Difficulties in the differential diagnosis of endogenous, organic and psychogenic disorders

Over the past decades, the number of acute reactive psychoses with a classic picture of clouding of consciousness, traditionally considered hysterical for pathogenesis, has been steadily decreasing. L.V. Romasenko (1988) provides data on the intranosomorphosis of hysterical manifestations in forensic psychiatric practice, a decrease in the number of hysterical reactions outside the framework of hysterical psychopathies during 60 years of observation. If in the 1946 manual on forensic psychiatry, hysterical twilight states are shown as a frequent occurrence, and Ganser's syndrome is considered at the same time as a kind of pseudodement state, then already in Forensic Psychiatry (1988) a typical clinic of Ganser's syndrome is defined as an acutely occurring twilight disorder of consciousness and the conclusion is made that "at present in the forensic psychiatric clinic there is rarely a clinically expressed Ganser syndrome." Finally, the latest manual from Forensic Psychiatry (1998) describes the same clinic and concludes that "this syndrome does not currently occur in the forensic psychiatric clinic." A classic description of the Ganser syndrome is given in the "Guide to Psychiatry" by E. Bleuler (1920). The most vividly pathogenetic mechanisms of reactive states are presented in "General psychopathology" by K. Jaspers (1997).