I am posting this topic here as it seems to have no specific catagory of its own. I see alot of people in my rural community who are reclusive packrats living in cluttered filth in ramshackle conditions. These people don't seem to be harmful to anyone except for creating a public health hazard what with the vermin and fire hazards that can result from having so much crap in their homes. And they arn't all elderly, either! I have encountered this many times as a census taker, animal rescue agent, handyman, ect. If anyone knows of a non threatening way to help such people please post.
Clinical features and aetiology:
The major difficulty in making generalizations about Diogenes syndrome from published research is that all the published studies have been restricted to subjects presenting to healthservices. It is unlikely that these are truly representative of the
group in general. However the major systematic studies of this condition have been notable for their similarities rather than their differences and a core body of knowledge has emerged about the disorder. There have been several major case series of the syndrome over the past 30 years. Macmillan and Shaw's pioneering study in Nottingham  was a 3-year prospective community study examining all cases of senile squalor which were reported by general practitioners, geriatricians, social workers and clergy. They called the condition senile
breakdown, viewed it as a distinct syndrome and reported no evidence of psychosis in 34 of the 72 cases encountered. They found that those at risk of lapsing into such squalor were 'old people of the independent and domineering type living alone, with poor or non-existent social links with their local community'. Clarke et al.  studied 30 cases of Diogenes syndrome admitted to an inpatient medical unit over a 10-month period and found a roughly similar proportion of cases (50%) where no psychiatric disorder was identified. Both studies identified a significant proportion of cases with higher than average intelligence. Clarke's study included personality assessment using the Cattell Personality Inventory and found patients were more aloof, suspicious, detached, aggressive and poorly socially integrated. In a study of 29 cases presenting to an old age psychiatry service, Wrigley and Cooney  found that about one-third of cases had no psychiatric disorder while most of the remainder suffered with dementia. There is a thus a consensus from the literature that at least half of the cases have psychiatric disorders [1, 4-6] the commonest diagnosis being dementia but with some cases of alcohol abuse, affective disorders and
paraphrenia. Although the majority of cases in all three studies were living alone, Macmillan and Shaw  and
Wrigley and Cooney  described five and four cases
respectively of couples in which both individuals fulfilled
criteria for the syndrome. The similarity with folie a deux has been noted [1, 8]. Diogenes syndrome by proxy  has
recently been described manifesting as a form of `elder abuse'
and could be an explanation for some cases of `Diogenes a deux'. To date all studies have concentrated exclusively on
persons in private households who exhibit the syndrome, although there is no doubt that it also occurs among homeless
elderly people. It is not easy to understand why a gross deterioration in
standards of personal and domestic hygiene should develop in persons who manifest no frank mental illness. A number of
hypotheses have been suggested. It has been argued that this condition represents the 'end stage of a personality disorder'  rather than a specific syndrome. Clinical experience suggests that many of those affected have previously been eccentric individuals who have led reclusive lives, but whether this constellation of personality traits justifies a diagnosis of personality disorder is debatable and would require more rigorous analysis. Orrell and Sahakian's  hypothesis that Diogenes syndrome is really a manifestation of a frontal-lobe dementia is intriguing but there is little supporting evidence. Frontal-lobe pathology may share symptoms in common with Diogenes syndrome, including irritability, aggression, reduced motivation and lack of insight, while syllogomania could represent a form of motor perseveration. However, the age distributions of the two conditions do not match, with frontal-lobe dementia occurring on average ten years earlier. Neuro-imaging or neuropathological studies of Diogenes syndrome cases would help to resolve this issue but would be difficult to conduct because of poor co-operation on the part of those affected.