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Guedes NLKO, Dwan AJ, Gerlero P, Nico MMS. Delusional infestation treated with risperidone: a series of 27 patients. Clin Exp Dermatol 2024; 49:364-367. [PMID: 38001055 DOI: 10.1093/ced/llad411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Patients with delusional infestation (DI) frequently refuse to be treated with psychoactive drugs. In the past, pimozide was commonly used as a first-line agent but is now prescribed more rarely. Risperidone was first used to treat DI in 1995. A recent review identified 12 studies that evaluated the use of risperidone in 43 patients with DI. OBJECTIVES To study the characteristics of and therapeutic results in patients with DI treated with risperidone at a university medical centre in São Paulo, Brazil. METHODS We performed a retrospective study of patients with DI treated with risperidone at a dermatological university clinic since 2016. Records were reviewed for personal data and findings related to treatment. RESULTS Twenty-seven patients were studied (20 women and 7 men). The maintenance dose of risperidone varied from 1 mg three times weekly to 8 mg daily. Control of symptoms was achieved in the majority of patients. A reduction in dosage due to side-effects was seen in four patients; risperidone had to be switched to another antipsychotic in three cases, despite a good response. Only one patient did not respond to risperidone. CONCLUSIONS Risperidone is an effective, well-tolerated and safe treatment for delusional parasitosis. Adequate follow-up is mandatory in order to obtain long-term control of symptoms.
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Affiliation(s)
| | - Alexandre J Dwan
- Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
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Gutierrez RA, Smith P, Kranyak A, Davis M, Koo J. Pimozide-induced tardive dyskinesia in the treatment of delusions of infestation. JAAD Case Rep 2024; 45:71-73. [PMID: 38406621 PMCID: PMC10883974 DOI: 10.1016/j.jdcr.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
| | - Payton Smith
- Department of Dermatology, University of California, San Francisco, California
| | - Allison Kranyak
- Department of Dermatology, University of California, San Francisco, California
| | - Mitchell Davis
- Department of Dermatology, University of California, San Francisco, California
| | - John Koo
- Department of Dermatology, University of California, San Francisco, California
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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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Mandari S, Aslan S, Deodatus S, Nyundo A. Delusional Infestation: A case of Ekbom syndrome in an elderly woman with a long history of HIV. Clin Case Rep 2023; 11:e7044. [PMID: 36911646 PMCID: PMC9994137 DOI: 10.1002/ccr3.7044] [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: 12/27/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
A 70-year-old female presented with a long history of HIV and 5 years of disturbing delusions of infestation that impaired her daily functioning. The delusions resolved with haloperidol but were followed by depressive symptoms. The case presents the complexity of managing neuropsychiatric manifestations of HIV/AIDS with comorbidities in old age.
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Affiliation(s)
- Sadiki Mandari
- Department of Psychiatry and Mental Health, School of Medicine and Dentistry The University of Dodoma Dodoma Tanzania.,Mirembe National Mental Health Hospital Dodoma Tanzania
| | - Suluma Aslan
- Department of Psychiatry and Mental Health, School of Medicine and Dentistry The University of Dodoma Dodoma Tanzania.,Mirembe National Mental Health Hospital Dodoma Tanzania
| | - Shani Deodatus
- Department of Dermatology Benjamin Mkapa Hospital Dodoma Tanzania
| | - Azan Nyundo
- Department of Psychiatry and Mental Health, School of Medicine and Dentistry The University of Dodoma Dodoma Tanzania.,Mirembe National Mental Health Hospital Dodoma Tanzania.,Department of Internal Medicine, Psychiatry Division Benjamin Mkapa Hospital Dodoma Tanzania
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5
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Turk T, Liu C, Fujiwara E, Straube S, Hagtvedt R, Dennett L, Abba-Aji A, Dytoc M. Pharmacological Interventions for Primary Psychodermatologic Disorders: An Evidence Mapping and Appraisal of Randomized Controlled Trials. J Cutan Med Surg 2023; 27:140-149. [PMID: 36802832 PMCID: PMC10068402 DOI: 10.1177/12034754231155888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The lack of clinical guidelines for the treatment of primary psychodermatologic disorders (PPDs) hinders the delivery of optimal care to patients. The review aimed to identify, appraise, and summarize the currently available evidence about the safety and effectiveness of pharmacological management of PPDs through randomized controlled trials (RCTs). METHODS The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRIMSA) statement and the Global Evidence Mapping Initiative guidance were followed. Medline, Embase, PsycInfo, Cochrane and Scopus were searched, and two reviewers independently completed article review, data extraction, and quality assessment. RESULTS Among 2618 unique studies, full texts of 83 were reviewed and 21 RCTs were included. Five PDDs were identified: trichotillomania (n = 12), pathologic skin picking (n = 5), nail biting (n = 2), delusional parasitosis (n = 1), and dermatitis from compulsive hand washing (n = 1). Seven different classes of medications were investigated: SSRIs (i.e., fluoxetine, sertraline, and citalopram), tricyclic antidepressants (i.e., clomipramine and desipramine), antipsychotics (i.e., olanzapine and pimozide), anticonvulsant (i.e., lamotrigine), N-acetylcysteine, inositol, and milk thistle. RCT-derived evidence supports the use of antidepressants in trichotillomania (sertraline and clomipramine), pathologic skin picking (fluoxetine), pathologic nail biting and dermatitis from compulsive hand washing (clomipramine or desipramine); antipsychotics in trichotillomania (olanzapine) and delusional parasitosis (pimozide); N-acetyl cysteine in trichotillomania and skin picking. CONCLUSION Few pharmacotherapies for primary psychodermatologic disorders are assessed through controlled trials in the literature. This review serves as a roadmap for researchers and clinicians to reach informed decisions with current evidence, and to build on it to establish guidelines in the future.
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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
| | - Chaocheng Liu
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Esther Fujiwara
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Sebastian Straube
- 12357 Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- 12357 ABA, Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Liz Dennett
- 67111 Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Adam Abba-Aji
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Marlene Dytoc
- 3158 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Canada
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González-Rodríguez A, Monreal JA, Natividad M, Seeman MV. Collaboration between Psychiatrists and Other Allied Medical Specialists for the Treatment of Delusional Disorders. Healthcare (Basel) 2022; 10:healthcare10091729. [PMID: 36141341 PMCID: PMC9498439 DOI: 10.3390/healthcare10091729] [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] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: There is increasing evidence that individuals with psychosis are at increased risk for cardiovascular disease, diabetes, metabolic syndrome, and several other medical comorbidities. In delusional disorder (DD), this is particularly so because of the relatively late onset age. Aims: The aim of this narrative review is to synthesize the literature on the necessity for medical collaboration between psychiatrists and other specialists. Methods: A non-systematic narrative review was carried out of papers addressing referrals and cooperation among specialists in the care of DD patients. Results: Psychiatrists, the primary care providers for DD patients, depend on neurology to assess cognitive defects and rule out organic sources of delusions. Neurologists rely on psychiatry to help with patient adherence to treatment and the management of psychotropic drug side effects. Psychiatrists require ophthalmology/otolaryngology to treat sensory deficits that often precede delusions; reciprocally, psychiatric consults can help in instances of functional sensory impairment. Close collaboration with dermatologists is essential for treating delusional parasitosis and dysmorphophobia to ensure timely referrals to psychiatry. Conclusions: This review offers many other examples from the literature of the extent of overlap among medical specialties in the evaluation and effective treatment of DD. Optimal patient care requires close collaboration among specialties.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, 5 Dr. Robert Square, 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, 08221 Terrassa, Spain
| | - José Antonio Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, 5 Dr. Robert Square, 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, 08221 Terrassa, Spain
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08221 Terrassa, Spain
- Correspondence:
| | - Mentxu Natividad
- Department of Mental Health, Mutua Terrassa University Hospital, 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto, 605 260 Heath Street West, Toronto, ON M5P 3L6, Canada
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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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Lu JD, Gotesman RD, Varghese S, Fleming P, Lynde CW. Treatments for Primary Delusional Infestation: Systematic Review. JMIR DERMATOLOGY 2022; 5:e34323. [PMID: 37632851 PMCID: PMC10334903 DOI: 10.2196/34323] [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: 10/18/2021] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delusional infestation, also known as Ekbom syndrome, is a rare delusional disorder characterized by the fixed belief that one is infested with parasites, worms, insects, or other organisms. Although delusional infestation is a psychiatric condition, patients often consult dermatologists with skin findings, and it is currently unclear what treatments are recommended for this disorder. OBJECTIVE We aimed to systematically review and describe the treatment and management of patients presenting with primary delusional infestation. METHODS A systematic search was conducted using Ovid on MEDLINE, Embase, PsycINFO, and the Cochrane Register of Clinical Trials. Relevant data, including treatment, dosage, response, adherence, and side effects, were extracted and analyzed. RESULTS A total of 15 case series were included, comprising 280 patients (mean age 53.3 years, 65.4% female) with delusional infestation. Overall, aripiprazole had the highest complete remission rate at 79% (11/14), although this was limited to 14 patients. Among drug classes, selective serotonin reuptake inhibitors were the most effective with a 79% (11/14) complete remission rate and 43% (9/21) partial remission rate in patients with comorbid depression, anxiety, or trichotillomania. First-generation antipsychotics and second-generation antipsychotics had similar complete remission rates (56/103, 54.4% vs 56/117, 47.9%, respectively) and partial remission rates (36/103, 35% vs 41/117, 35%, respectively). CONCLUSIONS Due to the rarity of delusional infestation, we only found 15 case series. However, we found that first-generation antipsychotics appear to be similar in effectiveness to second-generation antipsychotics for the treatment of primary delusional infestation. Larger studies and randomized controlled trials are needed to evaluate the efficacy of pharmacological therapy for delusional infestation. TRIAL REGISTRATION PROSPERO CRD42020198161; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=198161.
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Affiliation(s)
- Justin Di Lu
- Michael G DeGroote School of Medicine, Hamilton, ON, Canada
| | - Ryan D Gotesman
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shawn Varghese
- Michael G DeGroote School of Medicine, Hamilton, ON, Canada
| | - Patrick Fleming
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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Lepping P. Cogito, ergo praedico (I think, therefore I predict). BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2020.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYI comment on a new overview of the treatment of delusional infestation. I focus on the challenges of communicating with a patient who has delusions and evaluate practical advice. I look at philosophical models to explain those communication problems as well as theories of delusional formation, and examine how these may help clinicians to understand and overcome those challenges.
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Brownstone N, Koo J. Why is pimozide uniquely useful for the treatment of delusional patients in dermatology? J DERMATOL TREAT 2020; 33:1779. [PMID: 32940111 DOI: 10.1080/09546634.2020.1825611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nicholas Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, CA, USA
| | - John Koo
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, CA, USA
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