A CASE OF DIOGENES SYNDROME

Diogenes Syndrome (DS), also known as Senile Squalor Syndrome, is a complex spectrum of behaviours found in persons who are living reclusively. It is characterized by an extreme self-neglect of environment, health and hygiene, combined with compulsive hoarding of refuse and the patient’s complete denial of his or her surroundings or symptoms (Iqbal et al., 2010). DS was named after Diogenes the Cynic (412 323 BC), the Greek philosopher who was best known for wandering the streets of Athens in the daylight with a lamp in search of an honest man. Diogenes slept in a barrel, was often found begging and engaged in forbidden public habits. DS was first described as a geriatric syndrome in 1966 because of its multifactorial aetiology and association with functional decline. Most patients are single or widowed and live alone, and their decline tends to be lengthy in duration. There is an association with falls, incontinence and increased mortality. These reclusive patients present with some form of physical illness such as cutaneous ulcers or neuropathy or malnutrition. The incidence is 5 per 10,000 in patients 60 years and over. Some patients with DS have a prior psychiatric history; most of them have above average intelligence, work histories, stable family backgrounds and adequate social resources (Reyes-Ortiz, 2001). Diogenes Syndrome is often identified by chance (e.g. a person collapses, trapped in rubbish, etc.), by having recurrent visits to hospital for self neglect, or through a trigger by public health after complaints from neighbours. One should suspect Diogenes Syndrome in a filthy patient who is unkempt and malodorous with neglected feet and poor dentition. The patient’s family may raise issues Dr Peter FERRY CasE sTUDY