Ganser Syndrome Superimposed on Mania in Bipolar Disorder: A Case Report

Purpose Ganser syndrome is a rare and debated dissociative condition, typically associated with custodial or forensic settings. This case report aims to describe a transient Ganser state emerging during a manic episode of bipolar disorder and to discuss its diagnostic implications within affective psychopathology. Methods A detailed clinical assessment, including serial mental status examinations, physical examination, routine laboratory investigations, and MRI brain, was conducted in a 29-year-old man admitted with acute mania. Longitudinal observation on an inpatient unit was used to characterize the phenomenology, course, and response to treatment of his approximate answers and associated cognitive disturbances. Results The patient presented with classical manic symptoms alongside striking approximate answers across orientation, general knowledge, calculations, naming, and motor commands, despite preserved comprehension and intermittent correct responses. There were no abnormalities on physical examination, laboratory tests, or MRI brain. He lacked external incentives or forensic context suggestive of malingering. With risperidone, clonazepam, a supportive ward milieu, and reduction of psychosocial stressors, both affective and Ganser-like symptoms resolved completely, and he was unable to recall his earlier approximate answers. Conclusions This case supports the view that Ganser syndrome–like phenomena may emerge as a dissociative response within severe mood episodes, independent of custodial settings or clear secondary gain. Clinicians should consider Ganser syndrome when faced with organized but incorrect “near-miss” responses and assess carefully for underlying affective pathology, as timely, integrated management may facilitate full clinical recovery.