Delusional Parasitosis Research Articles

Delusional infestation in dermatology in the UK: prevalence, treatment strategies, and feasibility of a randomized controlled trial

Delusional infestation (DI) is considered rare, but true epidemiological studies are only available for Germany. Patients usually contact dermatologists, and psychiatric referral is often impossible. To estimate the prevalence of DI in UK dermatology clinics, to examine the feasibility of a multicentre randomized controlled trial (RCT) in dermatology, and to evaluate the psychopharmacotherapy of DI in dermatology. A short questionnaire survey was distributed to 231 UK dermatologists, asking how many new and ongoing patients with DI they had seen in the past 3 years, which treatments they had used, and whether they thought an RCT would be feasible. The return rate was good (44.6%, n=103 of 231). In total, 103 British dermatology consultants reported 182 cases seen over the past 3 years and 54 current cases. The 3-year prevalence of DI in dermatology outpatients was 4.99 per million; the point prevalence was 1.48 per million. Around a third (35%) of patients were prescribed psychotropic medication, mostly pimozide. Respondents were evenly split in their view of the feasibility of organizing an RCT of treatment of DI. Our survey covers more than half of the UK population, allowing the first estimate of basic epidemiological data on DI in dermatology in the UK. Our prevalence estimates indicate that DI is not as rare an illness in dermatological practice as previously assumed. There are potential difficulties in organizing an RCT of DI treatment. British dermatologists do not regularly use second-generation antipsychotics as their first choice of treatment.

Delusional Parasitosis as a Presenting Feature of Dementia

Delusional Parasitosis as a Presenting Feature of Dementia

Psychiatry for dermatologists: an update

This presentation highlights the need for a close link between the psychiatrists and the dermatologists. There is undoubtedly a high prevalence of psychiatric conditions amongst both the dermatology outpatients and the inpatients. The psychiatric symptoms can be either a manifestation of distress secondary to the primary dermatological pathology or a primary psychiatric condition presenting as dermatological pathology. In both the cases, the risk has to be recognised as the distress can lead to a suicide attempt and therefore, it can be challenging to both the treating dermatologist and the psychiatrist as the patient can actively refuse treatment because of the stigma associated with the label of having a psychiatric ailment. This presentation mentions various psychiatric conditions with regard to dermatology and specific issues about the psychotropic and dermatological medications.Mental disorders which can present in the dermatology clinics are anxiety, depression, obsessive-compulsive disorder, body dysmorphic disorder, delusional parasitosis or delusional infestation and dermatitis artefacta. It can be quite helpful for the dermatologist to be aware of the symptoms of these disorders whether primarily psychiatric or secondary to the dermatological pathology. The issues regarding medication are specifically with regard to Isotretinoin and combination treatments. An association had been reported between oral isotretinoin and mood changes, particularly depression and suicide but a recent systematic review did not find any conclusive evidence for such an association. Combination of cytotoxic agents with clozapine can exacerbate the risk of reduction in white blood cell counts. There is an increased risk of ventricular arrhythmias with the combination of erythromycin and antipsychotics. An increased risk of convulsions with a combination of erythromycin and clozapine has been mentioned. There are particular concerns about the over the counter use of St. John's wort, used in mild and moderate depressions with regard to interaction with various dermatological agents.In summary, a close liaison between dermatologists and psychiatrists is essential to provide holistic care for patients presenting with dermatological pathology.

Delusional Parasitosis as a Presenting Feature of Dementia

Delusional Parasitosis as a Presenting Feature of Dementia

Delusional Parasitosis and the Matchbox Sign Revisited: The International Perspective

Extramammary Paget disease that occurs in non-apocrine-bearing regions is referred to as ectopic and has been rarely reported. A 62-year-old man presented with a slowly progressive, asymptomatic light-brown plaque on his back. Histopathological examination revealed the presence of large pale cells with prominent nuclei, which proliferated diffusely and focally in the epidermis. Immuno–histochemically the tumour cells were positive for CK7, GCDFP-15, CEA, and p63. Based on these findings, we diagnosed the tumour as ectopic extramammary Paget disease. We reviewed the English and Japanese literature and found 29 previously reported cases of ectopic extramammary Paget disease, including our case, with a predominance of occurrence in the Asian population. The germinative milk line is known to be a possible site where extramammary Paget disease occurs. Like–wise, some germinative apocrine-differentiating cells might exist on the trunk preferentially in Asians. Attention should be paid to the development of ectopic as well as triple or quadruple EMPD in Asians.

Atypical anti‐psychotics in Delusional Parasitosis: a retrospective case series of 20 patients

Delusional Parasitosis (DP) is a relatively uncommon condition wherein there is a fixed belief that one is infested with living organisms despite a lack of medical evidence of such infestation. Pimozide has been mooted as specific for the treatment of this condition. Atypical anti-psychotics have received attention in recent years. We describe the clinical features and treatment responses in a retrospective review of 20 cases treated at this department over a 5 year period, and selectively review the literature. The majority were treated with atypical anti-psychotics and all subjects who followed up showed varying degrees of clinical improvement irrespective of the anti-psychotic used. The evidence for pimozide as first line drug in DP is limited to one small, non-randomized placebo-controlled trial. DP responds well to most anti-psychotics. Prospective randomized trials are needed to clarify optimal treatment of this relatively rare but debilitating condition.

Delusional parasitosis in neurological patients

Objective Delusional parasitosis has been described in a wide range of patients with general medical conditions, but there are few reports about its frequency and possible pathogenic mechanisms in neurological patients. This paper describes this delusional syndrome in a sample of neurological patients. Methods We reviewed all clinical charts of hospitalized patients at the neuropsychiatry ward of a neurological center, from January 2005 to June 2009. Cases with delusional parasitosis were described in terms of demographic, clinical and brain imaging features. Results From a total sample of 1598 patients, we identified 636 patients with neurological disease (39.80%); of these, four patients showed delusional parasitosis (0.62% of the neurological sample). Their diagnoses were brain cysticercosis ( n=1), cerebrovascular disease ( n=2), and dementia due to vitamin B12 deficit ( n=1). They were women in late life, with depressive features. Three of them had significant cognitive decline. Two of them had paraesthesia and pruritus related to peripheral neuropathy. One of them had pruritus of unknown origin (possibly hallucinatory). Conclusions Delusional parasitosis was infrequent in this sample of hospitalized neurological patients. Female sex, advanced age, depressive features, cognitive decline, pruritus and paraesthesia of peripheral or central origin may contribute to delusional parasitosis in this population.

Iatrogenic delusional parasitosis: a case of physician–patient folie a deux

This report presents a patient incorrectly diagnosed first with parasitic infestation and then with primary delusional parasitosis (DP). Neither diagnosis was correct. As she traveled from doctor to doctor, however, the primary DP label gained credibility via repetition, with her ongoing symptoms seen as proof of its truth.

Psychiatric treatments in dermatology: an update

There is a considerable degree of connection between psychiatry and dermatology. This connection is relevant both for diagnosis and management of dermatological pathology. This article summarises common psychiatric conditions seen in patients with skin disease, both primary psychiatric disorders and psychiatric disorders secondary to dermatological pathology. Diagnosis of relevant psychiatric conditions such as anxiety, depression, obsessive-compulsive disorder, delusional parasitosis and dermatitis artefacta, and psychiatric treatments are discussed. It gives an update of psychopharmacology relevant to the dermatologist including important interactions between psychotropic and dermatological agents.

Delusional infestation.

This papers aims at familiarizing psychiatric and nonpsychiatric readers with delusional infestation (DI), also known as delusional parasitosis. It is characterized by the fixed belief of being infested with pathogens against all medical evidence. DI is no single disorder but can occur as a delusional disorder of the somatic type (primary DI) or secondary to numerous other conditions. A set of minimal diagnostic criteria and a classification are provided. Patients with DI pose a truly interdisciplinary problem to the medical system. They avoid psychiatrists and consult dermatologists, microbiologists, or general practitioners but often lose faith in professional medicine. Epidemiology and history suggest that the imaginary pathogens change constantly, while the delusional theme "infestation" is stable and ubiquitous. Patients with self-diagnosed "Morgellons disease" can be seen as a variation of this delusional theme. For clinicians, clinical pathways for efficient diagnostics and etiology-specific treatment are provided. Specialized outpatient clinics in dermatology with a liaison psychiatrist are theoretically best placed to provide care. The most intricate problem is to engage patients in psychiatric therapy. In primary DI, antipsychotics are the treatment of choice, according to limited but sufficient evidence. Pimozide is no longer the treatment of choice for reasons of drug safety. Future research should focus on pathophysiology and the neural basis of DI, as well as on conclusive clinical trials, which are widely lacking. Innovative approaches will be needed, since otherwise patients are unlikely to adhere to any study protocol.

Needs assessment survey of psychocutaneous medicine

Psychocutaneous medicine studies the boundaries between skin and mind, and takes the unique approach of examining the patients in their biopsychosocial context. It can help patients with chronic skin problems cope with anxiety and the social stigma of their disease. Decreased psychologic stress can contribute to better treatment outcomes and be an important key to patient care. In addition, some primary psychiatric disorders may be expressed in the skin, such as delusions of parasitosis. A psychocutaneous specialist is well placed to treat these disorders. To assess the need for psychocutaneous medicine in dermatology, eighty-five attendees of the Wisconsin Dermatological Society (WDS) meeting were asked to complete a needs assessment survey. Forty-two percent of respondents felt that 30% of their patients would benefit from psychiatric interventions. In addition, 43% of respondents did not routinely inquire about mental health issues. When they did recognize psychiatric needs in a patient, 83% of responders did not feel comfortable prescribing psychotropic medications. Our data showed that about one-half of the members of WDS attending the meeting believed that a high percentage of their patients would benefit from psychocutaneous intervention. Moreover, it was found that the training during medical school and dermatology residency was insufficient for professionals to confidently prescribe psychotropic medications. Considering the fact that studies have shown psychiatric comorbidity in 30% of dermatologic diseases, and that many of the respondents who felt that their patients would not benefit from psychocutaneous intervention did not inquire about psychologic effects of skin disease in their patients, we conclude that psychocutaneous medicine is an under-recognized field in dermatology. Further evaluation of the demand for psychocutaneous clinics and their integration into daily dermatologic practices and residency training programs is needed.

Delusional parasitosis by proxy

Delusional parasitosis by proxy

Delusion of Oral Parasitosis and Thalamic Pain Syndrome

Delusional parasitosis is an uncommon psychiatric condition in which patients have the immutable conviction that small, living organisms, such as worms, insects, or larvae infest their skin or other organs. The authors describe a case of an unusual association of delusional parasitosis and thalamic pain syndrome after left-posterior thalamic hemorrhage. The patient initially suffered from dysesthesia and burning pain typical of thalamic pain syndrome and subsequently developed delusional oral parasitosis ("worms" infesting her mouth). Sulpiride 100 mg/day administered in addition to amitriptyline gradually improved her delusions within 3 months. The authors speculate that this specific type of delusion can be elicited by the disruption of the somatosensory pathway and that the subsequent cortical sensory deafferentiation and reorganization arising from this disruption may contribute to the development of delusional parasitosis.

Delusional parasitosis: six-year experience with 23 consecutive cases at an academic medical center

Objectives Delusional parasitosis is a syndrome with which most infectious diseases physicians and microbiologists are familiar. However, little is known about the epidemiology of this disorder, and most reports consist of case reports or small series. We conducted a case series with long-term questionnaire follow-up of delusional parasitosis patients presenting to our academic medical center. Methods From 1994 through 1999, 23 patients with primary delusional parasitosis (as defined by DSM IV criteria) were identified through the Infectious Diseases Clinic or Emergency Room at the University of Washington and cases were analyzed for prospectively established demographic, clinical, and social variables of interest. Results Of 23 patients, 15 were women and eight were men. Mean duration (± standard deviation) of symptoms was 2.6 ± 2.8 years (median 1.5), with shorter duration related to improved prognosis. Mean symptom duration in women was 3.1 ± 3.0 years versus 1.5 ± 1.5 years in men. Patients saw an average of six physicians before presenting to our center. Reduced social interactions were common, but employment affect was not significant. Treatment with pimozide or gabapentin combined with antidepressants appeared to be effective in some cases. Conclusions This is the largest study of primary delusional parasitosis originating from an academic medical center, and highlights the burden of disease borne by patients and the healthcare system.

Delusional Parasitosis Following Heroin Withdrawal: A Case Report

Delusional parasitosis (DP) is a delusional disorder in which the patient has the unshakable belief of being infested by parasites. Delusional parasitosis can be classified into primary or secondar...

Psycho‐cutaneous disorders: an epidemiologic study

Psycho-dermatology addresses the interaction between mind and the skin. Effective management of at least one third of the patients attending the skin department depends, to some extent, upon the recognition of emotional and psychologic factors. The aim of this study was to provide epidemiologic data about common psycho-dermatoses and their prevalence in dermatologic patients in Iran. Patients suspicious to have psychocutaneous problem with primary dermatologic chief complaint were included. After detailed dermatologic evaluation, all patients were visited by an expert psychologist to determine prevalence of DSM-IV disorders in each psychocutaneous category including delusion of parasitosis, trichotillomania, dermatitis artefacta and neurotic excoriation. A total of 178 patients including 78 (43.8%) males and 100 (56.2%) females entered the study. The commonest psychocutaneous disorder was neurotic excoriation followed by trichotillomania, delusion of parasitosis and dermatitis artefacta. Mood disorder was the commonest DSM-IV disorder in our patients, then anxiety disorder and drug-induced symptoms. According to our results, it seems that all psychocutaneous disorders but delusion of parasitosis are commoner in females. Mood and anxiety disorders were common in patients with dermatitis artefacta, as patients with neurotic excoriation. In trichotillomania, obsessive compulsive disorder was the commonest disorder. Drug abuse is a major background of delusional parasitosis.

Management of patients with delusional parasitosis in a joint dermatology/ liaison psychiatry clinic

British Journal of DermatologyVolume 161, Issue 1 p. 197-199 Management of patients with delusional parasitosis in a joint dermatology/ liaison psychiatry clinic R. Healy, R. Healy Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this authorR. Taylor, R. Taylor Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this authorS. Dhoat, S. Dhoat Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this authorE. Leschynska, E. Leschynska Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this authorA.P. Bewley, A.P. Bewley Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this author R. Healy, R. Healy Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this authorR. Taylor, R. Taylor Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this authorS. Dhoat, S. Dhoat Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this authorE. Leschynska, E. Leschynska Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this authorA.P. Bewley, A.P. Bewley Departments of Dermatology and Liaison Psychiatry, Bart’s and theLondon NHS Trust, Whitechapel, London, U.K.Search for more papers by this author First published: 22 June 2009 https://doi.org/10.1111/j.1365-2133.2009.09183.xCitations: 19 Anthony Bewley.E-mail: anthony.bewley@bartsandthelondon.nhs.uk Conflicts of interest: none declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume161, Issue1July 2009Pages 197-199 RelatedInformation

Treatment of Delusional Parasitosis With Aripiprazole

Treatment of Delusional Parasitosis With Aripiprazole

Morgellons disease, illuminating an undefined illness: a case series.

IntroductionThis review of 25 consecutive patients with Morgellons disease (MD) was undertaken for two primary and extremely fundamental reasons. For semantic accuracy, there is only one "proven" MD patient: the child first given that label. The remainder of inclusive individuals adopted the label based on related descriptions from 1544 through 1884, an internet description quoted from Sir Thomas Browne (1674), or was given the label by practitioners using similar sources. Until now, there has been no formal characterization of MD from detailed examination of all body systems. Our second purpose was to differentiate MD from Delusions of Parasitosis (DP), another "informal" label that fit most of our MD patients. How we defined and how we treated these patients depended literally on factual data that would determine outcome. How they were labeled in one sense was irrelevant, except for the confusing conflict rampant in the medical community, possibly significantly skewing treatment outcomes.Case presentationClinical information was collected from 25 of 30 consecutive self-defined patients with Morgellons disease consisting of laboratory data, medical history and physical examination findings. Abnormalities were quantified and grouped by system, then compared and summarized, but the numbers were too small for more complex mathematical analysis. The quantification of physical and laboratory abnormalities allowed at least the creation of a practical clinical boundary, separating probable Morgellons from non-Morgellons patients. All the 25 patients studied meet the most commonly used DP definitions.ConclusionsThese data suggest Morgellons disease can be characterized as a physical human illness with an often-related delusional component in adults. All medical histories support that behavioral aberrancies onset only after physical symptoms. The identified abnormalities include both immune deficiency and chronic inflammatory markers that correlate strongly with immune cytokine excess. The review of 251 current NLM DP references leads us to the possibility that Morgellons disease and DP are grossly truncated labels of the same illness but with the reversal of the cause-effect order. Further, the patients' data suggest that both illnesses have an infectious origin.

Delusional Parasitosis: Lessons Learnt

Delusional parasitosis manifests in the patient's firm belief that they have skin symptoms due to an infestation with insects. Patients often refuse to seek psychiatric care. This study reassessed patients with delusional parasitosis in order to review and learn from them, which is important due to the significant morbidity of this condition and the therapeutic difficulties it presents to the dermatologist. Between 1995 and 2008, 13 patients with delusional parasitosis (6 men, 7 women; mean age 46 years) were included in this retrospective study. Mean duration of follow-up was 50.1 months. Nine patients were treated with pimozide, but only two had complete remission. Four were treated with sulpiride with two reported partial remissions. Risperidone was given to four patients, resulting in one partial remission. Eight patients were seen in the last 6 months and five were lost to follow-up. These findings highlight the difficulties encountered in diagnosing delusional parasitosis, the lack of response to neuroleptic medication, compliance problems and the dermatologist's dilemma of managing a psychiatric condition in a dermatological setting.