Delusional parasitosis [abstract]

Delusional parasitosis is a rare psychiatric syndrome in which the patient believes that he/she is infested with parasites despite clear evidence to the contrary. It was first described in the literature about 100 years ago when it was referred to as psychogenic parasitosis. It can occur in the form of a delusional disorder of the somatic type (DSM IV) but it has also been reported in schizophrenia, affective or organic psychosis or induced psychosis. Patients with delusional parasitosis generally think that mites, lice or other insects have invaded their skin and most frequently seek treatment from dermatologists or family practitioners. It is a chronic disorder that may occur at any age but is more common in the elderly, particularly in females. The patient may try to pick the parasites out of the skin causing cutaneous lesions. Treatment is based on antipsychotic agents, psychotherapy and cooperation between dermatologist and psychiatrist. A case of delusional disorder of the somatic type (DSM IV) in a 55-year-old male is described. The patient sought medical attention because he strongly believed that his skin was infested with mites for three years. He tried to pick mites out of the skin of his face, neck, abdomen and back and this caused severe keloid formation. He was first seen by a dermatologist whose clinical and laboratory investigations for parasitic infestations were negative. After investigation, the patient was referred to the psychiatrist. Haloperidol was prescribed and there was good response to antipsychotic treatment. The delusional symptoms improved over the first three months and then a full recovery was observed. The patient maintained the recovery at one-year follow-up. (AU)

Psychosocial realities of schizophrenia: a study in social psychiatry

A retrospective qualitative look at the schizophrenias as seen from a cohort of fifty records (male 53.70 percent and female 46.30 percent) all active in 1996, but ranging up to 30 years. The profile of the disorder is of a life-long relationship with a biophysical substance rather than with a humanistic therapist. For each new admission there ensures a mean of 11 years of continued contact to access the intramuscular panacea called modecate (Fluphenazine decanoate). The decade of "refills" calls for a mean of 46.27 visits per patient (N=33). The clinical nurse emerges as the critical mediator of the technology of this chronic illness. Time budget demands a telescoped dossier. The realities point to unimanginable strains upon individuals and families. The need and demands of schizophrenia will remain the most intractable diagnostic category unless "self-help" and quality care provision by the client for the client are taken aboard. (AU)

Characteristics of freebase cocaine psychosis

Psychosis was present in 29 percent of cocaine disordered patients hospitalized in 1985 during an epidemic of freebase cocaine abuse in the Bahamas. Record reviews revealed that a variety of psychotic phenomenologic patterns were presented. Prior major mental disorders and increased dosage of cocaine were more common among psychotic than non psychotic patients. Violent behaviour was common among cocaine patients, especially those with psychosis. We conclude that freebase cocaine psychosis is neither rare nor benign. (AU)