RESUMEN
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.
Asunto(s)
Delirio de Parasitosis , Humanos , Delirio de Parasitosis/diagnóstico , Delirio de Parasitosis/terapia , Delirio de Parasitosis/tratamiento farmacológico , Delirio de Parasitosis/psicologíaRESUMEN
Ekbom syndrome, also known as delusional parasitosis (DP) or delusional infestation, is an uncommon psychiatric disorder distinguished by an enduring conviction of parasitic infestation, persisting notwithstanding the presence of medical evidence to the contrary. Primarily affecting middle-aged women, DP can manifest either as isolated psychological distress or as a component within a more intricate psychiatric framework, substantially influencing the quality of life for affected individuals. Its pathophysiological mechanism involves uncertain dopaminergic imbalances and dysfunction in the dopamine transporter system. Dermatologists often play a pivotal role in diagnosis, as patients first seek dermatological assessments of their signs and symptoms. However, DP frequently originates from underlying psychiatric disorders or medical variables, manifesting with neurological and infectious causative factors. The diagnostic complexity is attributed to patients' resolute convictions, leading to delayed psychiatric intervention. First-line DP treatment involves antipsychotics, with newer agents demonstrating promising prospects, but the lack of standardized protocols poses a significant therapeutic challenge. In this narrative review, both a comprehensive approach to this uncommon pathology and an update on the state of knowledge in this medical subfield focused on optimizing the management of DP are provided. The complexity of DP underlying its uncommon nature and the incomplete understanding of its pathophysiology highlight the need for further research through multicenter studies and multidisciplinary teams to enhance therapeutic efficacy and safety.
Asunto(s)
Antipsicóticos , Delirio de Parasitosis , Persona de Mediana Edad , Humanos , Femenino , Calidad de Vida , Delirio de Parasitosis/diagnóstico , Delirio de Parasitosis/tratamiento farmacológico , Delirio de Parasitosis/psicología , Antipsicóticos/uso terapéutico , Dopamina/uso terapéutico , Estudios InterdisciplinariosRESUMEN
This review synthesized evidence on the most up-to-date treatment outcomes in patients with delusional parasitosis and examined the impact of incorporating psychological interventions in conjunction with psychiatric treatment. The reporting of this review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed and Google Scholar were searched between 2013 and 2023. Nine studies were included in this review. Partial remission was observed across all cases, irrespective of the treatment approach employed. Complete remission was limited to only three studies. No correlation was observed between the incorporation of psychological intervention in conjunction with psychotropic medication and an enhanced remission outcome. The findings underscore the importance of psychotropic medication as a fundamental component in the treatment of delusional parasitosis. The results highlight that although first- and second-generation psychotropic medications are the mainstay treatment options, they nevertheless play a limited role because of the patients' steadfast delusions of infestations.
Asunto(s)
Delirio de Parasitosis , Humanos , Delirio de Parasitosis/terapia , Delirio de Parasitosis/diagnóstico , Delirio de Parasitosis/psicología , Resultado del Tratamiento , Psicotrópicos/uso terapéutico , Intervención Psicosocial , Terapia Combinada , Inducción de RemisiónAsunto(s)
Delirio de Parasitosis , Piel , Humanos , Prurito , Encéfalo , Delirio de Parasitosis/diagnósticoRESUMEN
Folie à deux or Shared psychotic disorder (SPD) is a rare condition characterized by shared psychotic symptoms between two or more individuals. Delusional parasitosis (DP) is an uncommon psychiatric illness in that patients believe they are infested by insects, without evidence to support this belief. DP occurs in 515% of SPD. We report a case of cutaneous DP with SPD between an elderly mother and a daughter that lived together and withdrew from other social contacts for the last three years. We aim to highlight the relationship between SPD and DP, its prognosis, and clinical implications.
Folie à deux ou Perturbação Psicótica Compartilhada (PPC) é uma condição rara caracterizada por sintomas psicóticos compartilhados entre dois ou mais indivíduos. O delírio parasitário (DP) é uma doença psiquiátrica incomum em que os pacientes acreditam estar infestados por insetos, sem evidências que sustentem essa crença. O DP ocorre em 5 a 15% das PPC. Relatamos um caso de um DP cutâneo com PPC entre uma mãe idosa e uma filha que viviam juntas e afastadas de outros contatos sociais nos últimos três anos. O nosso objetivo é destacar a relação entre PPC e o DP, o seu prognóstico e implicações clínicas
Asunto(s)
Trastorno Paranoide Compartido , Peste , Pronóstico , Delirio , Scientists for Health and Research for Development , Delirio de Parasitosis , Insectos , Trastornos MentalesRESUMEN
Delusional parasitosis (DP) is psychiatric disorder characterized by the unshakeable belief of being infested by endo- or ectoparasites, without any evidence of infestations. Hence, DP sufferers often consult medical entomologists or dermatologists, rather than seeking help from a mental health practitioner. Here we present 39 cases of suspected DP occurred in twenty years in two Italian public medical entomology laboratories, to highlight their common features and peculiarities, based on the interviews and material brought to our laboratories. Our results confirmed that DP affects both sexes, but is more frequent in females over the age of 50 years. Cases of psychological contagion, mostly affecting elderly people, were reported within seven family units. Some rare or unique features of DP sufferers involved: the fixed belief to be infested by endoparasites, olfactory hallucinations of unpleasant smell, self-harm to get rid of the imaginary parasite and suicidal thoughts. We suggest the term "Digital pics sign" to describe a modern derivative of the "Matchbox sign", where the DP sufferers showed pictures and videos, in person or sent by email, as proofs of being infested. Medical entomologists, being the most frequently contacted professionals by DP sufferers, may be crucial to raise awareness about this psychological disorder and to encourage a multidisciplinary approach amongst medical professionals and pest control operators.
Asunto(s)
Delirio de Parasitosis , Anciano , Delirio de Parasitosis/diagnóstico , Femenino , Humanos , Laboratorios , Masculino , Persona de Mediana EdadRESUMEN
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of delusional infestation (DI) in adults. Linked Comment: I. Coulson. Br J Dermatol 2022; 187:457.
Asunto(s)
Delirio de Parasitosis , Dermatólogos , Adulto , Delirio de Parasitosis/diagnóstico , Delirio de Parasitosis/terapia , HumanosRESUMEN
The presenile dermatozoic delusion, subsequently referred to as Ekbom's syndrome and delusional parasitosis is a rare chronic condition, having an undetermined etiology and rising challenging treatment approaches. The diagnosis of delusional parasitosis can be presumed on the basis of the clinical history, but it is important to thoroughly assess the existence of an underlying systemic disorder or unrecognized skin disorder. A skin examination must be performed to rule out an infestation or a skin disorder. We present a 63-year-old diabetic woman with a high level of resilience towards the psychiatric treatment for whom we successfully offered outpatient psychiatric and dermatological assistance during the pandemic COVID-19. The trigger for a successful treatment scheme in outpatient care in a case of delusional parasitosis was the close and trustful relationship between the patient and the doctor. Different pharmacological treatments were approached and adjusted according to the patient adherence and the objective result (quetiapine XR, duloxetine, risperidone, olanzapine, and lamotrigine along with chronic disease treatment and wound management). Having a mutual agreed objective criteria for the treatment outcome, and creating a throughout examination scheme with frequent medical checks, increased the patient adherence to the treatment.
Asunto(s)
COVID-19 , Delirio de Parasitosis , Diabetes Mellitus , Atención Ambulatoria , Delirio de Parasitosis/diagnóstico , Delirio de Parasitosis/tratamiento farmacológico , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Femenino , Humanos , Persona de Mediana Edad , PandemiasRESUMEN
It is considered that certain drugs might induce delusional infestation, yet, to date, no studies have been performed to identify the pharmacodynamics associated with these treatments. The aim of this review is to summarize current available knowledge of drug-induced delusional infestation. A literature search was performed for primary studies on suspected drugs reported to induce delusional infestation. Included articles were evaluated systematically using the Naranjo criteria. In addition, drug mechanisms of action were compared. The final selection included 31 studies, in which a total of 26 classes of drugs were identified. Anti-Parkinson drugs were most frequently associated with delusional infestation, followed by antidepressants, antiepileptics, antibiotics, prescription stimulants, and a few other drug groups. The current available literature suggests that the onset of delusional infestation is initiated by drug-induced alterations in neurotransmitter levels, predominantly dopamine, in the central nervous system.
Asunto(s)
Delirio de Parasitosis , Esquizofrenia Paranoide , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Delirio de Parasitosis/inducido químicamente , Delirio de Parasitosis/diagnóstico , Delirio de Parasitosis/tratamiento farmacológico , HumanosRESUMEN
Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.