Review: Diogenes Syndrome

摘要

A typical scene which must be familiar to many doctors, social workers, district health nurses and members of the public is that of a reclusive elderly person living alone in a dilapidated filthy house. The home is cluttered with rubbish and infested with vermin. Excrement and decomposing food are strewn around the floors and the stench emanating is unbearable to all but the occupant who is blissfully unconcerned by the situation. Diogenes syndrome, variously known as senile breakdown, social breakdown and senile squalor syndrome, refers to this condition and is characterized by extreme self-neglect, domestic squalor and social withdrawal and is often accompanied by excessive hoarding (syllogomania) and lack of concern about one's living conditions. The estimated annual incidence is 5 per ten thousand of the population aged over 60 years living at home, at least half of whom will have dementia or some form of mental illness. Most old age psychiatrists have some experience in managing this condition. The term was first suggested by Clarke et al. and has been in common usage since. Clarke did not define it operationally and there has been some confusion as to whether it is inclusive or exclusive of those with underlying mental illness or dementing disorder. Severe breakdown in standards of personal and environmental hygiene has also been described in younger adults and there seems to be no rationale for confining the term to elderly people.