Delusions of parasitosis

Background

Delusions of parasitosis (DP) is a rare psychiatric disorder in which the patient has a firm belief that she or he is infected by parasites. Although it is a psychiatric disorder, these patients often present to an emergency physician because they are convinced that they have a severe skin problem.

Treatment

Patients with DP often reject psychiatric referral. The diagnosis of DP can usually be made based on history alone. However, it is important that the patient does not have an organic skin disorder and that the delusion is not secondary to another mental or physical illness. The current treatments of choice are the antipsychotic medications risperidone and olanzapine.

Conclusions

In our experience, patients with DP seen in the emergency department who are suspected of having this condition can be a challenging diagnostic and treatment problem because they usually do not have health insurance. Consequently, we find it difficult to get dermatologic and psychiatric consultation to treat their illness.     

Emergency department presentation of ‘delusional parasitosis by proxy’. Delusional parent,injured child

We report a case of 'delusional parasitosis by proxy'. A sixyear old child was brought to the emergency department by a mother with concerns that her son had a skin and scalp infestation. Despite the absence of any clinical findings being found on exam, the mother remained disproportionately concerned. Follow up care was recommended with the child's primary care. The mother returned to the ED with her child three weeks later with concerns that her son had an inflamed scalp and eyes. The mother remained insistent that the child was infested with bugs and she had sought care at two other locations where the child was prescribed permethrin on both visits. She had been applying the medication repeatedly. On exam the boy's scalp had been shaved and was erythematous and irritated; his eyebrows and eyelashes had also been shaved off and likely contributed to an irritant conjunctivitis from repeated applications of topical permethrin lotion. No evidence of infestation was identified. We recruited the assistance of the maternal grandparents, child protective services and primary care pediatrics and the child was removed from the mother's custody and placed into the custody of the grandparents. Six weeks later with basic skin care and erythromycin ophthalmic ointment for the eyes, the child's hair, eyebrows and eyelashes grew had grown in, and the scalp irritation had resolved. The mother had sought and received psychiatric care and was improving.     

Delusions of parasitosis

I have presented a case of delusion of parasitosis, a relatively uncommon psychiatric condition, which was successfully treated with haloperidol.     

Psycho dermatology: the mind and skin connection.

A psychodermatologic disorder is a condition that involves an interaction between the mind and the skin. Psychodermatologic disorders fall into three categories: psychophysiologic disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychophysiologic disorders (e.g., psoriasis and eczema) are associated with skin problems that are not directly connected to the mind but that react to emotional states, such as stress. Primary psychiatric disorders involve psychiatric conditions that result in self-induced cutaneous manifestations, such as trichotillomania and delusions of parasitosis. Secondary psychiatric disorders are associated with disfiguring skin disorders. The disfigurement results in psychologic problems, such as decreased self-esteem, depression or social phobia. Most psychodermatologic disorders can be treated with anxiety-decreasing techniques or, in extreme cases, psychotropic medications.     

Pancreatic carcinoma in an elderly woman with an organic affective disorder and AIDS delusion

An elderly woman with symptoms of depression and an AIDS delusion was found also to have pancreatic carcinoma. I have discussed her case in conjunction with organic affective disorder, the evaluation of depression in the elderly, and suicide in the elderly.     

A case of Capgras delusion following critical illness

Hallucinations and paranoid delusions are recognised complications of critical illness. However, the occurrence of Capgras syndrome, in response to critical illness, where patients are convinced that doubles have replaced close family has not been described in the literature. There have been isolated case histories in the literature in response to medical procedures or illness but mostly in patients suffering from schizophrenia. A 42 year old woman was admitted to the intensive care unit (ICU) with pneumonia, following extensive surgery for a squamous cell carcinoma, secondary to Crohns disease. She had no history of previous head injury, cerebro-vascular problems or psychiatric disorder. She reported having memories of all her family, with the exception of her mother, being replaced by aliens while she was on the ICU. The delusion was only diagnosed once it had resolved and the patient was able to talk, and this highlights the difficulty of diagnosing delusions while patients are still intubated and unable to verbalise their concerns. It has been suggested that a defect in the ability to recognise the emotional significance of the face lies at the root of Capgras syndrome. Received: 16 December 1998/Final revision received: 25 June 1999/Accepted: 6 July 1999     

Psychotropics in dermatology

In dermatology, psychotropics are sometimes useful. But it is not still popular in clinical dermatology. It is recommended to use them for the patients who have psychosomatic aspect, anxiety and depression due to skin disease. Psychotropics are also useful to alleviate the sensation of itch. Trichotillomania and excess scratch are treated with antidepressants, anticonvulsants or antipsychotics. Cutaneous dysesthesia and delusional parasitosis are treated with antipsychotics. In prescribing benzodiazepines and hypnotics, we have to check abuse and dependency. Decrease of dosage should be made gradually. Antidepressants, anticonvulsants (except barbiturates) and antipsychotics have no dependency. They are much easily used than benzodiazepines. Drowsy and thirsty are main side effects that antihistamines also have. It should be noticed to use both simultaneously.     

Psychiatric and parasitologic aspects of dermatozoon delusion

Patients suffering from delusional parasitosis are not only seen by psychiatrists, but more often by dermatologists and parasitologists. Previous results published by researchers of differing specialities led to somewhat contradictory opinions concerning these patients. The main goals of the present study were, on the one hand, to examine the various and partly controversial hypotheses, which were mostly based on single case observations in a substantial sample of 107 patients with delusional parasitosis and, on the other hand, to investigate possible differences between patients who consulted the parasitologist initially and those who saw the dermatologist first and were subsequently treated by a psychiatrist. Hence, 34 patients treated by one of the authors (M.M.) at a special outpatient clinic for patients with delusional parasitosis of the Second Dermatological University Department, Vienna, have been compared with 73 patients who consulted the other author (E.K.) at the Institute of Parasitology of the University of Veterinary Medicine, Vienna. Some similarities, but also marked differences were found between the two groups: the sex ratio was similar in both groups but they differed with regard to age, social background (size of household) localisation of "parasites" and the mode of "infection". The results demonstrate the necessity of developing differentiated medical care programmes which take into account these differences.     

Pseudocyesis,delusional pregnancy,and psychosis: The birth of a delusion

Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature (2000-2014) on this subject (women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.     

Psychiatric Comorbidities and BMI: An Exploratory Analysis

Years of research and clinical practice have demonstrated that individuals with certain mental health conditions are at an increased risk of obesity. However, no identified research has examined associations between multiple comorbid psychiatric disorders and body mass index (BMI). This study uses a secondary analysis to examine associations between a large number of combinations of various mental health conditions and BMI. Surprisingly, the results of this study indicate that the most comorbid psychiatric disorders are not associated with an increased risk of elevated BMI. However, bipolar disorder, agoraphobia, attention-deficit hyperactivity disorder, and panic disorder had the greatest number of comorbid disorder associations linked with elevated BMI. The effect sizes ranged from a significant but relatively small Cohen's d of 0.3 to a more notable effect size of 0.7. The results of this study indicate that practitioners should be especially vigilant in helping their patients to avoid weight gain when they have one of the four identified disorders in combination with at least one other disorder. Future research is needed to understand the mechanisms underlying this increased risk and evaluate targeted interventions that would be the most effective for people with these diagnoses.     

住院Alzheimer病精神症状分析

目的：为了解Ａｌｚｈｅｉｍｅｒ（ＡＤ）的精神症状及其相关因素。方法：用自编的调查表对所有住院的ＡＤ病人及其精神症状作详细调查, 并对各种精神症状进行分析讨论。结果： ８９．６６％ 的ＡＤ病人有精神症状, 其中幻觉为２３．０８％ ,妄想为５７．６９％ ,情感障碍为３４．６２％ ,行为障碍为９２．３１％ ,年龄组越高,妄想和行为障碍多见,文化程度高、痴呆程度轻者幻觉发生率高,疗程短者抑郁多见。结论：ＡＤ病人的精神症状较为常见,且与年龄、文化程度、病程、痴呆程度等有关。     

Brief psychotic disorder associated with bereavement in a patient with terminal-stage uterine cervical cancer: a case report and review of the literature

We report here a terminally ill patient with uterine cervical cancer who developed a brief psychotic disorder after bereavement following the loss of three close friends also suffering from gynecological cancer. A 49-year-old housewife, who was diagnosed as having uterine cervical cancer and was receiving palliative care was referred for psychiatric consultation because of an abrupt onset of delusions, bizarre behavior, disorganized speech, and catatonic behavior. On psychiatric examination, she showed delusional thought and catatonic behavior. Laboratory data were unremarkable, as was brain MRI. She had no history of psychiatric illness or drug or alcohol abuse. After receiving haloperidol, psychiatric symptoms disappeared, and she returned to the previous level of functioning after 3 days. The patient explained that the death of three of her friend due to gynecological cancer was shocking event for her. She focused her attention on her own fears of dying from the same disease. Brief psychotic disorder in cancer patients is rare in the literature. However, our report of brief psychotic disorder associated with bereavement may highlight possible precipitating factors, which have not been adequately emphasized in the literature to date. From a clinical perspective, it would be informative for liaison psychiatrists to inquire about the patient's experience of loss of significant others with the same disease. This may provide useful information helpful to understanding the patient's conception of the disease process. Cancer patients' bereaving friends who had cancer is not rare in clinical settings. Therefore, medical staff should be mindful of interpersonal relationships between patients and bereavement arising from these relationships.     

Magic and forensic psychiatry: A case study and review of the literature

Forensic psychiatrists routinely appear in courts for crimes that have been perpetrated by mentally ill patients or when the defendant is suffering from a major psychiatric disorder. However, committing crimes under the presumed effects of magic and witchcraft is uncommon. A variety of delusional thoughts and personality disorders have been imputed in aggressive behaviour that might culminate in homicide. The patterns of a premeditated homicide, as well as the aberrations of the interpersonal relations, as a rule require long-term and close contact. As such, the family is a setting where such occurrences have been reported. We describe a case of first-degree murder by a woman who killed her mother-in-law after accusing her repeatedly of sorcery and witchcraft. Such complicated cases cannot be resolved without the help of forensic experts, whose role remains multifaceted and of particular importance.     

以精神病性症状为首发的阿尔茨海默病的临床特征

目的研究精神病性症状为首发的阿尔茨海默病（AD）的临床特征。方法以中国精神障碍分类和诊断标准（CCMD-3）为诊断标准，采用对照研究的方法分别对以精神病性症状为首发的AD患者及非精神病性症状为首发的AD患者在一般资料临床症状方面进行比较。结果两组在一般情况及智能方面比较差异无统计学意义（P〉0．05），而研究组在妄想和行为障碍方面较为突出。结论阿尔茨海默病患者的精神症状发生率较高，应引起重视。     

Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches

A multicenter study was carried out in 10 Italian Headache Centers to investigate the prevalence of psychosocial stress and psychiatric disorders listed by the IHS classification as the "most likely causative factors" of tension-type headache (TTH). Two hundred and seventeen TTH adult outpatients consecutively recruited underwent a structured psychiatric interview (CIDI-c). The assessment of psychosocial stress events was carried out using an ad hoc questionnaire. The psychiatric disorders that we included in the three psychiatric items of the fourth digit of the IHS classification were depressive disorders for the item depression, anxiety disorders for the item anxiety, and somatoform disorders for the item headache as a delusion or an idea. Diagnoses were made according to DSM-III-R criteria. At least one psychosocial stress event or a psychiatric disorder was detected in 84.8% of the patients. Prevalence of psychiatric comorbidity was 52.5% for anxiety, 36.4% for depression, and 21.7% for headache as a delusion or an idea. Psychosocial stress was found in 29.5% of the patients and did not differ between patients with and without psychiatric comorbidity. Generalized anxiety disorder (83.3%) and dysthymia (45.6%) were the most frequent disorders within their respective psychiatric group. The high prevalence of psychiatric disorders observed in this wide sample of patients emphasizes the need for a systematic investigation of psychiatric comorbidity aimed at a more comprehensive and appropriate clinical management of TTH patients.     

The use of hospice care in end-stage psychiatric patients

Hospice care is rarely used in end-stage psychiatric patients, yet situations exist where psychiatric intervention is futile and comfort care is the best option. Delusional disorder is rare, typically begins later in life, and has a chronic course that responds poorly to treatment. The prognosis is affected by factors such as chronicity and insight. A case of a chronic and intractable delusional disorder that affected eating behavior and subsequently caused serious medical complications. Due to the severity of the case and the unique ethical issues it presented, the prognosis was determined to be poor and the patient was discharged home with hospice care. The case presented a rare opportunity to assess hospice care provided to an end-stage psychiatric patient.     

A stranger in the looking glass: developing and challenging a hypnotic mirrored-self misidentification delusion

This article describes a study that used hypnosis to temporarily re-create mirrored-self misidentification, which is the delusional belief that the person one sees in the mirror is a stranger. Following a hypnotic suggestion to see a stranger in the mirror, high hypnotizable subjects described seeing a stranger with physical characteristics different to their own. Whereas subjects' beliefs about seeing a stranger were clearly false, they had no difficulty generating sensible reasons to explain the stranger's presence. The authors tested the resilience of this belief with clinically inspired challenges. Although visual challenges (e.g., the hypnotist appearing in the mirror alongside the subject) were most likely to breach the delusion, some subjects maintained the delusion across all challenges. Findings are discussed in light of the dominant theory of delusions and highlight the advantages of using hypnosis to explore delusional beliefs.     

Delusions of intestinal parasitosis

Delusions of parasitosis, though uncommon, are an important cause of distress for affected patients and frequently of frustration for their physicians. They occur primarily in middle-aged or older women, who have the delusional belief that they are infested with parasites. Although the vast majority of cases involve dermatologic manifestations, some patients may have delusions of intestinal infection, as illustrated by this case.     

Psychiatric disorders in geriatric medical/surgical patients. Part I: Report of 195 consecutive consultations

We reviewed psychiatric consultations (N = 195) for patients aged 60 years or more from a consecutive series of 1,000 psychiatric consultation requests. Consultations for geriatric patients were requested disproportionately less frequently than for nongeriatric patients and significantly more frequently for elderly women than for elderly men. The most frequent primary psychiatric diagnoses were organic psychiatric and depressive spectrum disorders. The referring primary care physician had either misdiagnosed or failed to recognize an underlying organic psychiatric disorder in more than half the patients with organic psychiatric illness. The study highlights the prevalent psychiatric disorders of the elderly medical/surgical patient, and opines that psychiatric consultants can be of significant assistance in the medical care of these patients.     

Aggressive change of a carotid-cavernous fistula in a patient with Ehlers–Danlos syndrome type IV

The authors report a rare case of a carotid-cavernous fistula (CCF) secondary to Ehlers–Danlos syndrome (EDS) type IV which showed an aggressive angiographical change.A 59-year-old woman presented with headache, right pulsatile tinnitus, and diplopia on the right side. The diagnostic angiography demonstrated a right CCF. Accordingly transarterial embolization of the fistula was attempted 5 days later. The initial right internal carotid angiography showed an aneurysm on the petrous portion of the internal carotid artery (ICA) which was not recognized in the diagnostic angiography. Spontaneous reduction of the shunt flow and long dissection of the ICA were also revealed. The aneurysm was successfully occluded with coils, and only minor shunt flow was shown on the final angiogram. EDS type IV was diagnosed with a skin biopsy for a collagen abnormality. After the operation, the stenosis of the right ICA gradually progressed, although there was no recurrence of the CCF.Interventional treatment for patients with EDS can cause devastating vascular complication. We should be aware of the possibility of EDS type IV when a spontaneous CCF shows unusual angiographical change because early diagnosis of EDS type IV is crucial for determination of the optimum treatment option.