Delusional parasitosis: Worms of the mind

Prakash, Jyoti; Shashikumar, R; Bhat, Pookala Shivaram; Srivastava, Kalpana; Nath, Santanu; Rajendran, Aruna

doi:10.4103/0972-6748.110958

Cited by 16 publications

(11 citation statements)

References 9 publications

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“…The mean age of onset in recent reports (Table 1) was older than 45 years. Further, in our summary of 25 individuals [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], women became ill significantly later than men which is consistent with other recent studies [2••, 7••, 12••] and some previous ones [10]. Since DD appears to be a disorder mostly seen in later stages of life, physicians and caregivers should be cautious about medication side effects and drug-drug interactions when it comes to pharmacological treatment.…”

Section: Psychopharmacological Treatment Methodssupporting

confidence: 90%

Current Treatments for Delusional Disorder

Roudsari¹,

Chun

Manschreck

2015

Curr Treat Options Psych

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Delusional disorders form part of the spectrum of psychotic disorders in psychiatry. They are poorly understood in practically every aspect of their nature, including cause, phenomenology, prevalence, comorbidity, course, treatment, and prognosis. The key symptom in delusional disorders is one or more delusions. A cardinal characteristic of delusional disorder, conviction that one is not mentally ill, contributes complexity to the treatment challenges and profoundly affects the therapeutic relationship. Diagnosis and differential diagnosis are critical tasks. Delusional conditions may arise from many sources and, only when the case conforms to the criteria and is clearly idiopathic-is a primary delusional disorder-can we feel confident that the patient suffers from delusional disorder rather than a secondary delusional condition. Adequate treatment follows principles for the treatment of delusions. First line pharmacological treatment for delusional disorder is antipsychotic medication, both first and second-generation agents, and some evidence suggests that clozapine may be effective in certain cases. The assumption in such a formulation is that the delusion(s) encountered in delusional disorders respond as a class of symptoms found in different disorders. Hence, the approach for failed interventions with these agents may be similar to that proposed for the treatment of schizophrenia or other psychotic disorders. Namely, searching for evidence of failure to take medication, inadequate dosing, a missed diagnosis of a substance disorder, medical condition, or even another psychiatric disorder should be considered. For individuals with delusional disorders who are also experiencing comorbid depression or anxiety, the addition of appropriate agents for those symptoms may provide a synergistic strategy for overall effectiveness. Psychotherapy is another important clinical tool. Cognitive behavioral therapy focusing on different aspects of delusions (i.e., anxiety, reasoning biases, faulty logic, etc.) has demonstrated some value for at least short-term improvement. Various techniques may be useful in allying with the patient and supplying means to assist in managing their thinking and approach to circumstances and factors that promote delusion formation and encourage actions taken to respond. A significant problem in applying what we know about delusional disorders to treatment is the limited available evidence. Lack of randomized controlled trials, which form the standard in most clinical disorders, is a major shortcoming. Recent observations of compromised cognitive functioning in working memory, attention, and executive function should be replicated with similar standards. Systematic case studies and large series are useful, and a growing effort to be more rigorous methodologically in all contributions including case registries and longer followup studies is promising. Nevertheless, our knowledge remains less than optimal. These comments apply not only to pharmacological observations but also to those of neuropsyc...

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Section: Psychopharmacological Treatment Methodssupporting

confidence: 90%

Current Treatments for Delusional Disorder

Roudsari¹,

Chun

Manschreck

2015

Curr Treat Options Psych

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“…Patients with delusional parasitosis report tactile hallucinations or paresthesia and often have skin damage from their attempts to remove the parasites. This illness can be classified into primary and secondary forms: the former cannot be explained by other psychiatric or organic diseases, whereas the latter can occur in other psychiatric disorders and medical illnesses, as well as in substance abuse disorders and medication side effects[ 2 ]. The treatment of delusional parasitosis is a therapeutic challenge because many patients refuse psychiatric treatment owing to the belief that parasitic infestation is unshakable and not a psychiatric condition.…”

Section: Introductionmentioning

confidence: 99%

Delusional parasitosis as premotor symptom of parkinson’s disease: A case report

Oh¹,

Kim²,

Lee³

2022

WJCC

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BACKGROUND Delusional parasitosis is characterized by a false belief of being infested with parasites, insects, or worms. This illness is observed in patients with Parkinson’s disease and is usually related to dopaminergic treatment. To our knowledge, no cases of delusional parasitosis have been reported as a premotor symptom or non-motor symptom of Parkinson’s disease. CASE SUMMARY A 75-year-old woman presented with a complaint of itching that she ascribed to the presence of insects in her skin, and she had erythematous plaques on her trunk, arms, buttocks, and face. These symptoms started two months before the visit to the hospital. She took medication, including antipsychotics, with a diagnosis of delusional parasitosis, and the delusion improved after three months. A year later, antipsychotics were discontinued, and anxiety and depression were controlled with medication. However, she complained of bradykinesia, masked face, hand tremor, and mild rigidity, and we performed fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane positron emission tomography (PET), which showed mildly decreased DAT binding in the right anterior putamen and caudate nucleus. Parkinson’s disease was diagnosed on the basis of PET and clinical symptoms. CONCLUSION In conclusion, delusional parasitosis can be considered a non-motor sign of Parkinson’s disease along with depression, anxiety, and constipation.

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“…In primary delusional parasitosis, the patient has the delusion of being infested with parasites but no other psychiatric or organic disorders is present. The secondary (functional) and organic forms of delusional parasitosis occur secondarily to other disorders, namely psychiatric and organic disease, respectively [2]. There are several mental disorders that can be accompanied by Ekbom syndrome, such as schizophrenia, depression, dementia, anxiety, and phobia, while the organic type is linked with hypothyroidism, anemia, vitamin B12 deficiency, hepatitis, diabetes, infections (e.g., HIV, syphilis), and cocaine abuse [3].…”

Section: Introductionmentioning

confidence: 99%

Delusions of Parasitosis: An Update

Reich

Kwiatkowska

Pacan³

2019

Dermatol Ther (Heidelb)

100

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Delusional parasitosis, also known as delusional infestation or Ekbom syndrome, is a relatively infrequent psychotic disorder characterized by an unwavering false belief that there is a parasitic infestation of the skin, despite the absence of any medical evidence that could support this claim. Delusional parasitosis can be categorized into primary, secondary, and organic forms. Sometimes, close relatives also experience identical delusions. This phenomenon was reported to occur in 5–15% of cases, and is known as shared psychotic disorder–delusional parasitosis with folie à deux. Patients with delusional parasitosis frequently seek help from many physicians. Close multidisciplinary cooperation between clinicians is often key to shortening the time taken to diagnose this disorder. Initiation of psychopharmacological therapy is a challenge, as many patients refuse any psychiatric treatment because of the stigma associated with mental illness and because of their firm belief that they have a parasitic infestation, not a psychiatric condition. For many patients, a sense of a lack of understanding leads to isolation and the development of depression symptoms, which is why it is crucial to earn the trust of such patients while taking care of them.

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Delusional parasitosis: Worms of the mind

Abstract: 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.

Cited by 16 publications

References 9 publications

Current Treatments for Delusional Disorder

Current Treatments for Delusional Disorder

Delusional parasitosis as premotor symptom of parkinson’s disease: A case report

Delusions of Parasitosis: An Update

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