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Mendelsohn A, Sato T, Subedi A, Wurcel AG. State-of-the-Art Review: Evaluation and Management of Delusional Infestation. Clin Infect Dis 2024; 79:e1-e10. [PMID: 39039925 DOI: 10.1093/cid/ciae250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Indexed: 07/24/2024] Open
Abstract
Delusional infestation is a condition encountered frequently by healthcare professionals across a variety of specialties in which patients have a fixed, false belief that they are infested with living creatures, such as bugs, parasites, worms, or mites, or nonliving objects, such as fibers. Delusional infestation can be debilitating for patients, who not only present with intense psychological distress and physical discomfort but are also at risk of developing numerous dermatological and psychiatric complications. This condition poses unique diagnostic challenges, as these symptoms can occur secondary to many metabolic or infectious causes, as well as unique treatment challenges, with patients frequently refusing psychiatric care and consequently seeking evaluation by other healthcare professionals. In this review, we aim to use existing literature to provide clinicians in infectious diseases or other specialties with sufficient clinical context and treatment guidance for the appropriate management of delusional infestation.
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Affiliation(s)
- Alexandra Mendelsohn
- Tufts University School of Medicine, Infectious Diseases, Boston, Massachusetts, USA
| | - Taisuke Sato
- Tufts Medicine, Department of Infectious Diseases and Geographic Medicine, Boston, Massachusetts, USA
| | - Ankita Subedi
- Tufts Medicine, Department of Infectious Diseases and Geographic Medicine, Boston, Massachusetts, USA
| | - Alysse G Wurcel
- Tufts University School of Medicine, Infectious Diseases, Boston, Massachusetts, USA
- Tufts Medicine, Department of Infectious Diseases and Geographic Medicine, Boston, Massachusetts, USA
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2
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Abdulraouf Almarzooqi K, Dimitrov D, Alharmoodi K. Skin Deep: An Overlap of Delusions. Cureus 2024; 16:e62681. [PMID: 39036144 PMCID: PMC11258938 DOI: 10.7759/cureus.62681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Delusional infestation (DI) describes a fixed, false belief where a person believes that they are infested with living or inanimate pathogens despite the absence of medical evidence for such infestation. Descriptions of alleged pathogens have evolved over time, incorporating inanimate objects such as fibrous strands. With the emergence of Morgellons disease and its controversy, we report a case of a 40-year-old female presenting with a strong belief of scabies infestation along with fibers emerging from her skin. Further, although insects are still the most alleged source of infestation, the overlap of Morgellons disease and the delusion of infestation supports it as a DI variant and questions the notion of its existence as a separate diagnostic entity.
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Affiliation(s)
| | - Dimitre Dimitrov
- Department of Dermatology, Sheikh Khalifa Medical City, Abu Dhabi, ARE
| | - Khaled Alharmoodi
- Department of Psychiatry, Essex Partnership University NHS Foundation Trust, Colchester, GBR
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Espiridion ED, Charron L. Delusional Parasitosis Without Cutaneous Presentation: "I Have Moths in My Belly". Cureus 2024; 16:e63185. [PMID: 39070332 PMCID: PMC11273935 DOI: 10.7759/cureus.63185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Delusional parasitosis is a psychiatric illness characterized by a false belief of a parasite infestation, despite evidence to the contrary. The disorder typically presents as a dermatologic condition since patients often itch and pick at their skin to relieve the perceived infestation. Patients often have numerous cutaneous lesions that never heal due to persistent picking. Another hallmark presentation known as the "matchbox sign" has patients collecting "evidence" of their perceived infestation. This patient believed that he had "moths" infesting his stomach, creating "web-like" structures that spread as far as his nostrils. In this case study, we describe this presentation of the disorder and contextualize our patient in the current literature on delusional parasitosis.
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Affiliation(s)
- Eduardo D Espiridion
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
- Psychiatry, Reading Hospital, West Reading, USA
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4
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Sinha N, Suresh SB, Patil PS, Unni N. A Rare Presentation of Delusional Parasitosis With Koro-Like Syndrome. Cureus 2024; 16:e59946. [PMID: 38854356 PMCID: PMC11161850 DOI: 10.7759/cureus.59946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Delusional parasitosis (DP) with Koro-like syndrome poses a complex clinical challenge, demanding a comprehensive and empathetic approach from healthcare professionals. This exceptional combination of fixed beliefs about infestation and experiences of genital retraction can profoundly impact patients' well-being and daily functioning. The associated stigma and misconceptions further compound the difficulties faced by individuals struggling with these co-occurring conditions. Given the rarity of encountering both conditions simultaneously, navigating the diagnosis and treatment of delusional parasitosis with Koro-like syndrome requires a thorough understanding of its multifaceted nature. Embracing a holistic strategy encompassing psychoeducation, psychotherapy, and pharmacological interventions is essential for effectively addressing these dual conditions.
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Affiliation(s)
- Nayan Sinha
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sneha B Suresh
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pradeep S Patil
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Navaneetha Unni
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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5
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Katamanin O, Jafferany M. Psychological interventions in the treatment of delusional parasitosis: a brief review. Int J Dermatol 2024; 63:580-584. [PMID: 38115719 DOI: 10.1111/ijd.16968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
This review synthesized evidence on the most up-to-date treatment outcomes in patients with delusional parasitosis and examined the impact of incorporating psychological interventions in conjunction with psychiatric treatment. The reporting of this review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed and Google Scholar were searched between 2013 and 2023. Nine studies were included in this review. Partial remission was observed across all cases, irrespective of the treatment approach employed. Complete remission was limited to only three studies. No correlation was observed between the incorporation of psychological intervention in conjunction with psychotropic medication and an enhanced remission outcome. The findings underscore the importance of psychotropic medication as a fundamental component in the treatment of delusional parasitosis. The results highlight that although first- and second-generation psychotropic medications are the mainstay treatment options, they nevertheless play a limited role because of the patients' steadfast delusions of infestations.
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Affiliation(s)
- Olivia Katamanin
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
| | - Mohammad Jafferany
- Central Michigan University, College of Medicine/CMU Medical Education Partners, Saginaw, MI, USA
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6
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Christensen RE, Jafferany M. Unmet Needs in Psychodermatology: A Narrative Review. CNS Drugs 2024; 38:193-204. [PMID: 38386200 DOI: 10.1007/s40263-024-01068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
Psychodermatology, the multidisciplinary field that explores the intricate interplay between the mind and the skin, has gained increasing recognition over the past decade. However, several knowledge gaps and unmet needs persist in the field. The objective of this narrative review was to investigate the unmet needs in the field of psychodermatology as they pertain to medical training, treatment, research, and care access. PubMed was searched from inception through December 2023 to identify articles related to psychodermatology. Findings revealed several unmet needs within the field of psychodermatology. First, there is a need for further investigation into the pathophysiology that links psychological stress to cutaneous disease including the development of novel therapies targeting key neuropeptides. Second, the existing literature focuses primarily on the pharmacologic treatment of body dysmorphic disorder and body-focused repetitive behaviors, as well as delusional parasitosis, for which the first-line agents are selective serotonin reuptake inhibitors and atypical antipsychotics, respectively. However, additional research into the efficacy and safety of the remaining psychotropic medications and the treatment of other common psychocutaneous diseases is required. Finally, there exists a significant gap in knowledge amongst clinicians tasked with treating psychocutaneous diseases. Dermatologists report low rates of training in psychodermatology and discomfort with prescribing psychotropic medications. In conclusion, increasing resources for dermatologist education on psychotropic agent use, development of new drugs targeting stress-induced skin conditions, and research on the psychocutaneous applications of current medications may greatly improve the quality and access of psychodermatology care.
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Affiliation(s)
- Rachel E Christensen
- Department of Psychiatry and Behavioral Sciences, Central Michigan University College of Medicine/CMU Medical Education Partners, Saginaw, MI, 48603, USA
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, IL, 60611, United States
| | - Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, Central Michigan University College of Medicine/CMU Medical Education Partners, Saginaw, MI, 48603, USA.
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Mindru FM, Radu AF, Bumbu AG, Radu A, Bungau SG. Insights into the Medical Evaluation of Ekbom Syndrome: An Overview. Int J Mol Sci 2024; 25:2151. [PMID: 38396826 PMCID: PMC10889746 DOI: 10.3390/ijms25042151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Ekbom syndrome, also known as delusional parasitosis (DP) or delusional infestation, is an uncommon psychiatric disorder distinguished by an enduring conviction of parasitic infestation, persisting notwithstanding the presence of medical evidence to the contrary. Primarily affecting middle-aged women, DP can manifest either as isolated psychological distress or as a component within a more intricate psychiatric framework, substantially influencing the quality of life for affected individuals. Its pathophysiological mechanism involves uncertain dopaminergic imbalances and dysfunction in the dopamine transporter system. Dermatologists often play a pivotal role in diagnosis, as patients first seek dermatological assessments of their signs and symptoms. However, DP frequently originates from underlying psychiatric disorders or medical variables, manifesting with neurological and infectious causative factors. The diagnostic complexity is attributed to patients' resolute convictions, leading to delayed psychiatric intervention. First-line DP treatment involves antipsychotics, with newer agents demonstrating promising prospects, but the lack of standardized protocols poses a significant therapeutic challenge. In this narrative review, both a comprehensive approach to this uncommon pathology and an update on the state of knowledge in this medical subfield focused on optimizing the management of DP are provided. The complexity of DP underlying its uncommon nature and the incomplete understanding of its pathophysiology highlight the need for further research through multicenter studies and multidisciplinary teams to enhance therapeutic efficacy and safety.
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Affiliation(s)
- Florina Madalina Mindru
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Adrian Gheorghe Bumbu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Ada Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
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Coetzee S, Mahajan C, França K. The Diagnostic Workup, Screening, and Treatment Approaches for Patients with Delusional Infestation. Dermatol Ther (Heidelb) 2023; 13:2993-3006. [PMID: 37872445 PMCID: PMC10689332 DOI: 10.1007/s13555-023-01053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023] Open
Abstract
Delusional infestation (DI) is a psychiatric disorder defined by the fixed, false belief that one has been infested by an organism without evidence to support this. Patients may present with skin lesions and report abnormal cutaneous sensations. The diagnostic workup for patients presenting with delusional infestation is essential to ensuring accurate diagnosis in ruling out other explanations for symptoms and investigating potential secondary causes of DI. In addition to a comprehensive history and physical examination, laboratory workup should be considered depending on the clinical picture. Antipsychotic medications are the most common drugs used in management of adults with DI and tailor the choice of treatment according to patient characteristics. This article serves as a guide for dermatologists, psychiatrists, and other clinicians as it reviews the workup and screening that should be considered when managing a patient with delusional infestation and subsequent treatment protocols once the diagnosis has been made.
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Affiliation(s)
- Skyler Coetzee
- University of Miami/Holy Cross Health, Fort Lauderdale, FL, USA
| | - Chandrally Mahajan
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Katlein França
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1295 NW 14th St Suite K/L/M, Miami, FL, 33125, USA.
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, 33136, FL, USA.
- Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, P.O. Box 016960 (M-825), Miami, 33101, FL, USA.
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Gajbhiye A, Ali T, Aziz S, Singh P, Gandhi S, Chaudhury S, Patil J. Delusional parasitosis: A case series. Ind Psychiatry J 2023; 32:S258-S261. [PMID: 38370972 PMCID: PMC10871419 DOI: 10.4103/ipj.ipj_240_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/08/2023] [Accepted: 04/26/2023] [Indexed: 02/20/2024] Open
Abstract
Delusional parasitosis (DP) is an infrequent psychotic illness, where the patient has a false but firm belief that his body is infested with parasites. It can be primary or secondary. Usually, these patients consult nonpsychiatric specialties from where they are referred to psychiatry. The presentation of DP varies among patients, although it typically manifests as a crawling and pinpricking sensation. Hallucinations are commonly seen. Antipsychotics show good remission of symptoms. A series of seven cases of DP have been described, and the condition is briefly discussed.
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Affiliation(s)
- Akanksha Gajbhiye
- Department of Psychiatry, Dr. D Y Patil Medical College, Pimpri, Pune, Maharashtra, India
| | - Tahoora Ali
- Department of Psychiatry, Dr. D Y Patil Medical College, Pimpri, Pune, Maharashtra, India
| | - Sadaf Aziz
- Department of Psychiatry, Dr. D Y Patil Medical College, Pimpri, Pune, Maharashtra, India
| | - Pratishtha Singh
- Department of Psychiatry, Dr. D Y Patil Medical College, Pimpri, Pune, Maharashtra, India
| | - Shivang Gandhi
- Department of Psychiatry, Dr. D Y Patil Medical College, Pimpri, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D Y Patil Medical College, Pimpri, Pune, Maharashtra, India
| | - Jaideep Patil
- Department of Psychiatry, Dr. D Y Patil Medical College, Pimpri, Pune, Maharashtra, India
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Sevestre J, Marty P, Hubiche T, Pomares C, Delaunay P. Groundbreaking outpatient activity in medical entomology in France: An eight-year experience in a french university hospital. Infect Dis Now 2023; 53:104728. [PMID: 37295744 DOI: 10.1016/j.idnow.2023.104728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/21/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Arthropods are known to impair human health in various manners, acting as infectious disease vectors, or as simple nuisances. Even though considerable research is being produced in medical entomology, no reports on patient management in clinical entomology units are available in the literature. PATIENTS AND METHODS We retrospectively surveyed all the records from patients having consulted in our outpatient clinical entomology unit in Nice University Hospital from 2012 to 2020. For each patient, physical examination findings and treatment data were analyzed. RESULTS A total of 518 patients were analyzed in this study. Most were diagnosed with arthropod infestation (55.8%), the most common being Sarcoptes scabiei (35%), bedbugs (23%), Pyemotes dermatitis (17.6%) and flea infestation (15.9%). Along with symptomatic treatments, targeted environmental measures could be proposed for infested patients. For many of our patients, on the other hand, active infestation was ruled out. CONCLUSION Given today's lack of expertise in medical entomology, we advocate for the creation of medical entomology units in university hospitals, not only allowing fair and proportionate multidisciplinary management of patients in whom arthropod infestation is suspected, but also generating cost savings.
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Affiliation(s)
- Jacques Sevestre
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, Nice, France.
| | - Pierre Marty
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, Nice, France; C3M, INSERM 1065, Université de la Côte d'Azur, Nice, France
| | - Thomas Hubiche
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Christelle Pomares
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, Nice, France; C3M, INSERM 1065, Université de la Côte d'Azur, Nice, France
| | - Pascal Delaunay
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, Nice, France
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Adams SH, Endy TP, Larsen DA. Using Google Trends to Estimate the Geographic Distribution of Soil-Transmitted Helminthiasis in the United States from 2016 to 2021. Trop Med Infect Dis 2023; 8:tropicalmed8040212. [PMID: 37104338 PMCID: PMC10145709 DOI: 10.3390/tropicalmed8040212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Soil-transmitted helminth infections are assumed to be uncommon in the US, despite numerous studies in the past few decades showing high burdens in Appalachia and the southern states. We assessed trends of interest in the Google search engine to gauge spatiotemporal patterns of potential soil-transmitted helminth transmission. We conducted a further ecological study comparing Google search trends to risk factors for soil-transmitted helminth transmission. Google search trends for terms related to soil-transmitted helminths were clustered in Appalachia and the south, with seasonal surges suggestive of endemic transmission for hookworm, roundworm (Ascaris), and threadworm. Furthermore, lower access to plumbing, increased septic tank use, and more rural environments were associated with increased soil-transmitted helminth-related Google search terms. Together, these results suggest that soil-transmitted helminthiasis remains endemic in parts of Appalachia and the south.
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Affiliation(s)
- Steven H. Adams
- Department of Pathology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Timothy P. Endy
- Departments of Internal Medicine and Infectious Diseases, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - David A. Larsen
- Department of Public Health, Syracuse University, Syracuse, NY 13244, USA
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Alhendi F, Burahmah A. Delusional Parasitosis or Morgellons Disease: A Case of an Overlap Syndrome. Case Rep Dent 2023; 2023:3268220. [PMID: 37152271 PMCID: PMC10159739 DOI: 10.1155/2023/3268220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/22/2022] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
Background. Delusional parasitosis (DP) is a monosymptomatic hypochondriacal psychosis where the patient has the delusion of being infested with parasites, whereas Morgellons disease (MD) is described when the patient has fixed ideation of fibers or other materials emerging from skin. Both psychological and organic causes can result into the delusion of infestation, and careful examination is required to exclude secondary causes. Oral DP can result in self-inflected mutilations of the oral mucosa. To our knowledge, oral DP is only rarely reported in the literature. Here, we describe and discuss the management of a case of overlap between oral DP and oral MD at the oral medicine (OM) clinic. Case Report. A 50-year-old male presented to the OM clinic with ulcerations of oral and perioral tissues. Patient reported inflicting wounds to himself using a shaving blade to extirpate worms and pieces of glass from underneath his oral and perioral mucosa. Clinical and laboratory investigations ruled out parasitic infestations. Self-inflected ulcers were treated with topical steroids and prophylactic antifungals, and the patient was referred for psychiatric evaluation. A diagnosis of primary DP was reached, and the patient was managed with antipsychotics. Practical Implications. Oral health care providers should be familiar with oral manifestations of psychiatric disorders and should be able to manage such patients in a multidisciplinary team of internist, dermatologist, and psychiatrist.
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Affiliation(s)
- Fatmah Alhendi
- Department of Oral Medicine, Ministry of Health of Kuwait, P. O. Box (5), Safat 13001, Kuwait
| | - Abdullatif Burahmah
- Department of Oral Medicine, Ministry of Health of Kuwait, P. O. Box (5), Safat 13001, Kuwait
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Coyner T. Skin Test. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Muacevic A, Adler JR. Treatment of Ekbom Syndrome With Clozapine and Electroconvulsive Therapy. Cureus 2022; 14:e30469. [PMID: 36415401 PMCID: PMC9673619 DOI: 10.7759/cureus.30469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 01/25/2023] Open
Abstract
Delusion of parasitosis (DP), which is also known as Ekbom syndrome, is a delusional disorder characterised by a false, fixed belief of being infested by insects or mites, despite the lack of supporting medical evidence. This disorder presents most commonly with the "Matchbox sign." DP can present as a primary or secondary delusional disorder. It can be associated with various psychiatric conditions such as schizophrenia spectrum disorders, mood disorders, anxiety or substance abuse. Several organic conditions such as dementia, malignancies, vitamin deficiencies and cerebrovascular accidents can mimic symptoms of DP. Hereby, we present a case of schizophrenia in a young woman associated with DP in our inpatient care and the treatment outcome with the use of clozapine and electroconvulsive therapy (ECT) regimen.
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Romiti F, Magliano A, Del Lesto I, Filugelli L, Montarsi F, Carlin S, De Liberato C. Delusional parasitosis: an entomological perspective after a 20-years-experience in two public medical and veterinary entomology laboratories. Acta Trop 2022; 234:106614. [PMID: 35872007 DOI: 10.1016/j.actatropica.2022.106614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/01/2022]
Abstract
Delusional parasitosis (DP) is psychiatric disorder characterized by the unshakeable belief of being infested by endo- or ectoparasites, without any evidence of infestations. Hence, DP sufferers often consult medical entomologists or dermatologists, rather than seeking help from a mental health practitioner. Here we present 39 cases of suspected DP occurred in twenty years in two Italian public medical entomology laboratories, to highlight their common features and peculiarities, based on the interviews and material brought to our laboratories. Our results confirmed that DP affects both sexes, but is more frequent in females over the age of 50 years. Cases of psychological contagion, mostly affecting elderly people, were reported within seven family units. Some rare or unique features of DP sufferers involved: the fixed belief to be infested by endoparasites, olfactory hallucinations of unpleasant smell, self-harm to get rid of the imaginary parasite and suicidal thoughts. We suggest the term "Digital pics sign" to describe a modern derivative of the "Matchbox sign", where the DP sufferers showed pictures and videos, in person or sent by email, as proofs of being infested. Medical entomologists, being the most frequently contacted professionals by DP sufferers, may be crucial to raise awareness about this psychological disorder and to encourage a multidisciplinary approach amongst medical professionals and pest control operators.
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Affiliation(s)
- Federico Romiti
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, M. Aleandri, Via Appia nuova, 1411, 00178 Rome (RM), Italy
| | - Adele Magliano
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, M. Aleandri, Via Appia nuova, 1411, 00178 Rome (RM), Italy
| | - Irene Del Lesto
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, M. Aleandri, Via Appia nuova, 1411, 00178 Rome (RM), Italy.
| | - Lorena Filugelli
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10, 35020 Legnaro (PD), Italy
| | - Fabrizio Montarsi
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10, 35020 Legnaro (PD), Italy
| | - Sara Carlin
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10, 35020 Legnaro (PD), Italy
| | - Claudio De Liberato
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, M. Aleandri, Via Appia nuova, 1411, 00178 Rome (RM), Italy
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Management of delusions of parasitosis: an interview with experts in psychodermatology. Int J Womens Dermatol 2022; 8:e035. [PMID: 35822193 PMCID: PMC9270601 DOI: 10.1097/jw9.0000000000000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 06/09/2022] [Indexed: 11/26/2022] Open
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Cohen PR. “Doctor, You Must Examine My Creature Collection!”: A Case Report of Delusional Infestation. Cureus 2022; 14:e25758. [PMID: 35812529 PMCID: PMC9270088 DOI: 10.7759/cureus.25758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
Delusional infestation--either secondary when attributed to a medical condition (including a bon-a-fide parasite infestation) or a pharmacologic agent (prescribed or illicit) or primary when secondary etiologies have been excluded--is a psychosis in which, for at least one month duration, the patient not only has a delusion that an animate organism or an inanimate pathogen has infested them, but also has abnormal tactile sensation (such as pruritus) of their skin caused by the etiology of their delusion. In patients over the age of 50 years, a delusional infestation is three times more common in women than men; however, delusional infestation in younger patients is often secondary, associated with illicit drug exposure, and equally common in women and men. Primary skin lesions are typically absent in delusional infestation patients; however, secondary skin lesions--resulting from the patient’s efforts to remove the parasite from their skin--can be observed, such as excoriations, prurigo nodules, scars, and ulcers. Delusional infestation patients typically strive to convince the person evaluating them that their infestation is valid and many of these individuals do this by collecting the parasites in a container. Presentation of the pathogen-filled containers is a pathognomonic feature of delusional infestation that has been referred to as either a positive creature collection sign, match box sign, parasite preservation sign, pillbox sign, or specimen sign. Morgellons disease--in which the pathogen being extruded from the skin is a fiber--has several features (including an excellent response to treatment with antipsychotic agents) in common with delusional infestation; therefore, most investigators consider Morgellons disease to be a variant of delusional infestation. Delusional infestation can be associated with numerous diseases, including comorbid psychiatric conditions. Indeed, up to 15 percent of delusional infestation patients have one (folie a deux) or more individuals with similar symptoms. A man with delusional infestation is described who had a positive creature collection sign, a fixed belief that his symptoms were caused by the infesting organism, and refusal to accept that he had a psychiatric disorder. He insisted that the evaluating dermatologist examine the pathogens in the clear plastic container he brought with him to his appointment. He was convinced that the pruritus of his scalp, eyebrows, and eyelashes was associated with a non-existent lice infestation. Secondary delusional infestation was excluded and his concurrent mild seborrheic dermatitis was treated topically; however, his itching did not resolve. He eventually agreed to seek treatment with a psychiatrist. The management of delusional infestation is based on its etiology; resolving the underlying medical condition or discontinuing the causative pharmacologic agent is the treatment approach for secondary delusional infestation, whereas low-dose antipsychotic agents are the intervention of choice for treating primary delusional infestation.
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Kalovidouri C, Kowalewski L, Mos DV, Waqar MU. A Case of Delusional Parasitosis With Folie à Deux Treated With Low-Dose Quetiapine. Cureus 2022; 14:e25344. [PMID: 35774659 PMCID: PMC9236695 DOI: 10.7759/cureus.25344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
A patient with a three-month history of persistent delusions of infestation presented to the emergency department with suicidal ideation secondary to complaints of worsening pruritus. Routine investigations failed to disclose any underlying organic cause for her pruritic sensations. The patient ascribed these to a parasitic infestation acquired following a brief stay at her maternal aunt’s residence. Following a thorough psychiatric assessment and collateral history obtained from her aunt, it became clear that both the patient and her aunt held similar delusions of infestation. Her aunt was found to be the main inducer. The patient was admitted, successfully treated with low-dose quetiapine, and eventually deemed fit for discharge. Delusional parasitosis and folie à deux are both rare conditions that may sometimes co-occur.
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Ahmed A, Affleck AG, Angus J, Assalman I, Baron SE, Bewley A, Goulding JMR, Jerrom R, Lepping P, Mortimer H, Shah R, Taylor RE, Thompson AR, Mohd Mustapa MF, Manounah L. British Association of Dermatologists guidelines for the management of adults with delusional infestation 2022. Br J Dermatol 2022; 187:472-480. [PMID: 35582951 DOI: 10.1111/bjd.21668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Alia Ahmed
- Frimley Health Foundation Trust, Windsor, SL4 3DP, UK.,Barts Health NHS Trust, London, E1 2ES, UK
| | | | - Janet Angus
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Avon, BS1 3NU, UK
| | - Iyas Assalman
- East London NHS Foundation Trust, London, E1 8DE, UK
| | - Susannah E Baron
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Anthony Bewley
- Barts Health NHS Trust, London, E1 2ES, UK.,Queen Mary University of London, London, E1 4NS, UK
| | | | - Richard Jerrom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Peter Lepping
- Wrexham Maelor Hospital Liaison Psychiatry, Betsi Cadwaladr University Health Board, Wrexham, LL13 7TD, UK
| | - Helen Mortimer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Reena Shah
- Central and North West London NHS Foundation Trust, London, NW1 3AX, UK
| | | | - Andrew R Thompson
- Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK.,Cardiff University, Cardiff, Wales, CF10 3AT, UK.,British Psychological Society, London, EC2A 4UE, UK
| | | | - Lina Manounah
- Willan House, British Association of Dermatologists, London, W1T 5HQ, UK
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20
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Mardhiyah SA, Effendy E. Case Report: Ekbom Syndrome Presented with Shared Psychotic Disorder. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Ekbom syndrome, which is also known as delusional parasitosis, is an infrequent psychotic disorder that is marked by a very intense and strongly unshakeable false belief that there is a parasitic infestation, usually occurring on or beneath the skin, even though there is no medical proof to explain it. This phenomenon can also present with a shared psychotic disorder which eventually is very rare, accounting for only 5-15% of psychiatric cases worldwide.
Case Presentation: Mrs. Z, a 56-year-old woman, consulted the emergency unit of Universitas Sumatera Utara General Hospital along with her daughter, complaining of serious itchiness and skin problem due to crawling bugs and worms beneath her skin. Mrs. Z appeared furious, agitated and hyperventilating. Her daughter also admitted that she has the same skin condition. They have tried to appoint a consultation to several doctors but did not get any “appropriate” explanation. 1 ml of Haloperidol (5mg/ml) was initially administered via IM injection to calm Mrs. Z, and oxygen was given to help ease her breathing. We then advised Mrs. Z and her daughter to visit our psychiatry outpatient clinic the day afteron the next day. Through a careful interview, we found that Mrs. Z experienced Ekbom syndrome or delusional parasitosis that is also shared with her daughter. Both were given risperidone with an initial dose of 1 mg/day and sertraline 50mg/day.
Conclusion: We found a rare case of delusional parasitosis presented with shared psychotic disorder among a mother and a daughter. Initiation of psychiatric therapy is quite challenging, as patients often refuse due to stigmatization and their firm belief that instead of psychiatric illness, they actually have a parasitic infection. A multidisciplinary approach and strong patient-therapist relationship are a necessity in treating this type of patient.
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21
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Orsolini L, Corona D, Salvi V, Volpe U. Long-acting paliperidone in Ekbom's syndrome in Lewy body dementia: A case report. Transl Neurosci 2022; 13:201-210. [PMID: 35975126 PMCID: PMC9334881 DOI: 10.1515/tnsci-2022-0230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Ekbom Syndrome (ES) is characterised by fixed, delusional beliefs that one's body is infested by parasites or other vermin in absence of supporting clinical evidence. Antipsychotic (AP) treatment, including long-acting injectable (LAI) AP in subjects with poor compliance, is prescribed to manage behavioural and psychotic symptomatology. Objectives We describe a 70-year-old woman who was hospitalised after experiencing new-onset delusions of infestation with visual and tactile hallucinations that led to bizarre behaviours and progressive social withdrawal. Methods She was diagnosed with ES and was initially treated with risperidone 3 mg; however, due to poor compliance and a lack of insight, she was switched to LAI palmitate paliperidone (LAI-PP). She was followed up for 8 months, administering Positive and Negative Syndrome Scale, Montreal Cognitive Assessment, Global Assessment of Functioning, Brief Psychiatric Rating Scale, neurocognitive assessment, and neuroimaging. Results After a progressive cognitive deterioration, she was diagnosed with an ES secondary to Lewy body dementia (DLB). Conclusion The LAI-PP treatment determined a complete clinical remission of psychotic symptoms despite the emergence of an iatrogenic akinetic-rigid syndrome. The delay of confirmatory neurological diagnosis, the associated risky behaviours of the patient, and poor treatment adherence led clinicians to prescribe LAI-PP following a good clinical response to oral paliperidone. However, in the case of a suspected DLB diagnosis, the prescription of an LAI-PP as a first-line strategy should be carefully evaluated.
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Affiliation(s)
- Laura Orsolini
- Department of Clinical Neurosciences/DIMSC, Unit of Clinical Psychiatry, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Diana Corona
- Department of Clinical Neurosciences/DIMSC, Unit of Clinical Psychiatry, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Virginio Salvi
- Department of Clinical Neurosciences/DIMSC, Unit of Clinical Psychiatry, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Umberto Volpe
- Department of Clinical Neurosciences/DIMSC, Unit of Clinical Psychiatry, Polytechnic University of Marche, 60126, Ancona, Italy
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22
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Khan A, Pooja V, Patil J, Saldanha D. Delusional parasitosis after sexual abuse. Ind Psychiatry J 2021; 30:S348-S349. [PMID: 34908733 PMCID: PMC8611579 DOI: 10.4103/0972-6748.328853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/19/2021] [Accepted: 08/02/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Aslam Khan
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - V Pooja
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Jaideep Patil
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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23
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Delusional infestation in clinical practice over a period of two decades. Postepy Dermatol Alergol 2021; 38:144-150. [PMID: 34408581 PMCID: PMC8362780 DOI: 10.5114/ada.2019.88464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Patients presenting with cutaneous symptomatology may in fact suffer from underlying psychiatric conditions. Individuals diagnosed with delusional infestation (DI) have a fixed false belief of being infested with certain organisms or objects. Aim To analyse clinical features of subjects with DI who were admitted to the tertiary dermatology ward. Material and methods A retrospective analysis concerning DI patients hospitalized between 1997 and 2019 was carried out. The emphasis was put on the duration of symptoms, psychiatric symptomatology (including the "specimen sign"), comorbidities as well as therapy. Results We gathered data regarding 21 consecutive patients with DI. The mean age of subjects was 65.2 ±13.3 years, the majority were females (76.2%). The mean time span between the disease onset and diagnosis was 1.9 ±1.7 years. Previous psychiatric consultations were attended by 57.0% of patients. The specimen sign was present in 47.6% of cases, whereas the most common suspected causative factors were described as worms (52.4%), unspecified parasites (42.9%), "something" (33.3%) and flies (19.0%). Primary delusional disorder was diagnosed in 76.2%, followed by shared delusional disorder and secondary delusional disorder of organic origin (9.5% each). Risperidone monotherapy was initiated in 61.9% of patients. In total, only 33.3% of patients attended the follow-up visit. Conclusions DI features a wide spectrum of clinical signs and symptoms. Risperidone remains the drug of choice in the majority of cases. Successful management of each DI case requires collaboration between dermatologists and psychiatrists and still remains a major challenge.
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24
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Windbiel-Rojas K, Matuskey R, Parilo DW. Delusional infestation: What nurses should know. Nursing 2021; 51:50-54. [PMID: 34347755 DOI: 10.1097/01.nurse.0000757152.58008.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
ABSTRACT Patients with delusional infestation, a rare psychiatric disorder, have a false and fixed belief that insects or other organisms are crawling in or on their skin. This article describes signs and symptoms, available treatments, and appropriate nursing interventions for patients with primary delusional infestation.
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Affiliation(s)
- Karey Windbiel-Rojas
- Karey Windbiel-Rojas is associate director for urban and community integrated pest management at the University of California Statewide Integrated Pest Management Program/UC Agriculture and Natural Resources in Davis, Calif. Rachel Matuskey is a recent graduate of the School of Nursing, California State University in Sacramento, Calif., where Denise Wall Parilo is a professor
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25
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Norman FF, López-Vélez R. Delusional parasitosis: An unrecognized and underdiagnosed entity? Enferm Infecc Microbiol Clin 2021; 39:221-222. [PMID: 33810893 DOI: 10.1016/j.eimc.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
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26
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Turk T, Fujiwara E, Abba-Aji A, Mathura P, Dytoc M. Psychodermatology in Canada: A National Survey Assessment of Dermatologists' Perception, Practice Patterns, and Challenges. J Cutan Med Surg 2020; 25:249-256. [PMID: 34039041 DOI: 10.1177/1203475420977473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to assess the perception of psychodermatology, practice patterns, and challenges reported by Canadian dermatologists. METHODS We designed an online questionnaire based on previous literature, including questions about practitioners' perceptions, practice patterns, training, and challenges in psychodermatology. We solicited their opinions on desired training, research needs, and clinical approach recommendations. Our survey was distributed nationally by the Canadian Dermatology Association (CDA). RESULTS Of the total of 78 participating dermatologists, >75% reported treating patients with psychodermatological conditions, with higher frequencies of secondary than primary psychodermatological conditions. While practitioners had some confidence in their understanding of psychodermatology (median = 4 on a 5-point scale), their comfort levels to approach these patients were lower (median = 3), and their confidence in prescribing psychotropic medication was markedly low (median = 2). A total of 50% reported that a "multidisciplinary approach" would be best for these patients. Poor access to psychiatry was the most reported (26.9%) challenge, together with time constraints, lack of training, poor communication with patients, and lack of patient insight and resources. While 46.2% reported having never participated in psychodermatology training, 55.1% expressed interest in doing so. CONCLUSION We identified several challenges with knowledge, awareness, and healthcare delivery in psychodermatological practice in Canada. Increasing dermatologists' access to psychiatric consultations/services, a multidisciplinary approach with dermatologists and psychiatrists co-providing care, and more specialized training in this area are recommended to narrow the identified gaps.
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Affiliation(s)
- Tarek Turk
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada.,Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Ministry of Health, Damascus, Syria
| | - Esther Fujiwara
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Adam Abba-Aji
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Pamela Mathura
- 3158 Department of Medicine, University of Alberta, Edmonton, Canada
| | - Marlene Dytoc
- 3158 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Canada
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Abstract
Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition—processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social organization and the ongoing reconceptualization of belief as serving a social organizational function.
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Affiliation(s)
- Vaughan Bell
- Research Department of Clinical, Educational and Health Psychology, University College London.,Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Foundation Trust, London, England
| | - Nichola Raihani
- Department of Experimental Psychology, University College London
| | - Sam Wilkinson
- Department of Sociology, Philosophy and Anthropology, Exeter University
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28
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Tan G, Zhang H, Feng W, Liu Z. A patient with delusional parasitosis secondary to herpes zoster and comorbid depression: a case report. Psychogeriatrics 2020; 20:941-943. [PMID: 33047441 DOI: 10.1111/psyg.12619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Guifeng Tan
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Han Zhang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenhui Feng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhonglin Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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29
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Torales J, García O, Barrios I, O'Higgins M, Castaldelli-Maia JM, Ventriglio A, Jafferany M. Delusional infestation: Clinical presentations, diagnosis, and management. J Cosmet Dermatol 2020; 19:3183-3188. [PMID: 33098221 DOI: 10.1111/jocd.13786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delusional infestation is a primary psychiatric disorder characterized by a somatic-type delusional disorder (primary delusional infestation) that may lead to self-induced cutaneous lesions which are often difficult to recognize and treat properly. It may be also secondary to other psychiatric disorders, medical diseases, or substance abuse. AIMS This review will describe prevalence, common clinical features, different clinical presentations, differential diagnoses, and treatment recommendation. Special focus has been put on psychological aspects. METHODS We conducted a literature search on PubMed from January 2001 to June 2020 with the search terms of delusional parasitosis, delusional infestation, psychological, Reference lists of identified articles were examined for further relevant studies. The search was limited to English language articles. No specified quality criteria were used for study inclusion. RESULTS The clinical manifestations of delusional infestation are very important in the differential diagnosis and its psychological implications and management perspectives. CONCLUSION This article presents an update regarding the clinical aspects and treatment options of delusional infestation in order to provide an up-to-date review for dermatologists and general practitioners.
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Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Mount Pleasant, MI, USA
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30
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Delusional parasitosis. A multicenter retrospective study in Spanish infectious disease services. Enferm Infecc Microbiol Clin 2020; 39:223-228. [PMID: 33010962 DOI: 10.1016/j.eimc.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Delusional parasitosis or Ekbom syndrome is a condition described mainly in the fields of psychiatry and dermatology, with a complex diagnostic and therapeutic approach. However, it is uncommon to assess patients with this disease in infectious disease units. The objective of this work is to describe the experience of three infectious diseases departments with respect to this entity. METHODS A retrospective descriptive study of 20 patients diagnosed with delusional parasitosis in three Infectious Diseases Services was performed between 2003 and 2017. RESULTS The median age of the patients was 54 years, with a female/male ratio of 1.5:1. In 9 patients, an endoparasitic delirium (mainly digestive) was described, in 5 an ectoparasitic form was described, and in the remaining 6, a mixed form was described. Fourteen patients presented some type of psychiatric disorder. Four patients had alcohol or drug abuse disorder. All patients had made consultations to other specialties with a median of three per patient (range 1-7). Ten patients received "empirical" antiparasitic treatment and 8 received some type of psychopharmaceutical treatment. The evolution was very variable: in 3 patients, the delusional parasitosis was resolved; in 9 patients, the clinical manifestations persisted, and the remaining patients were lost to follow-up. CONCLUSIONS Ekbom syndrome is a common process in infectious diseases, presenting some differences with other series evaluated by dermatologists and psychiatrists. Management of this disease should promote a multidisciplinary approach to enable a joint treatment, thus optimizing patient management and therapeutic adherence.
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Abstract
Ekbom's syndrome represents a relatively uncommon neuropsychiatric condition characterized by the recurrent and bizarre fixed delusional belief to be infested by small organisms or even unanimated materials ('Morgellons disease'), without any objective evidence of infestation/parasitosis. The condition, mainly diagnosed in a nonpsychiatric setting, is supposed to be largely underestimated and, hence, undermanaged. The present comprehensive review aims at investigating Ekbom's syndrome, from a historical, epidemiological, clinical and therapeutic perspective, by providing diagnostic-treatment strategies in managing this condition in routine psychiatric clinical settings. The prototypical patient is a middle-aged woman (or a younger subject in those cases in which substance and/or alcohol abuse is implicated), often single, divorced or widowed (loneliness component and social withdrawal), who has already consulted several specialists due to skin lesions associated with a firm and delusional belief to be infested. The identification and diagnosis are challenging due to poor patient's insight, poor knowledge and collaboration between specialists and differential diagnoses to be considered before asking for a psychiatric referral. Management and treatment strategies mainly derive from isolated case reports or observational studies with a small sample size. Further randomized clinical trials should be performed to evaluate the efficacy of newer antipsychotic drugs, including long-acting injectable formulations.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Alessia Gentilotti
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Giordani
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
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32
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Shenoi SD, Soman S, Munoli R, Prabhu S. Update on Pharmacotherapy in Psychodermatological Disorders. Indian Dermatol Online J 2020; 11:307-318. [PMID: 32695685 PMCID: PMC7367593 DOI: 10.4103/idoj.idoj_330_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/28/2019] [Accepted: 09/28/2019] [Indexed: 12/15/2022] Open
Abstract
Psychodermatological (PD) conditions encountered in dermatologic practice include primary psychiatric conditions such as delusions of parasitosis or secondary psychiatric conditions such as anxiety and depression due to dermatologic disease. The psychotropics include antipsychotic agents, anti-anxiety agents, antidepressants, and miscellaneous drugs such as anti convulsants. Anti psychotics are further divided into first-generation and second-generation drugs. Currently, second-generation drugs e.g., risperidone are preferred over first-generation drugs e.g., pimozide in delusional infestation owing to the side effect profile of the latter. Anti-anxiety agents include benzodiazepines used in acute anxiety and buspirone in chronic anxiety disorders. They are frequently prescribed along with antidepressants. Although dependence and necessity of tapering is a problem with benzodiazepines, delayed onset of action is a feature of buspirone. The commonly used antidepressants in dermatology include selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), selective serotonin norepinephrine reuptake inhibitors (venlafaxine, desvenlefaxine, and duloxetine), norepinephrine dopamine reuptake inhibitors (bupropion), tricyclic antidepressants (doxepin, amitriptyline, imipramine, and clomipramine), and tetracyclic antidepressants (mirtazapine). Miscellaneous drugs include anticonvulsants such as gabapentin and pregabalin, naltrexone, and N-acetyl cysteine. The principles of PD treatment are first establish the psychiatric diagnosis, followed by initiating drug treatment. The choice of drugs is dependent on multiple factors such as side-effect profile, drug interactions, and co-morbid conditions. Usually, drugs are started at a low dose and gradually increased. A literature search was done in Pubmed, Google Scholar, and Medline databases, and articles on treatment were analyzed.
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Affiliation(s)
- Shrutakirthi D Shenoi
- Department of Dermatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Savitha Soman
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Ravindra Munoli
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Smitha Prabhu
- Department of Dermatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India
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Abstract
Delusional parasitosis, also known as delusional infestation or Ekbom syndrome, is a relatively infrequent psychotic disorder characterized by an unwavering false belief that there is a parasitic infestation of the skin, despite the absence of any medical evidence that could support this claim. Delusional parasitosis can be categorized into primary, secondary, and organic forms. Sometimes, close relatives also experience identical delusions. This phenomenon was reported to occur in 5-15% of cases, and is known as shared psychotic disorder-delusional parasitosis with folie à deux. Patients with delusional parasitosis frequently seek help from many physicians. Close multidisciplinary cooperation between clinicians is often key to shortening the time taken to diagnose this disorder. Initiation of psychopharmacological therapy is a challenge, as many patients refuse any psychiatric treatment because of the stigma associated with mental illness and because of their firm belief that they have a parasitic infestation, not a psychiatric condition. For many patients, a sense of a lack of understanding leads to isolation and the development of depression symptoms, which is why it is crucial to earn the trust of such patients while taking care of them.
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Affiliation(s)
- Adam Reich
- Uniwersytet Rzeszowski, Rzeszow, Poland.
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Garcia-Mingo A, Dawood N, Watson J, Chiodini PL. Samples From Cases of Delusional Parasitosis as Seen in the UK Parasitology Reference Laboratory (2014-2015). Open Forum Infect Dis 2019; 6:ofz440. [PMID: 31660383 PMCID: PMC6810309 DOI: 10.1093/ofid/ofz440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/06/2019] [Indexed: 11/13/2022] Open
Abstract
Delusional parasitosis is a common syndrome seen in Infectious Diseases clinics. These patients characteristically provide samples as evidence of their infestation. We prospectively catalogued and characterized 138 samples from these patients, processed in the UK Clinical Parasitology reference laboratory from January 2014 to April 2015. No human parasites were identified.
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Affiliation(s)
| | - N Dawood
- Brighton and Sussex University Hospital
| | - J Watson
- Hospital for Tropical Diseases, London, United Kingdom
| | - P L Chiodini
- Hospital for Tropical Diseases, London, United Kingdom
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Çınar M, Kutlutürk P, Ertek İE, Coşar B. Aripiprazole as a treatment option for delusional parasitosis: case series of 8 patients. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1653134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Meltem Çınar
- Department of Psychiatry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Pelin Kutlutürk
- Department of Psychiatry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - İrem Ekmekçi Ertek
- Department of Psychiatry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Behçet Coşar
- Department of Psychiatry, Faculty of Medicine, Gazi University, Ankara, Turkey
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Fisher JD. Emergency department presentation of 'delusional parasitosis by proxy'. Delusional parent, injured child. Am J Emerg Med 2019; 37:1806.e1-1806.e2. [PMID: 31182365 DOI: 10.1016/j.ajem.2019.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022] Open
Abstract
We report a case of 'delusional parasitosis by proxy'. A sixyear old child was brought to the emergency department by a mother with concerns that her son had a skin and scalp infestation. Despite the absence of any clinical findings being found on exam, the mother remained disproportionately concerned. Follow up care was recommended with the child's primary care. The mother returned to the ED with her child three weeks later with concerns that her son had an inflamed scalp and eyes. The mother remained insistent that the child was infested with bugs and she had sought care at two other locations where the child was prescribed permethrin on both visits. She had been applying the medication repeatedly. On exam the boy's scalp had been shaved and was erythematous and irritated; his eyebrows and eyelashes had also been shaved off and likely contributed to an irritant conjunctivitis from repeated applications of topical permethrin lotion. No evidence of infestation was identified. We recruited the assistance of the maternal grandparents, child protective services and primary care pediatrics and the child was removed from the mother's custody and placed into the custody of the grandparents. Six weeks later with basic skin care and erythromycin ophthalmic ointment for the eyes, the child's hair, eyebrows and eyelashes grew had grown in, and the scalp irritation had resolved. The mother had sought and received psychiatric care and was improving.
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Affiliation(s)
- Jay D Fisher
- UNLV School of Medicine, Department of Emergency Medicine, United States of America.
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What We Know and Still Need to Know about Gender Aspects of Delusional Disorder: A Narrative Review of Recent Work. ACTA ACUST UNITED AC 2019. [DOI: 10.20900/jpbs.20190009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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