Diogenes Syndrome

Specialty: Geriatrics.

• extreme abandonment of self-care
• senile silogomania
• compulsive hoarding disorder in the elderly
• senile neglect syndrome

Why it occurs

• Frontotemporal lobar degeneration or behavioral variant of Alzheimer's disease
• Pathological accentuation of previous personality traits (schizotypy, obsessiveness) aggravated by social isolation
• Late-onset major depressive episode with symptoms of extreme apathy or latent psychotic features
• Chronic delusional disorder of a persecutory type or delusional ideas of poverty
• Multifocal ischemic lesions in the ventromedial prefrontal cortex secondary to cerebral microvascular pathology

Initial workup

Assessment of the state of legal capacity and decision-making in the elderly; comprehensive cognitive evaluation that includes the Mini-Cognitive Examination (MEC) and the Frontal Assessment Battery (FAB) to objectively identify dysfunction of the executive functions of the frontal lobe; blood analysis with determination of hemogram, albumin, prealbumin, electrolytes, serum levels of vitamins B12, folate, D, zinc and selenium; chest x-ray and general physical examination looking for chronic decompensated pathologies and skin parasites; social report of the home environment.

Standard management

• Haloperidol — 0.5 mg to 1 mg orally or in drops at night if there are structured delusions of harm that condition isolation and aggressive behavior, closely monitoring extrapyramidal symptoms
• Olanzapine — 2.5 mg to 5 mg orally at night, useful if a marked component of psychomotor agitation and anorexia coexist, monitoring the appearance of metabolic syndrome or glycemic decompensation
• Sertraline (25 mg to 50 mg orally in the morning if the clinical picture is associated with severe depressive symptoms or underlying obsessive-compulsive features, monitoring serum sodium to rule out hyponatremia due to SIADH).