Social factors, such as widowhood, family bereavement, and loneliness.
• Medical factors: long-term conditions that cause people to take less care of themselves.
Clinical Characteristics:
➣ Psychological and behavioural
• Extreme self-neglect, including poor personal hygiene and denial of medical treatment.
• Pathological hoarding, which includes trash, strange items, and animals.
• Social disengagement and seclusion.
• A lack of concern or embarrassment over living circumstances.
Physical and environmental aspects
• Living in filthy, occasionally dangerous, or rodent-infested conditions.
• Skin diseases, scabies, lice, and malnourishment.
• The possibility of medical crises, fire dangers, and falls.
Cognitive
• Coexisting with executive dysfunction or dementia;
• Impairment of judgement and decision-making.
Types
➣ According to some specialists, Primary Diogenes Syndrome occurs when there is no significant underlying mental disorder.
• Secondary Diogenes Syndrome: Linked to a neurological or mental condition (e.g., brain damage, dementia, schizophrenia).
Difficulties
• Serious illnesses brought on by inadequate hygiene.
• Dehydration and malnutrition.
• Mishaps (fire, falls).
• Legal action or social services (eviction, forced cleanups).
• High death rate if left untreated.
● Diagnosis: clinical diagnosis based on observed living circumstances, history, and home visits.
• Disqualify mood disorders, OCD, psychosis, and dementia.
• Evaluate cognitive abilities (MMSE, MoCA).
• Laboratory tests to assess infections, dehydration, and malnutrition.
Oversight
A multidisciplinary approach is necessary since there is no one effective treatment:
➣ Medical Care
• Address skin issues, malnourishment, and severe infections.
• Take care of underlying mental or physiological issues.
➣ Psychiatric/Psychological Support: When depression, OCD, or psychosis are present, medications may be helpful. Psychotherapy is frequently challenging because of inadequate understanding.
➣ Community/Social Interventions
• The participation of adult protective services, home care, and social services.
• If safety is a concern, supportive housing or supervised living may be necessary.
• Cleanup and intervention should be done gradually as opposed to forcibly removing anything (which might exacerbate resistance).
➣ Support for Family and Carers
• Promotion of continued observation and assistance;
• Education of the problem.
Case presentation
➣Details: 35-year-old married lady who resides with her husband and daughter.
➣ Current grievances include:
• Excessive hoarding of belongings and rubbish.
• Being combative as the family tried to clean
•Items (food, trash, and items) are labelled and stored in a clean manner according to her own system.
➣ Previous mental health history:
• Severe OCD from childhood (continuous checking, obsessive thoughts, ruminative doubts).
Symptoms of depression.
➣ Hoarding started at age 25, following the birth of a daughter.
•Developed an obsessive inspection of garbage bags ten years after losing precious goods during a relocation.
➣Illness course:
• Became withdrawn, worried that family would throw away belongings.
Behaviour was acknowledged as undesirable, but things were defended as "potentially useful."
• Stopped taking 200 mg of fluvoxamine per day since it was thought that the medicine would stop hoarding.
➣ Hospitalisations:
• Frequently admitted for housekeeping.
• Continued hoarding (trash in closet or handbag) and cleaning anxiety during admissions.
Protocol
● Issues Diogenes Syndrome Nurses Face:
➣ Issues Concerning Patients:
• Refusal of care: Patients frequently lack understanding and oppose nursing or medical treatments.
• Poor compliance: Having trouble following diet programs, cleanliness regimens, or prescription regimens.
• Mistrust or aggression: suspicion of medical professionals, occasionally animosity.
• Barriers to communication include cognitive deterioration, social disengagement, and little contact.
Hoarding or refusing to part with unclean items or animals are examples of unpredictable conduct.
➣ Environmental Challenges:
• Unsafe conditions: In the house, nurses may come across rodents, a bad smell, clutter, and fire dangers.
• Risk of infection: Prolonged exposure to respiratory illnesses, lice, scabies, or polluted settings.
• Physical risks: Patients and nurses are more likely to fall or get hurt in confined or obstructed areas.
➣ Professional and Ethical Difficulties:
• Autonomy vs. Safety: Juggling the need for intervention with respect for patient autonomy.
• Emotional burden: Compassion fatigue, stress, and dissatisfaction are all possible for nurses.
• Resource constraints: Care is hampered by a lack of organised social or community assistance.
• Legal conundrums: Issues with ability, negligence, or required reporting requirements.
● Strategies for Nursing Management:
➣ Evaluation
•Perform a thorough medical and psychological evaluation, taking into account factors like diet, cleanliness, mental health, and cognitive function.
•If you are a community nurse, conduct home visits to assess environmental hazards.
•Determine any underlying illnesses, such as schizophrenia, depression, or dementia.
➣ Care Planning
•Establish reasonable, incremental objectives (e.g., a steady improvement in hygiene instead of a complete cleansing right now).
•Work together with interdisciplinary teams that include doctors, social workers, occupational therapists, and psychiatrists.
Create customised treatment programs depending on the priorities and tolerance of each patient.
➣Execution
•Building trust: Communicate politely and without judgement to build rapport.
• Health education: Give concise, understandable explanations of medicine, diet, and cleanliness.
•Basic needs support: Help with wound care, bathing, grooming, and making sure you're getting enough food and liquids.
•Medication management: Monitor dosage if there is cognitive deterioration or disobedience.
• Environmental safety: Collaborate with social services to eliminate pests and gradually declutter.
➣Cooperation
•When feasible, involve family members or carers to ensure regular observation.
• Work together with social services to arrange for community, housing, and financial assistance.
•Suggest protective services if the patient is in danger because to dangerous living conditions or maltreatment.
➣ Assessment
• Track advancements in living circumstances, diet, and self-care.
•Reevaluate the patient's readiness to use the services.
• Monitor progress rather than perfection in order to stabilise safety and health.
● Nursing diagnoses, objectives, interventions, and justifications for NANDA-I:
← Deficit of Self-Care (cleaning, dressing, eating, bathing)
➣ Objective: With help, the patient will maintain appropriate personal grooming and cleanliness.
➣ Interventions:
• Evaluate present capacity for self-care.
• Help with clothing, grooming, and bathing.
• Promote self-reliance in minor activities (e.g., cleaning teeth).
• To encourage involvement, provide positive reinforcement.
← Unbalanced Diet: Not Enough to Meet Needs
➣ Objective: The patient will maintain or enhance their nutritional status by consuming enough calories and water each day.
➣ Interventions:
• Regularly evaluate weight and eating patterns.
• Serve quick, simple meals on a regular basis.
•Work together with a dietitian to create customised food plans.
•Check labs for malnutrition (electrolytes, albumin).
↑ The chance of infection
➣ Objective: The patient will not get any new infections while receiving care.
Interventions:
• Check for infestations (scabies, lice) and skin deterioration.
• With assistance from services, progressively maintain a clean atmosphere.
• Spread knowledge about personal hygiene and handwashing.
•When necessary, provide prescription medicines and antiparasitics.
Social Isolation
➣ Objective: The patient will exhibit more social engagement with community, family, and staff services.
➣ Interventions:
• Develop a polite, consistent approach to build trust.
• Promote engagement in basic social activities.
•Connect the patient with daycare centres or community support organisations.
← Poor Maintenance of Health
➣ Objective: The patient will accept help in managing their health requirements and adhering to nursing and medical treatment.
➣ Interventions:
• Evaluate understanding of disease and care-related obstacles.
• Educate people about health requirements in a straightforward manner.
•If required, monitor drug consumption.
• Work together with social services and families to follow up.
Notes
https://doi.org/10.7759/cureus.78289
