Lyme disease or a complication of delusional parasitosis?

Abstract

Australian & New Zealand Journal of Psychiatry, 48(1) severe depression with delusional thoughts about inappropriate digestive tract function, aversion to eating and further weight loss continued. We also observed further life-threatening weight loss despite a high-calorie diet. Apart from hyperthyroidism other diseases were excluded. The patient maintained compliance of all prescribed drugs (sertraline 100 mg/ day, risperidone 5 mg/day, mirtazapine 45 mg/day and methimazole 40 mg/day). Repeat blood tests showed TSH 46.8039 uIU/ml, fT4 1.47 ng/dl and fT3 1.60 pg/ml. On the basis of these results the endocrinologist diagnosed hypothyroidism. Treatment with 25 μg/day of levothyroxinum up to a dose of 150 μg/day was started and after a few weeks euthyroid (normal thyroid function) was obtained. Despite this the patient still had suicidal thoughts, nihilistic delusions and hypochondriacal delusions related to the necrobiosis of his digestive tract. As a result, ECT was commenced. The patient received a course of 12 procedures of ECT under anaesthesia every second day. Simultaneously, the patient received venlafaxine 225 mg/day and olanzapine 10 mg/day. ECT together with pharmacotherapy was effective. The patient’s mood, appetite and psychomotor drive increased and delusions with suicidal thoughts disappeared. This case report distinctly shows that the coexistence of a somatic disease (thyroid hormone imbalance) might cause a significant delay in the onset of starting ECT in patients with drugresistant depression. Therefore, it is crucial to obtain euthyroid as soon as possible, otherwise the inability to use ECT and antidepressant drugs can be fatal.