Delusional Parasitosis Research Articles

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

UNDER MY SKIN: A REVIEW ON DELUSION OF PARASITOSIS

Delusion of parasitosis is a fixed and firm belief of being infested by parasite, usually perceiving those parasites are crawling and burrowing beneath skin with onset at 20-30 age groups and other at 50 years and older. Women show a greater prevalence of developing this condition. Diagnosis can only be confirmed if the most essential criteria are met. Patient should be experiencing two conditions: idea of being infested by pathogen and abnormal sensation in skin that can only be explained because of the first situation. Management is focused on Dermatological therapy to include treatment for the visible damage on skin like intensified skin care, Psychopharmacology and Social psychiatric services.

Abstract- Poster

Background:Delusional Infestation is characterized by patients' fixed belief that their skin and body is infested by small,vivid(or less frequently inanimate)pathogens,although there is no medical or microbiological evidence for this. It is a type of Somatic Delusion.Case Report:63year old female,referred by dermatologist with complaints of being infested with both animate and inanimate particles and itching all over the body from 6months. She was preoccupied with multiple somatic sensations all over her body. She reported that these particles were being emitted from her orifices like ears,eyes,nose,and skin pores. These particles penetrated her bones and were crushing them in to powder. The animate ones flowed through her skin and would be found on the place where she sits. These would get collected in clusters under her skin and she could feel them as nodules. Patient also had symptoms of mild depressive disorder secondary to these symptoms. There was a positive Specimen(Match box)sign observed.Results:Diagnosis of Persistent delusional disorder- infestation type with mild depressive disorder was made and was treated with antipsychotics.20% improvement in the symptoms was reported a week later.Conclusion:This patient has been experiencing primary delusional infestation. She has continued to present to many different specialists with her complaints and is adamant about the presence of these particles. Due to the very low prevalence of this disorder,it is valuable to document it in order to understand and treat this phenomenon.

Adverse psychocutaneous effects of prescription stimulant use and abuse: A systematic review.

Although rare, psychocutaneous disorders induced by prescription stimulants have been reported throughout the literature. A systematic review was conducted to identify all case reports and case series of prescription stimulant-induced trichotillomania, tactile hallucinations, and delusional infestation. A total of 22 case reports were identified and relevant information was analyzed. Patients presenting with trichotillomania and tactile hallucinations induced by prescription stimulants were typically pediatric male patients being treated for attention deficit hypersensitivity disorder. Symptoms resolved after discontinuation of the offending medication. Patients presenting with delusional infestation secondary to stimulant use or abuse were typically adults who were misusing or abusing stimulant medication. Although symptoms typically improved or resolved after decreasing or discontinuing medication, several patients required the use of antipsychotic medication. While the observational nature of case reports and small number of patients limits meaningful analysis of trends and comparison, this study demonstrates that physicians, especially dermatologists and psychiatrists, should be aware of the potential for prescription stimulants to precipitate adverse psychocutaneous disorders in a minority of individuals.

Successful Treatment of Delusional Parasitosis With Cognitive Behavioral Therapy and Medication in a Patient With Early-onset Alzheimer’s Disease

Successful Treatment of Delusional Parasitosis With Cognitive Behavioral Therapy and Medication in a Patient With Early-onset Alzheimer’s Disease

A review of the diagnosis and management of pediatric psychodermatologic conditions: Part II.

Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self-induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient-perceived stigma and lack of educational opportunities for dermatology providers. This two-part series highlights the most up-to-date evidence-based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Part I includes trichotillomania, skin picking disorder, and onychophagia, and part II covers dermatitis artefacta, body dysmorphic disorder, and delusions of parasitosis by proxy, with special considerations for family dynamics.

Review of the diagnosis and management of pediatric psychodermatologic conditions: Part I

Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self-induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient-perceived stigma and lack of educational opportunities for dermatology providers. This two-part series highlights the most up-to-date evidence-based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Part I includes trichotillomania, skin-picking disorder, and onychophagia, and part II covers dermatitis artefacta, body dysmorphic disorder, and delusions of parasitosis by proxy, with special considerations for family dynamics.

How to improve the interface between dermatology and psychiatry: a review and expert suggestion regarding the management of delusional patients.

Psychodermatological problems are prevalent in dermatology practices. Among those, delusional infestation (DI) is the subject of one of the most challenging patient encounters practicing dermatologists may experience. This difficulty arises, at least partly, from the unavailability of psychiatric knowledge and skillset necessary to properly manage these patients, reflecting that most dermatology residency programs are unable to provide training in psychodermatology. This relates to the lack of faculty available with such expertise. This article reviews various suggestions made in the medical literature to try to improve this current unfortunate situation. However, the more common suggestion regarding organizing a multidisciplinary psychodermatologic clinic may be difficult to achieve as reflected by the scarcity of such clinics in the U.S. The authors offer alternative suggestions beyond the idea of organizing a multidisciplinary clinic.

Successful Treatment of Delusional Infestation with Olanzapine Depot

Successful Treatment of Delusional Infestation with Olanzapine Depot

551 - Case Report: De Archambault’s syndrome in the early stage of dementia with Lewy bodies

Background:Dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia after Alzheimer’s disease. In some patients with DLB, relatively rare delusions are known to emerge, such as Othello syndrome, delusional parasitosis and delusion of duplication. Erotomania, also known as de Clerambault’s syndrome, is characterized by the delusion that a person has fallen in love with the patient. It occasionally appears secondary to psychiatric disorders and organic brain diseases. However, there have been no reports on cases secondary to patients with DLB.Case presentation:The patient was an 83-year-old woman who lived alone. Mild cognitive impairment appeared at the age of 82 years. Soon after, she had the delusional conviction that her family doctor was in love with her. Her symptoms, such as gradually progressive cognitive impairment, cognitive fluctuations, and parkinsonism, indicated DLB. Although small doses of quetiapine, brexpiprazole and risperidone were prescribed for the treatment of the delusion, each of them was discontinued soon because of the adverse reactions. Finally, the delusion was successfully treated with a small dose of blonanserin without sever side effects.Discussions and Conclusions:This case report suggests the possibility of de Clerambault’s syndrome during the early stages of DLB. Recently, psychiatric-onset DLB has increasingly gained attention in recent years. Further accumulation of knowledge about delusions in patients with DLB for an early diagnosis.

Morgellons disease etiology and therapeutic approach: a systematic review.

Morgellons disease is characterized by patient reports of fibers embedded in and protruding from the skin. Etiologies from infection to delusion have been endorsed, and treatment guidelines are not well-defined. The objective of this manuscript is to evaluate the existing evidence regarding the etiology and treatment of Morgellons disease in an effort to better inform clinical management. A PubMed search including key words "Morgellons," "delusional parasitosis and fibers," "delusions of parasitosis and fibers," or "delusional infestation and fibers" was completed. Original publications directly assessing etiology or treatment methods of Morgellons disease published between January, 2010 and the time of manuscript preparation were reviewed and evaluated. Sixteen articles regarding etiology were reviewed. All studies were correlative in nature with various limitations. Support for a psychiatric etiology was more widespread than support for an infectious etiology. Eleven articles regarding treatment efficacy were reviewed. Antipsychotic regimens have the most evidence of efficacy. Existing data regarding Morgellons disease suggests a psychiatric etiology and supports treatment with a low-dose antipsychotic agent once non-psychiatric causes have been excluded.

Ekbom Syndrome Secondary to a Major Depressive Episode.

Ekbom syndrome, or delusional parasitosis, is a rare disorder in which patients believe that their body, mainly the skin, is infested by small organisms or bugs. Here, the authors present a case of delusional parasitosis in the context of depression.

28651 Substance use and psychiatric comorbidity in patients with delusions of infestation

Importance: Delusions of infestation (DI) is characterized by a fixed, false belief of being infested with parasites. Patients with DI experience crawling sensations and pruritus, often accompanied with self-induced traumatic skin lesions.

Delusional infestation: What nurses should know.

Patients with delusional infestation, a rare psychiatric disorder, have a false and fixed belief that insects or other organisms are crawling in or on their skin. This article describes signs and symptoms, available treatments, and appropriate nursing interventions for patients with primary delusional infestation.

Cogito, ergo praedico(I think, therefore I predict)

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.

Delusional parasitosis. A multicenter retrospective study in Spanish infectious disease services

IntroductionDelusional parasitosis or Ekbom syndrome is a condition described mainly in the fields of psychiatry and dermatology, with a complex diagnostic and therapeutic approach. However, it is uncommon to assess patients with this disease in infectious disease units. The objective of this work is to describe the experience of three infectious diseases departments with respect to this entity. MethodsA retrospective descriptive study of 20 patients diagnosed with delusional parasitosis in three Infectious Diseases Services was performed between 2003 and 2017. ResultsThe median age of the patients was 54 years, with a female/male ratio of 1.5:1. In 9 patients, an endoparasitic delirium (mainly digestive) was described, in 5 an ectoparasitic form was described, and in the remaining 6, a mixed form was described. Fourteen patients presented some type of psychiatric disorder. Four patients had alcohol or drug abuse disorder. All patients had made consultations to other specialties with a median of three per patient (range 1–7). Ten patients received “empirical” antiparasitic treatment and 8 received some type of psychopharmaceutical treatment. The evolution was very variable: in 3 patients, the delusional parasitosis was resolved; in 9 patients, the clinical manifestations persisted, and the remaining patients were lost to follow-up. ConclusionsEkbom syndrome is a common process in infectious diseases, presenting some differences with other series evaluated by dermatologists and psychiatrists. Management of this disease should promote a multidisciplinary approach to enable a joint treatment, thus optimizing patient management and therapeutic adherence.

Clozapine-Induced Reversible Pisa Syndrome in a Patient With Delusional Parasitosis

Clozapine-Induced Reversible Pisa Syndrome in a Patient With Delusional Parasitosis

Successful treatment of primary delusional parasitosis with paroxetine: A case report and narrative review

IntroductionAntipsychotics have been classically considered the treatment of choice for delusional disorder (DD) and antidepressant medications have been restricted to patients with comorbid depression.ObjectivesOur aim is to describe the case of a patient with DD with delusions of parasitosis, who responded to paroxetine as monotherapy. We also aimed to review the recent literature on the potential use of antidepressants as the main treatment for somatic type DD.MethodsAfter the case report, we present a narrative review on the use of antidepressants in DD, somatic type (DSM-criteria) by using PubMed database from inception until 2020.ResultsCase: 74 year-old woman without previous psychiatric diagnosis who suffered from long-term cutaneous and vulvar pruritus. She was referred to psychiatry from dermatology to assess thought content and sensoperceptive disturbances. In the past, she had received unsuccessful treatment with antihistamines. The patient brought a collection of “the identified parasite” (matchbox sign) to our first appointment. On assessment, she was diagnosed with DD with delusions of parasitosis. Risperidone 1mg/day was poorly tolerated (excessive sedation). She refused further antipsychotic treatment, so we started paroxetine up to 20mg/day. The patient went into total remission of her pruritus and delusions of parasitosis. Review. In line with our case, 6 studies reported on the successful use of antidepressants as monotherapy for DD, somatic type. Most of studies report the successful use of an antipsychotic/antidepressant combination (case-series, case reports).ConclusionsAlthough antipsychotics are the treatment of choice, antidepressant medications may be an effective alternative in somatic type DD when patients refuse antipsychotics.

Delusional infestation: Two case reports

IntroductionDelusional infestation (DI), also known as delusional parasitosis or Ekbom syndrome, is a rare disorder, characterised by fixed belief that the skin, body or immediate environment is infested by small pathogens, despite the lack of any medical evidence for it.ObjectivesTo describe and discuss two clinical cases of DI, in order to show two different ways of presenting in this entity.MethodsTwo case report and non-systematic review.ResultsWe present the case of a 76-year-old woman, without psychiatric history, with an DI with 5 years of evolution, referred to a psychiatric consultation by a dermatologist. The second case, is a 41-year-old woman with a history of multiple substance use disorder, with an DI with a month of evolution, who resorted to the emergency department. DI is not a single diagnostic entity. The classic form, as represented in the first case,is a primary form, which develops without any known cause or underlying disease, corresponding to a persistent delusional disorder. However, about 60% of patients have secondary forms of DI, in the context of substance misuse, some medications or in the course of physical or psychiatric diseases (e.g. stroke, delirium, dementia, depression, schizophrenia).ConclusionsDI can occur as a primary delusional disorder or secondary to several other medical conditions. An in-depth clinical history is essential in order to make the correct diagnosis. A multidisciplinary approach is also important, to exclude any possible organic etiology, not forgetting that many patients may turn to other medical specialities first.DisclosureNo significant relationships.

Case series of delusional parasitosis in an emergency department: Sociodemographic features and clinical outcomes

IntroductionA delusion of parasitosis is defined as the fixed, false belief of infestation by invisible organisms or fibrous material of unknown origin. The differential diagnosis is true infection, substance use disorder, dementia or other neuropsychiatric disease.ObjectivesOur goal was to characterize delusions of parasitosis, classically named Ekbom syndrome, among individuals attending our emergency department (ED).MethodsOver a four-year period (2017-2020), we carried out a retrospective case-register study of patients with DSM-5 Ekbom syndrome attending an ED that provides mental health services to an area of nearly 450.000 inhabitants in Sabadell (Barcelona, Spain).ResultsThere were 13 eligible patients: 7 were diagnosed for the first time and 6 had multiple episodes. Female-to-male ratio was 1.6:1; average age was 56.9. The most common diagnosis was delusional disorder (n=5;8.5%), followed by schizophrenia (n=3;23.1%) and organic disorders (n=2;15.4%). Origin: Africa (n=5;38.5%), South-America (n=4;30.8%) and Spain (n=4;30.8%). Fifty percent showed poor treatment compliance. Antipsychotics used: risperidone (n=8;61.54%), olanzapine (n=4;30.8%). Five patients received antidepressants. Most patients had previously been seen by other medical specialties (internal medicine, dermatology and hematology). ‘’Match box sign’’: 7 patients (53.8%). Cerebral atrophy was present on brain scan in 4 patients. After discharge: acute psychiatric unit (n=7), outpatient appointments (n=4), day hospital (n=1) and 1 to a psychogeriatric unit.ConclusionsDelusions of parasitosis are rare in our emergency department. The typical patient is a postmenopausal woman, a visitor or immigrant to Spain. Effective treatment requires a focus on cultural, gender, and age aspects, with close cooperation between psychiatry and other relevant specialties.