Delusional Parasitosis Research Articles

Patient Information Leaflet Feedback on Delusional Infestation.

Delusional parasitosis, also known as Ekbom syndrome, is a poorly understood condition often surrounded by misinformation. Patients and their families frequently encounter skepticism regarding their experiences. This research aimed to create a patient information leaflet (PIL) with a patient centred approach and to gather feedback on its usefulness for sharing information and validating their experiences. To evaluate patient feedback on a newly developed PIL designed for individuals with delusional parasitosis, assessing its perceived usefulness and impact. A survey was administered to 18 patients before their appointments, incorporating the new PIL. The survey included questions on the leaflet's clarity, usefulness, ability to validate patient experiences and other pointers, measured on a 10-point Likert scale (0 = No answer, 1 = Strongly Disagree, 10 = Strongly Agree). Data was analysed using descriptive statistics and factor analysis. Additionally, the final question allowed for written feedback, which was examined through thematic analysis. The survey results revealed that the majority of patients were satisfied with the new PIL. Specifically, 94% agreed or strongly agreed that the leaflet was logical and easy to follow, 72% found it useful for understanding their condition, and 89% felt it validated their experiences. Mean scores for these concepts were 8.83, 7.61, and 7.78, respectively. Thematic analysis of written feedback highlighted themes of improved understanding but uncertainty around acknowledgement of experiences. This new patient-centered PIL for delusional parasitosis was well-received, indicating its potential as a valuable tool for patients and their support networks. By addressing the specific needs and experiences of patients, the leaflet can improve communication and reduce the stigma associated with the condition. Future research should explore long-term impacts and the effectiveness of similar resources in other patient populations.

Patients with Delusional Infestation are being given conflicting advice by pharmacy colleagues.

The role of pharmacists in psychodermatology includes counseling patients on psychotropic medications, ensuring adherence, and providing guidance that complements the advice of dermatology health care professionals. This pilot study is the first to highlight discrepancies in counselling effectiveness between clinicians and pharmacists. Patients were provided with suboptimal, conflicting or contradictory advice and training specialized pharmacists with prescribing privileges and providing specific information on psychotropic medications are essential.

Delusional parasitosis (Ekbom Syndrome): A case report

Background: Ekbom syndrome or Delusional Parasitosis (DP) is an infrequent psychotic illness, where the patient has a false but firm and strong belief that his body is infested with parasites, worms, insects, or other organisms. This is a monothematic delusion of hallucinatory origin that typically affects older women. The aim: To report two cases of DP. Case report: The first patient presented a generalized sensation of parasite infestation following ischemic stroke. In the second case, the delusions of parasitosis were concentrated in the head only. Conclusion: Delusional parasitosis (DP) or Ekbom syndrome is an infrequent psychotic illness. Collaboration between dermatologists and psychiatrists is important in managing this rare disease. Neurologists must be aware of DP in patients with stroke.

Delusional Parasitosis in a Patient With a History of COVID-19 and Substance Use Disorder.

Delusional parasitosis is a psychotic disorder that manifests as a belief that the skin is infested with parasites. This case report documents the association between COVID-19 infection and new-onset delusional parasitosis superimposed on preexisting psychosis, which has not been previously documented in the current literature. A 28-year-old male presented with new-onset delusional parasitosis superimposed on existing psychosis following COVID-19 infection. Computed tomography scan of the head was unremarkable. He was treated with olanzapine, which appeared to lessen the intensity of the delusions. This case report should encourage increased monitoring of COVID-positive patients with psychosis.

A combined tropical medicine and psychiatry approach to patients with possible delusional infestation.

Delusional infestation (DI) is a well-recognized delusional disorder presenting as the persisting belief of being infested. Combined clinics have been run by dermatology and psychiatry in a small number of centres. In this article we focus on our Liverpool University Hospitals NHS Foundation Trust clinic hosted at the Liverpool School of Tropical Medicine, UK, where we run a specialist clinic for DI. We describe the specific set-up and approach of our clinic as a guide for clinicians working in specialties likely to see patients with DI (including tropical medicine, infectious diseases and dermatology) who may either want to set up similar clinics or be better equipped to manage DI patients promptly within existing practice. We describe the details of the clinic's approach. Between 2018 and 2023, the service saw 208 patients, of which 82.7% could be assessed and 55.7% had DI. The female:male ratio was 2:1. Interdisciplinary combined clinics with medical and psychiatry consultants working together offer an approach to managing this rare, challenging and high-consequence condition.

49657 Dupilumab as a novel therapy for management of delusional parasitosis: a case series

49657 Dupilumab as a novel therapy for management of delusional parasitosis: a case series

State-of-the-Art Review: Evaluation and Management of Delusional Infestation.

Delusional infestation is a condition encountered frequently by healthcare professionals across a variety of specialties in which patients have a fixed, false belief that they are infested with living creatures, such as bugs, parasites, worms, or mites, or nonliving objects, such as fibers. Delusional infestation can be debilitating for patients, who not only present with intense psychological distress and physical discomfort but are also at risk of developing numerous dermatological and psychiatric complications. This condition poses unique diagnostic challenges, as these symptoms can occur secondary to many metabolic or infectious causes, as well as unique treatment challenges, with patients frequently refusing psychiatric care and consequently seeking evaluation by other healthcare professionals. In this review, we aim to use existing literature to provide clinicians in infectious diseases or other specialties with sufficient clinical context and treatment guidance for the appropriate management of delusional infestation.

Executive Summary: State-of-the-Art Review: Evaluation and Management of Delusional Infestation.

Executive Summary: State-of-the-Art Review: Evaluation and Management of Delusional Infestation.

Psychodermatology in Hungary: Awareness and practice patterns of dermatologists.

Psychodermatology is an interdisciplinary branch of medicine between psychiatry /psychology and dermatology. This study aimed to assess Hungarian dermatologists' awareness, practice patterns and attitudes towards psychodermatology. A questionnaire-based survey was sent from October 2020 to June 2021 to 100 dermatologists (including residents in dermatology) in Hungary with a response rate of 51%. The participants were asked about understanding of the concept of psychodermatology and their training in this field, comfort in treatment, and interest in continuing medical education on dermatological disorders with psychological components. 49% of the respondents understood psychodermatology as a bidirectional interaction of the patient's mental and dermatological conditions, and 25.5% were comfortable in treating psychodermatological patients. The most common dermatological diagnoses with psychological/psychiatric involvement reported were psoriasis and atopic dermatitis. Atopic dermatitis, anxiety, delusional parasitosis, and depression were the most common diagnoses when dermatologists referred patients to psychiatrists. In total, 76.5% of participants could not name any resource (magazine, website, etc.) for patients and their families where information about psychodermatology is available, and 58.8% showed a definite interest in attending training on psychodermatology. The results of our study suggest that Hungarian dermatologists have a high awareness of the term "psychodermatology", and only a quarter of practitioners feel adequately equipped and comfortable managing patients with psychosomatic aspects in their treatment. The relatively large gap between the number of patients with a psychodermatological component and referrals by dermatologists to mental health specialists indicates the potential importance of more intensive collaboration between dermatologists, psychiatrists and/or psychologists.

Historical H01 A published case of delusional parasitosis in an entomologist

Historical H01 A published case of delusional parasitosis in an entomologist

Ekbom Syndrome: A Case Study

This case study examines the diagnosis, treatment, and management of a 42-year-old female patient presenting with delusional parasitosis, also known as Ekbom syndrome. The patient experienced severe itching, crawling sensations, and self-inflicted skin lesions due to her persistent belief in parasitic infestation despite negative medical test results. The patient was referred to a psychiatrist after a dermatology consultation and was diagnosed with Ekbom syndrome. Treatment involved antipsychotic medication (aripiprazole) and cognitive-behavioral therapy (CBT), which led to a decrease in symptom intensity and improved patient insight. The study highlights the importance of a multidisciplinary approach to diagnosing and treating delusional parasitosis, emphasizing the need for early referral to a psychiatrist and the effectiveness of combined therapy in managing symptoms.

Efficacy of antipsychotics in delusional infestation.

Data remain scarce for the first-line antipsychotic choice in treating delusional infestation (DI). We evaluated the treatment responses associated with different antipsychotics in DI patients. We undertook a multicentre, retrospective observational study using anonymised electronic patient records from two hospitals in the United Kingdom from 1 January 2011 to 1 January 2023. Eligible participants were adults (≥18 years) diagnosed with DI treated with an antipsychotic, and had both an assigned baseline and follow-up Clinical Global Impression Scale (CGI-S) score. The CGI-S is a validated psychiatric research tool. Participants were excluded if they had known limited or non-adherence to an antipsychotic, or if no CGI-S scores were present at follow-up. First clinic visits before the initiation of an antipsychotic were assigned as the baseline CGI-S score. The last available CGI-S score before the patient either changed antipsychotic or left the clinic for any reason was used to assign follow-up CGI-S scores. The primary outcome was the response to each individual antipsychotic treatment, measured by the difference in the baseline and last available follow-up CGI-S scores. Differences in CGI-S changes between antipsychotic episodes were tested by analysis of variance (ANOVA). In total, 414 patient records were analysed, and data were extracted. The mean age was 61.8 years (SD 14.1). One hundred seventy (41%) of 414 patients were men and 244 (59%) were women. In total, 156 (38%) of 414 patients were eligible, yielding a total of 315 antipsychotic prescribing episodes. The ANOVA, ranking in order of treatment response, showed that the highest mean score (expressing highest treatment response) was observed in amisulpride (31 [67%] of 46) and risperidone (95 [57%] of 167), followed by some distance by quetiapine (9 [36%] of 25), aripiprazole (13 [28%] of 46) and olanzapine (7 [25%] of 28). Amisulpride and risperidone were associated with a higher treatment response than quetiapine, aripiprazole and olanzapine. Amisulpride and risperidone should therefore be considered the first-line treatment options in DI patients.

A Rare Presentation of Delusional Parasitosis With Koro-Like Syndrome

A Rare Presentation of Delusional Parasitosis With Koro-Like Syndrome

Ornithonyssus bacoti Dermatitis Incorrectly Diagnosed as Delusional Parasitosis.

Ornithonyssus bacoti Dermatitis Incorrectly Diagnosed as Delusional Parasitosis.

Examining the Mr Tsafendas enquiry trial: Current insights on forensic psychiatric assessment and ethics

On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis of schizophrenia; Consideration of cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis.

Exploring delusional parasitosis – a case series of three patients

Delusional parasitosis is a psychiatric condition where individuals believe they are infested with parasites despite lacking medical evidence. This often leads to underestimation within psychiatric settings. Three patients with delusional parasitosis, aged above and below 50, presented with symptoms lasting from 1 to 6 months. Two had consulted specialists before, and one had primary delusional parasitosis while two had secondary due to schizophrenia and depression. Tablet Olanzapine showed partial response in one patient before admission. Tablet Risperidone resulted in complete symptom resolution within 10 days in two patients and within 1 month in one patient. Randomized controlled trials on antipsychotics for delusional parasitosis treatment are lacking. Further research is needed to assess treatment recommendations. Psychiatrists should report cases to provide clinical evidence supporting treatment decisions.

Ekbom síndrome (Parasitosis delirium): Cocaine Use vs. Psychotic Depression. A case report

IntroductionParasitosis delirium represents a rare mono-symptomatic psychosis characterized by the delirious firm belief of the patient, against all evidence, of being infested by cutaneous parasites. The syndrome affects in particular middle-aged women, and can be the single manifestation of psychological uneasiness or represent one of the aspects of a more complex psychiatric case, compromising almost totally any normal daily work and/or social activity. It is often accompanied by a refusal to seek psychiatric care. This condition can be associated with various underlying causes, including substance use disorders and psychotic depression. Understanding the differences and similarities between delirium of infestation in the context of cocaine use and psychotic depression is crucial for accurate diagnosis and effective treatment.ObjectivesThis study aims to compare and contrast the clinical features, etiology, and treatment approaches of delirium of infestation in individuals with cocaine use and those with psychotic depression. By examining these two distinct populations, we can gain insights into the unique challenges and considerations associated with each condition.MethodsA case report of a 44-year-old woman with delirium of parasitosis, depressive symptoms and cocaine use in the last three days. Also a comprehensive literature review using the PubMed database to identify relevant clinical articles on delirium of infestation, cocaine use, and psychotic depression.Results Cocaine use and psychotic depression can both cause delirium of infestation. Cocaine-induced delirium is characterized by agitation, paranoia, and delusions of infestation. Psychotic depression is characterized by a depressed mood, delusions, and hallucinations. Delusions of infestation are a common feature of bothconditions. However, the underlying mechanisms and treatment approaches differ. Cocaine-induced delirium is primarily associated with the acute effects of cocaine on the central nervous system, while psychotic depression involves a complex interplay of biological, psychological, and environmental factors. Treatment for cocaine-induced delirium involves addressing the underlying cocaine use, while treatment for psychotic depression involves antidepressant and antipsychotic medications. Otherwise, Anti-Parkinson drugs were most frequently associated with delusional infestationConclusionsDelirium of infestation can occur in individuals with cocaine use and those with psychotic depression, albeit with different etiologies. Clinicians should consider the underlying cause when diagnosing and treating patients with this condition. Further research is needed to explore the specific neurobiological mechanisms and optimal treatment strategies for delirium of infestation in these distinct populations.Disclosure of InterestNone Declared

Delusional parasitosis: the importance of a multidisciplinary approach

IntroductionDelusional parasitosis, also known as delusional infestation or Ekbom’s syndrome, is a rare psychotic disorder characterized by the false belief that a parasitic skin infestation exists, despite the absence of any medical evidence to support this claim. These patients often see many physicians, so a multidisciplinary approach among clinicians is important. Many patients refuse any treatment due to their firm belief that they suffer from an infestation, not a psychiatric condition, so it is crucial to gain the trust of these patients.ObjectivesThe comprehensive review of this clinical case aims to investigate Ekbom syndrome, from a historical, clinical and therapeutic perspective.MethodsLiterature review based on delusional parasitosis.ResultsA 65-year-old woman comes to the psychiatry consultation referred by her primary care physician concerned about being infested by insects that she perceives through scales on her skin for the last three months. She recognizes important impact on her functionality. She is also convinced that her family is being infected too. As psychiatric history she recognizes alcohol abuse in the past (no current consumption) and an episode of persecutory characteristics with a neighbor, more than ten years ago. On psychopathological examination, she shows delusional ideation of parasitosis, with high behavioral repercussions, cenesthetic and cotariform hallucinations, as well as feelings of helplessness and anger. Treatment with Pimozide was started and the patient was referred to dermatology for evaluation, a plan she accepted. Her primary care physician and dermatology specialist were informed about the case and the treatment plan. In the recent reviews, the patient is calmer, however, despite the corroboration of dermatology and in the absence of organic lesions in cranial CT, she is still unsatisfied with the results, remaining firm in her conviction of infestation. It was decided to start treatment with atypical neuroleptics (Aripiprazole), with progressive recovery of her previous functionality.ConclusionsDespite the increase in the number of studies in recent years, there are still few studies on this type of delirium. The female:male ratio varies in the bibiliography (between 2:1 and 3:1). The onset is usually insidious, generally appearing as a patient who comes to his primary care physician convinced of having parasites in different skin locations. It is usual to observe scratching lesions or even wounds in search of the parasite. In the past, the most used and studied treatment was Pimozide. Currently the treatment of choice is atypical neuroleptics due to their lower side effects. The latest reviews on the prognosis of this disorder show data with percentages of complete recovery between 51% and 70%, and partial responses between 16.5% and 20%. Finally, for a good diagnosis and therapeutic management, it is important to achieve a multidisciplinary approach.Disclosure of InterestNone Declared

Differential diagnosis of acute psychosis after cocaine consumption: a case report

IntroductionPsychosis is a common clinical presentation of mental disorder in many psychiatric patients, however, an etiological diagnosis is important when it occurs for the first time in a patient. Regarding a case seen in the Emergency Department recently, with major depression and acute cocaine use, a differential diagnosis was made after adequate organic screening. When presenting delusion of infestation after the consumption of the substance, the main hypothesis was what we call Ekbom syndrome. However, among other possibilities we consider a toxic psychosis or a major depression with psychotic symptoms.ObjectivesReview the different causes of acute psychosis and the importance of a good clinical history to achieve a specific diagnosis. Perform a differential diagnosis between the main causes of psychosis in a patient with depression who has recently consumed cocaine.MethodsPresentation of the case and review of the available literature on the risk of developing psychosis after cocaine use and depression concomitantly.ResultsThere is a low number of reported cases of delusional infestation after acute cocaine use, being more likely toxic psychosis or major depression with psychotic symptoms. A good anamnesis, with systematic questions about toxic habits, can lead us to a more accurate main hypothesis.ConclusionsWe mark the importance of a systematic anamnesis to achieve a better diagnosis, as well as a correct study by the clinician of the specific syndromes described in phenomenology such as Ekbom syndrome, to make a correct association of ideas in the differential diagnosis.Disclosure of InterestNone Declared

Unmet Needs in Psychodermatology: A Narrative Review.

Psychodermatology, the multidisciplinary field that explores the intricate interplay between the mind and the skin, has gained increasing recognition over the past decade. However, several knowledge gaps and unmet needs persist in the field. The objective of this narrative review was to investigate the unmet needs in the field of psychodermatology as they pertain to medical training, treatment, research, and care access. PubMed was searched from inception through December 2023 to identify articles related to psychodermatology. Findings revealed several unmet needs within the field of psychodermatology. First, there is a need for further investigation into the pathophysiology that links psychological stress to cutaneous disease including the development of novel therapies targeting key neuropeptides. Second, the existing literature focuses primarily on the pharmacologic treatment of body dysmorphic disorder and body-focused repetitive behaviors, as well as delusional parasitosis, for which the first-line agents are selective serotonin reuptake inhibitors and atypical antipsychotics, respectively. However, additional research into the efficacy and safety of the remaining psychotropic medications and the treatment of other common psychocutaneous diseases is required. Finally, there exists a significant gap in knowledge amongst clinicians tasked with treating psychocutaneous diseases. Dermatologists report low rates of training in psychodermatology and discomfort with prescribing psychotropic medications. In conclusion, increasing resources for dermatologist education on psychotropic agent use, development of new drugs targeting stress-induced skin conditions, and research on the psychocutaneous applications of current medications may greatly improve the quality and access of psychodermatology care.