Delusional Parasitosis Research Articles

Clinical, epidemiologic, histopathologic and molecular features of an unexplained dermopathy.

BackgroundMorgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies.MethodsA descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 2006–2008. A case was defined as the self-reported emergence of fibers or materials from the skin accompanied by skin lesions and/or disturbing skin sensations. We collected detailed epidemiologic data, performed clinical evaluations and geospatial analyses and analyzed materials collected from participants' skin.ResultsWe identified 115 case-patients. The prevalence was 3.65 (95% CI = 2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p = .113). Case-patients had a median age of 52 years (range: 17–93) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD = 12.9) and 35.45 (SD = 12.89), respectively. Cognitive deficits were detected in 59% of case-patients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants' skin were composed of cellulose, likely of cotton origin.ConclusionsThis unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation.

Delusional infestation: Clinical presentation in 147 patients seen at Mayo Clinic

Delusional infestation is the conviction that one's skin is infested with foreign organisms or materials despite contradictory objective evidence. To delineate clinical characteristics of patients presenting with delusional infestation. We performed a retrospective study of patients meeting delusional infestation criteria who were seen for diagnosis and treatment in our tertiary care academic medical center (2001-2007). Medical records were reviewed to abstract demographic, historical, and physical findings and treatment. Over 7 years, 147 patients presented with delusional infestation; 87% (123/142) for another opinion. Mean age was 57 years; female-to-male ratio was 2.89 to 1; 82 (56%) were married. Mean duration of symptoms was 31 months. Employment data were available for 145 patients: 48 (33%) were self-described as disabled, 16 of whom cited delusions as their disability; 41 (28%) were retired; and 38 (26%) were employed. Reported infestations included multiple materials (45% [64/143]), not limited to insects (79% [113/143]), worms (27% [39/143]), and fibers (20% [29/143]). Most patients presented initially to dermatology or other specialties; only 3 presented to psychiatry. A high proportion (81%) had prior psychiatric conditions. Thirty-eight (26%) of the 147 patients had a shared psychotic disorder. The retrospective nature of the study and the incompleteness of some data because not all the characteristics that were analyzed were documented for every patient. Patients were predominantly female, had a long history of symptoms, and had been seen previously at many medical centers. A large proportion were disabled or retired. Patients reported skin infestation with both animate and inanimate objects.

Dermatologic infestations

Head lice are transmitted by head to head contact. Optimal therapy includes malathion lotion 0.5% repeated in one week left on for 30 minutes to 8 hours. Spinosad topical suspension 0.9% repeated in one week left on for 10 minutes is another option. Scabies is transmitted mainly by direct contact but also via heavily infested fomites due to crusted scabies. Permethrin 5% cream to the body repeated in four days is often sufficient; however, scalp treatment with malathion lotion 0.5% is helpful in crusted scabies and in infested children. Oral ivermectin 200 mcg/kg is another option, repeated in four days. For scabies more than lice, fomites should be placed in a drier at 60 °C for 10 minutes to kill the arthropods. Treatment of close contacts in both cases will control outbreaks and repeated infestations. Both have been associated with methicillin-resistant Staphylococcus aureus infection. Bed bugs are a common cause for papular urticaria. Identification of the insect in the mattress or bedding confirms the diagnosis. Prevention involves encasing the mattress in a sealed plastic cover and extermination. Delusions of parasitosis is a diagnosis of exclusion that is best treated with an antipsychotic.

P-1036 - Ekbom's syndrome. a case report

Introduction Ekbom's syndrome or delusional parasitosis (DP), is an “uncommon psychiatric syndrome” characterized by the presence of delusion of infestation. The syndrome may be seen in association wiht a number of neuropsychiatric conditions, including bipolar disorder, paranoia,schizophrenia, dementia, depression as well as abuse of drugs, such as cocaine or amphetamines. Previously, DP was often considered to be a monosymptomatic hypochondraical psychosis. Delusions of parasitosis has also been reported in association with a number of medical conditions that are characterized by itching. Objective To review the literature through a case report. Case report A 52 year-old female, unmarried who lives alone, was admitted for parasitosis delusions that had started in the last two months. She complained of vermins crawling through her skin, mainly on her face and scalp. The illness began with pricking and itching sensations on her head. She used to put the “little animals” in a piece of paper to prove their existence. Risperodone was started up to 3 mg per day. She had a progressive clinical improvement and in one week was discharged. Conclusions In conclusion, rather than a unique illness, DP is a neuropsychiatric syndrome that can follow primary psychotic and depressive disorders, dementia or other organic diseases. The typical patient is an elderly woman who is unmarried or living along. There have been no double-blind studies confirming that atypical antipsychotics are more effective than pimozide in the treatment of DP. Further trials are warranted to study the true efficacy of atypical antipsychotics in the treatment of DP.

Delusional parasitosis: Worms of the mind

Delusional parasitosis is an uncommon psychotic illness. Patients often report to dermatologists and physicians for treatment and are brought to psychiatric attention only for associated psychological distress. One such case is discussed in this report.

Delusional Parasitosis in a Female Treated with Mixed Amphetamine Salts: A Case Report and Literature Review

Objectives. To explore factors underlying the onset of delusional parasitosis; a condition in which an individual has a fixed, false belief that he/she is infested with insects. Case Description. MJ is a 57-year-old female who presents with symptoms of fatigue and AD/HD. Upon treatment with extended release mixed amphetamine salts, the patient displayed symptoms of delusional parasitosis. After eventual discontinuation of this medication, her delusions resolved. Comments. In order to maintain confidentiality, all identifying information was removed. To this end, please note that MJ is a fictitious name.

P-885 - Morgellons disease and / or psychosis

Morgellons disease is a condition sometimes referred to as unexplained dermopathy. It appeared about a decade ago, although a disease with roughly similar features and symptoms was noted at the beginning of the 17 th century, along with its name - “morgellons”. It is characterized by a number of different skin symptoms, including crawling, biting and stinging sensations, persistent skin lesions, finding fibers on or under the skin, but also cognitive defects, behavioral changes, tiredness and etc. Nowadays most physicians consider Morgellons disease to be just a new name for a well known medical condition, delusional parasitosis. We will present the case of a 49 year old female patient who was psychiatrically treated for two years for the symptoms of depression and underlying personality disorder. During the last five months she verbalized and described symptoms observed with Morgellons disease, although she had no prior knowledge of the disease itself.

Delusional infestation with fungus

Delusional infestation with fungus

Delusional Parasitosis Associated With Donepezil

Delusional Parasitosis Associated With Donepezil

Patients with delusional infestation (delusional parasitosis) often require prolonged treatment as recurrence of symptoms after cessation of treatment is common: an observational study

Delusional infestation (DI) is an uncommon psychiatric disorder in which patients present with the false and fixed belief of infestation. Numerous studies have demonstrated improvement with pharmacological treatment; however, recurrence rates on cessation of treatment remain unknown. To assess the clinical response and recurrence rates following treatment for DI. All patients with DI seen in our combined dermatology/psychiatry clinic to date (n=73) were offered pharmacological therapy. Patients were contacted to complete a telephone questionnaire to assess clinical outcomes, including remission and recurrence rates following treatment. Fifty-nine of 73 (81%) patients with DI received treatment, of whom 40/59 (68%) reported improvement or resolution of symptoms, and the remaining 19/59 (32%) failed to respond. Fifteen of 40 patients with DI completed a course of treatment, 12/40 patients are still undergoing treatment, and outcomes are unknown for 13/40. Of those who completed treatment, 11/15 (73%) reported total remission for at least 9months after discontinuing treatment (range 9months-2·5years). Recurrence of symptoms occurred in 4/15 (27%) within 4months of stopping treatment. Pharmacological treatment of DI can be effective, particularly in a combined dermatology/psychiatry clinic. Most treated patients have a good prognosis, and a remission period can be expected. However, more than 25% of patients may relapse on stopping treatment, with the greatest risk being within the first few months of discontinuation. These patients may require longer treatment courses, or long-term maintenance therapy for symptom control, although further studies are needed to provide recommended guidelines on drug and dosing regimen.

Delusional infestation with unusual pathogens: a report of three cases

Delusional infestation (DI) is a psychiatric disorder characterized by a fixed, false belief that the patient is infested with extracorporeal agents. It is known by several names, including the more commonly used term 'delusional parasitosis'. The psychiatric disease is responsible for the cutaneous pathology. About 90% of patients with DI seek help from dermatologists, and most reject psychiatric referral. Thus, effective management requires incorporation of psychiatric principles. We report three cases of DI with inanimate materials, and examine 'Morgellons' disease. We believe that patients with unusual presentations of DI are likely to be seen more commonly in the future. These patients appear to be a subgroup of DI, and may be even more difficult to treat than other patients with DI.

What on Earth?!: Diatomaceous earth as evidence of delusional infestation

Journal of Cutaneous PathologyVolume 38, Issue 10 p. 762-764 What on Earth?!: Diatomaceous earth as evidence of delusional infestation Kali L. Tu MD, Kali L. Tu MD Department of Pathology and Laboratory Medicine, University of California, DavisSearch for more papers by this authorVictoria R. Sharon MD, Victoria R. Sharon MD Department of Dermatology, University of California, DavisSearch for more papers by this authorMaxwell A. Fung MD, Corresponding Author Maxwell A. Fung MD Department of Pathology and Laboratory Medicine, University of California, Davis Department of Dermatology, University of California, Davise-mail: maxwell.fung@ucdmc.ucdavis.eduSearch for more papers by this author Kali L. Tu MD, Kali L. Tu MD Department of Pathology and Laboratory Medicine, University of California, DavisSearch for more papers by this authorVictoria R. Sharon MD, Victoria R. Sharon MD Department of Dermatology, University of California, DavisSearch for more papers by this authorMaxwell A. Fung MD, Corresponding Author Maxwell A. Fung MD Department of Pathology and Laboratory Medicine, University of California, Davis Department of Dermatology, University of California, Davise-mail: maxwell.fung@ucdmc.ucdavis.eduSearch for more papers by this author First published: 26 August 2011 https://doi.org/10.1111/j.1600-0560.2011.01775_2.xCitations: 4Read 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 Volume38, Issue10October 2011Pages 762-764 RelatedInformation

What on Earth?!: Diatomaceous earth as evidence of delusional infestation

What on Earth?!: Diatomaceous earth as evidence of delusional infestation

Pediatric Psychocutaneous Disorders

Psychocutaneous disorders (PCDs) are conditions that are characterized by psychiatric and skin manifestations. Classifications of PCDs and their nomenclature are matters of debate. For the purpose of this review, we adopted the classification that distinguishes primary dermatologic disorders with psychiatric co-morbidity (PDDPC) from primary psychiatric disorders with dermatologic manifestations (PPDDM). PDDPC includes the psychophysiologic disorders such as atopic eczema, psoriasis, vitiligo, and alopecia areata. PPDDM includes impulse control disorders, obsessive-compulsive disorders, factitious disorder, factitious disorder by proxy, self-mutilation, delusions of parasitosis, psychogenic purpura/Gardner-Diamond syndrome, and cutaneous sensory disorders. Diagnosis and treatment of PCDs are challenging and require that the underlying psychopathology be addressed. A specific PCD may have different underlying psychopathologies and, at times, multiple overlapping psychopathologies may coexist. Most often, both non-pharmacologic management and psychopharmacologic treatment are necessary. The choice of psychopharmacologic agent depends on the nature of the underlying psychopathology (e.g. anxiety, depression, obsessive-compulsive disorder, psychosis). This article reviews the spectrum of PPDDM in children.

Delusional infestation: treatment outcome with antipsychotics in 17 consecutive patients (using standardized reporting criteria)

Objective The multietiological nature of delusional infestation (DI) implies that therapy needs to be customized according to the various forms of DI (primary/secondary). Usually, treatment of DI is difficult to achieve in psychiatric settings because of the patients' nonpsychiatric concept of the illness. Methods We analyzed the data of all consecutive DI patients seen in the Psychiatric Outpatient Department of the General Hospital Bruneck/Italy from 1998 to 2010, including structural brain imaging findings. Standardized reporting criteria are applied for the presentation of the cases in a naturalistic setting. Results Our sample consisted of 17 patients. Notably, 15 out of these 17 patients (88%) could be engaged in an antipsychotic treatment trial. With different, mainly second-generation antipsychotics, all but one patient profited from antipsychotics, at least after substances were changed: 12 (71%) of the cases reached full remission, and another 2 (12%) had partial remission. The average duration of treatment was remarkably long: 3.8 years. Eight cases were classified as secondary to a brain disorder or medical condition, four cases were classified as secondary to psychiatric disorders and five cases fulfilled the criteria for primary DI (i.e., delusional disorder somatic type). All cases secondary to a brain disorder/medical condition showed macroscopic brain lesions mainly in the basal ganglia. Conclusions Our study confirmed previous experience that an excellent clinical outcome can be achieved in unselected patients with different DI forms provided that patients can be engaged in antipsychotic treatment. Although studies in DI are difficult to conduct, randomized controlled trials would be desirable to evaluate specific antipsychotic medication in DI in general and in the different forms of DI. More sophisticated investigations (single photon emission computed tomography and positron emission tomography) than structural brain imaging (magnetic resonance imaging and computed tomography) are needed to better elucidate underlying brain dysfunction in DI.

Skin Biopsy Doesn't Scratch Delusional Infestation Itch

Skin Biopsy Doesn't Scratch Delusional Infestation Itch

Biopsy Doesn't Aid Delusional Infestation Dx

Biopsy Doesn't Aid Delusional Infestation Dx

Delusional Infestation, Including Delusions of Parasitosis

To review the results of skin biopsies and patient-provided specimens from patients whose assessment was consistent with delusional infestation, including delusions of parasitosis. Retrospective medical record review. Mayo Clinic, Rochester, Minnesota. The study population comprised all patients who were seen at Mayo Clinic and had a diagnosis of delusional skin infestation, including delusions of parasitosis, between 2001 and 2007, and who underwent biopsies as part of their dermatologic evaluations or brought samples to their clinical consultations. The results of examination of these biopsy and patient-provided specimens. A total of 108 patients met inclusion criteria for this study: 80 received biopsies, 80 had self-procured skin specimens, and 52 patients received biopsies and provided specimens. No biopsy specimen (0 of 80) provided evidence to support skin infestation. The most common interpretations in the 80 biopsy specimens were dermatitis in 49 of 80 (61%); excoriation, ulceration, or erosion in 38 (48%); and nonspecific dermal inflammation in 25 (31%). Patient-provided specimens were most frequently assessed by the physician (generally a dermatologist) evaluating the patient, although 20 of the 80 samples (25%) were submitted for pathologic evaluation. Of these 80 specimens, 10 (13%) contained insects. All but 1 of the insects were noninfesting varieties; 1 (1%) was a pubic louse. The remaining findings consisted of cutaneous debris, environmental detritus, or plant material. In patients with suspected delusional infestation, neither skin biopsies nor examination of patient-provided specimens provided objective evidence of skin infestation.

P01-467 - Ekbom syndrome - cultural aspects from a clinical case

IntroductionEkbom syndrome is a delusional parasitosis in which the patient has the delusion of infestation by parasites. This condition might occur in concordance with senile dementia or cerebrovascular disease, but it is also present in mood disorders or schizophrenia.ObjectivesTo present a clinical description of a delusional parasitosis that appeared in a young nigerian women after she immigrated in France.AimsOur case is suggestive for showing that delusional parasitosis might develop in circumstances of social vulnerability such as the immigration and might have different cultural aspects.MethodsWe present the case of a 29 years old nigerian women that developed a delusional parasitosis 3 years after her arrival in France. The diagnosis was based on a carefully detailed clinical history, an MMSE was also applied. In order to exclude secondary causes an extensive laboratory evaluation was performed including: complete blood cell count, liver, renal and thyroid function tests, serum electrolytes and glucose levels, vitamin B12, folate, iron studies, coproanalysis, neuroimaging.ResultsThe patient had all laboratory and neuroimaging tests normal. She presented a delusional parasitosis and she described an infestation with multiple intestinal worms. She was capable of describing them and their movements under the skin and also in all the organs. She described dracunculiasis and three more different species that are commonly present in Nigeria, she never mentioned lice or mites.ConclusionsEkbom syndrome is a delusion of hallucinatory mechanism that might have different cultural presentations and could be favored by social vulnerability such as immigration.

Delusional infestation: Analysis of “matchbook” sign specimens and biopsy results

Delusional infestation: Analysis of “matchbook” sign specimens and biopsy results