Delusional parasitosis (DP), also known as delusional infestation, monosymptomatic hypochondriacal psychosis, or Ekbom's syndrome, is a rare primary psychiatric disorder.[1] It is characterized by patients' fixed belief that their skin and body and rarely also their close personal environment are infested by small, vivid, or less frequently inanimate pathogens, although there is no medical or microbiological evidence for this.[2] Most, but not all, patients blame the pathogens for causing various tactile sensations and itching. It has most frequently been reported in women, the sixth decade of the person's life. There are some case reports of the condition as an initial syndrome of neurodegenerative diseases, such as dementia, multiple system atrophy, cerebral infarction, severe heart disease, diabetes mellitus, and other severe systemic disorders.[3] Proper diagnosis and treatment of such patients will lead to better functioning and quality of life.[4] Studies indicate that following sexual abuse, the subjects may develop anxiety disorders, depression, eating disorders, PTSD, and sleep disorders and may attempt suicide.[5] A case of DP after sexual abuse is reported because of its rarity. 45 year old female, came to the outpatient department with complaints of being eaten up by insects from inside her body, itching, worrying thoughts that she would die because of the insects, and disturbed sleep for the past 3 years. She revealed a history of alleged rape by a local goon 10 years ago. She initially believed that she may have contacted HIV following the sexual assault, due to which she is having the sensations but it was ruled out. Later gradually she began to believe that she is harboring insects within her, which are eating her from the inside. She has never seen the insects, but she referred to the black dots on her skin as holes created by the insects. No past history of any mental or physical disorder was noted. No history suggestive of intellectual disabilities was noted. No history of any substance use or family history of psychiatric illness was noted. She was successfully treated with tablet trifluoperazine of 20 mg and tablet trihexyphenidyl of 4 mg along with regular counseling. Patients with DP are on average in the older age group often with comorbid disorders, but our patient was only 45 years old and had no comorbid disorders.[3] Approximately 80% of individuals with DP have a history of having concomitant mental disorders. Depression (74%) was the most frequent concomitant mental disease, followed by drug addiction (24%) and anxiety (24%), as also observed in our patient. Patients are frequently disturbed, and their illness takes over their life, causing personal and professional relationships to suffer. Some people manage to maintain a high level of productivity at work, while their personal lives are overrun by illusions. Many of the patients have done a lot of researches on the parasites they think are infecting them.[6] Patients may claim being exposed to a filthy environment or having a sexual interaction as the source of the infection, which was elaborated by the patient.[7] After therapy with conventional antipsychotics, the majority of studies reported aggregate partial and complete remission rates of 60%–100%. After 3–6 weeks, antipsychotic medication had an effect on delusional parasitosis.[8] Reassurance that there is no evidence of organic disease seldom brings solace to the patient. Patients frequently see several doctors in search of someone who will believe them and cure their illness. Establishing a favorable physician–patient connection is critical as is emphasizing the need of a comprehensive assessment and care plan that addresses all elements of the condition, including medication to relieve symptoms.[6] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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Sep 30, 2024
Mamoune El Mostarchid + 2
Open Access