Housing Quality and Mental Health: the Association between Pest Infestation and Depressive Symptoms among Public Housing Residents.

Housing quality, which includes structural and environmental risks, has been associated with multiple physical health outcomes including injury and asthma. Cockroach and mouse infestations can be prime manifestations of diminished housing quality. While the respiratory health effects of pest infestation are well documented, little is known about the association between infestation and mental health outcomes. To address this gap in knowledge and given the potential to intervene to reduce pest infestation, we assessed the association between household pest infestation and symptoms of depression among public housing residents. We conducted a cross-sectional study in 16 Boston Housing Authority (BHA) developments from 2012 to 2014 in Boston, Massachusetts. Household units were randomly selected and one adult (n = 461) from each unit was surveyed about depressive symptoms using the Center for Epidemiologic Study-Depression (CES-D) Scale, and about pest infestation and management practices. In addition, a home inspection for pests was performed. General linear models were used to model the association between pest infestation and high depressive symptoms. After adjusting for important covariates, individuals who lived in homes with current cockroach infestation had almost three times the odds of experiencing high depressive symptoms (adjusted OR = 2.9, 95% CI 1.9-4.4) than those without infestation. Dual infestation (cockroach and mouse) was associated with over five times the odds (adjusted odds = 5.1, 95% CI 3.0-8.5) of experiencing high depressive symptoms. Using a robust measure of cockroach and mouse infestation, and a validated depression screener, we identified associations between current infestation and depressive symptoms. Although the temporal directionality of this association remains uncertain, these findings suggest that the health impact of poor housing conditions extend beyond physical health to include mental health. The study adds important information to the growing body of evidence that housing contributes to population health and improvements in population health may not be possible without addressing deficiencies in the housing infrastructure.

Delusional Infestation: State of the Art.

Patients with a delusional infestation (DI) have an overwhelming conviction that they are being infested with (non) pathogens without any medical proof. The patients need a systematic psychiatric and dermatological evaluation to assess any possible underlying cause that could be treated. Because they avoid psychiatrists, a close collaboration of dermatologists and psychiatrists, who examine the patient together, seems to be a promising solution. It helps to start a trustful doctor-patient relationship and motivates the patient for psychiatric treatment. We here review diagnostic criteria, classification of symptoms, pathophysiology and treatment options of DI. Antipsychotic medication is the treatment of choice when any other underlying cause or disorder is excluded. Further research is needed to assess the pathophysiology, and other treatment options for patients with DI.

Cimex lectularius ("Bed Bugs"): Recognition, Management, and Eradication.

Reports of bed bug infestations in major cities in the United States and abroad have been in the public press. Physicians and other clinicians who care for children need to be able to recognize bed bug bites and understand the social, psychological, and medical implications that this diagnosis will have on patients and their families. In this article, a case presentation serves to guide discussion regarding establishing the diagnosis, differential diagnosis, and the management of bed bug bites and their complications. Integrated pest management programs involving housing managers, residents, and professional pest exterminators provide both chemical and nonchemical solutions for eradication of bed bug infestations.

Delusional infestation: an Australian multicentre study of 23 consecutive cases.

Delusional infestation remains a debilitating condition that is therapeutically challenging for clinicians. This case series identifies 23 patients with delusional infestation in an Australian setting. The majority of patients are women and unlikely to have a psychiatric comorbid background. The use of unnecessary anti-parasitic medication is prevalent.

Bed bugs: clinical relevance and control options.

Since the late 1990s, bed bugs of the species Cimex lectularius and Cimex hemipterus have undergone a worldwide resurgence. These bed bugs are blood-sucking insects that readily bite humans. Cutaneous reactions may occur and can start out as small macular lesions that can develop into distinctive wheals of around 5 cm in diameter, which are accompanied by intense itching. Occasionally, bullous eruptions may result. If bed bugs are numerous, the patient can present with widespread urticaria or eythematous rashes. Often, bites occur in lines along the limbs. Over 40 pathogens have been detected in bed bugs, but there is no definitive evidence that they transmit any disease-causing organisms to humans. Anemia may result when bed bugs are numerous, and their allergens can trigger asthmatic reactions. The misuse of chemicals and other technologies for controlling bed bugs has the potential to have a deleterious impact on human health, while the insect itself can be the cause of significant psychological trauma. The control of bed bugs is challenging and should encompass a multidisciplinary approach utilizing nonchemical means of control and the judicious use of insecticides. For accommodation providers, risk management procedures should be implemented to reduce the potential of bed bug infestations.

Delusional infestation and patient adherence to treatment: an observational study.

BACKGROUND: Delusional infestation (DI) is the persistent belief of pathogenic infestation of the skin or body, without objective medical evidence. Treatment for symptoms of delusions can be particularly challenging, especially when patients are difficult to engage and adverse to the possibility of a nonskin disorder. To date there has been no study to evaluate patient adherence to DI treatment. OBJECTIVES: To assess the adherence of patients with DI to psychotropic and/or dermatological medication. PATIENTS AND METHODS: Sixty-nine consecutive patients with DI receiving treatment from our psychodermatology clinic were identified from a departmental database. Patient adherence to treatment was assessed via medical records, patient letters and a telephone questionnaire. RESULTS: Eighteen of 69 patients were noncontactable, reducing the sample size to 51. Forty-nine of 51 patients were receiving psychotropic medication (96%). Psychotropic agents included second-generation antipsychotics and antidepressants. Twenty-nine of 49 patients were adherent to psychotropic medication. Secondary nonadherence was reported by 18 of 49 patients. Two patients were nonadherent to psychotropic medication. Adherence to dermatological medication was high (96%). CONCLUSIONS: This is the first study to assess the adherence of patients with DI to treatment. The majority of patients on psychotropic medication were compliant. Secondary nonadherence was mainly due to drug side-effects. The adherence to dermatological medications is high. Thorough counselling of patients with regard to indication, dosage and side-effects of psychotropic agents can improve adherence to medication and is an essential part of the treatment process for DI.

Delusional infestation: clinical presentation in 147 patients seen at Mayo Clinic.

BACKGROUND: Delusional infestation is the conviction that one's skin is infested with foreign organisms or materials despite contradictory objective evidence. OBJECTIVE: To delineate clinical characteristics of patients presenting with delusional infestation. METHODS: We performed a retrospective study of patients meeting delusional infestation criteria who were seen for diagnosis and treatment in our tertiary care academic medical center (2001-2007). Medical records were reviewed to abstract demographic, historical, and physical findings and treatment. RESULTS: Over 7 years, 147 patients presented with delusional infestation; 87% (123/142) for another opinion. Mean age was 57 years; female-to-male ratio was 2.89 to 1; 82 (56%) were married. Mean duration of symptoms was 31 months. Employment data were available for 145 patients: 48 (33%) were self-described as disabled, 16 of whom cited delusions as their disability; 41 (28%) were retired; and 38 (26%) were employed. Reported infestations included multiple materials (45% [64/143]), not limited to insects (79% [113/143]), worms (27% [39/143]), and fibers (20% [29/143]). Most patients presented initially to dermatology or other specialties; only 3 presented to psychiatry. A high proportion (81%) had prior psychiatric conditions. Thirty-eight (26%) of the 147 patients had a shared psychotic disorder. LIMITATIONS: The retrospective nature of the study and the incompleteness of some data because not all the characteristics that were analyzed were documented for every patient. CONCLUSION: Patients were predominantly female, had a long history of symptoms, and had been seen previously at many medical centers. A large proportion were disabled or retired. Patients reported skin infestation with both animate and inanimate objects.

Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

OBJECTIVE: Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. METHOD: We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. RESULTS: During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. CONCLUSIONS: Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation.

Psychology and psychiatry in the dermatologist's office: an approach to delusions of parasitosis.

Most dermatologists will treat at least one patient suffering from delusions of parasitosis (DP) in their career.1 These patients are memorable not only for the peculiarity of their delusions and their repeated visits to the office, but for the challenges they present in their treatment. These patients are also frustrating. It seems that if they could only stop scratching, picking and manipulating their skin their symptoms would improve. However, these cutaneous signs only hint at the underlying psychiatric problem that drives these patients to manipulate their skin. These patients seek out the assistance of dermatologists and eschew the help of psychiatrists or therapists because they believe that they have a primary skin disease. Although the treatment of DP is conceptually simple, it is not intuitive. Thus as dermatologists, we should have at the ready a full set of dermatologic, psychologic, and pharmacologic tools to treat these patients.

Delusional infestation.

This papers aims at familiarizing psychiatric and nonpsychiatric readers with delusional infestation (DI), also known as delusional parasitosis. It is characterized by the fixed belief of being infested with pathogens against all medical evidence. DI is no single disorder but can occur as a delusional disorder of the somatic type (primary DI) or secondary to numerous other conditions. A set of minimal diagnostic criteria and a classification are provided. Patients with DI pose a truly interdisciplinary problem to the medical system. They avoid psychiatrists and consult dermatologists, microbiologists, or general practitioners but often lose faith in professional medicine. Epidemiology and history suggest that the imaginary pathogens change constantly, while the delusional theme "infestation" is stable and ubiquitous. Patients with self-diagnosed "Morgellons disease" can be seen as a variation of this delusional theme. For clinicians, clinical pathways for efficient diagnostics and etiology-specific treatment are provided. Specialized outpatient clinics in dermatology with a liaison psychiatrist are theoretically best placed to provide care. The most intricate problem is to engage patients in psychiatric therapy. In primary DI, antipsychotics are the treatment of choice, according to limited but sufficient evidence. Pimozide is no longer the treatment of choice for reasons of drug safety. Future research should focus on pathophysiology and the neural basis of DI, as well as on conclusive clinical trials, which are widely lacking. Innovative approaches will be needed, since otherwise patients are unlikely to adhere to any study protocol.

Ekbom syndrome: the challenge of "invisible bug" infestations.

Ekbom Syndrome is synonymous with delusory parasitosis, a belief that one's body is infested by invisible bugs. Persons suffering from this syndrome often claim to feel dermal sensations and to visualize the bugs, although no one else can see them. Ekbom Syndrome is a delusional condition; it is intractable and cannot be corrected by argument or evidence. Ekbom Syndrome sufferers exhibit a range of predictable behaviors in their attempts to eliminate their infestations, including seeking identifications and treatment from physicians and entomologists. Frequently they also experience comorbid psychological conditions. Because this is a delusional affliction, successful treatment typically requires neuroleptic medications, necessitating intervention by medical professionals.

Delusional infestation: a prototype of psychodermatological disease.

Delusional infestation (DI) is a disorder in which patients express a firm, unwavering belief that they are infested with some type of organism but otherwise have a typical grasp on reality with relatively normal cognitive functioning. Although classified as a somatic delusional disorder, DI requires special consideration due to its complicated clinical presentation, requiring attention to several possible explanations for the symptoms the patients describe. The purpose of the current review is to first summarize the clinical background and features of the diagnosis then explore treatment options. DI is a rare disorder though has reported cases dating back to the 19th century and spanning across the globe. Patients often experience the disorder as secondary to a medical condition, including substance use/withdrawal. However, there have also been many reported cases of primary DI, occurring in the absence of any other psychiatric or medical disorder. Clinically, DI is a diagnosis of exclusion, where the physician must rule out other medical conditions, including genuine dermatological disorders or infestations, or contributions from medications or substances. Patients with the disorder more commonly present to nonpsychiatric healthcare providers, making it essential for all clinicians to be able to identify the disease. Treatment can include either first or second generation antipsychotics, but it is important to proceed tactfully in discourse with the patient, being careful to address patients in a straightforward manner without reinforcing or questioning the delusion and focusing conversation on what can be done for the symptoms. Future research can continue to evaluate pathophysiology underlying primary DI, which historically has been an under-studied topic.

Secondary delusional parasitosis treated with paliperidone.

Second-generation antipsychotics (SGA) are increasingly used in primary and secondary delusional parasitosis (DP) because of their better overall tolerability compared with first-generation antipsychotics (FGA) such as pimozide. Controlled clinical trials with antipsychotics in DP are lacking, owing to difficulties in obtaining informed consent and in securing adherence to a study protocol by patients with DP. We present the case of an 88-year-old man with a 12-year history of DP secondary to leucoencephalopathy. After 9 days of an age-adapted dose of paliperidone, the patient no longer experienced the presence of vermin on his skin and stopped showering at night to get rid off of them. Paliperidone was well tolerated. At follow-up after 2 weeks, the DP was still remitted. Paliperidone appears to expand the therapeutic arsenal in treating DP with modern SGAs; however, this finding needs to be replicated.

Delusional parasitosis over dermatological morbidity: diagnostic and therapeutic challenges.

Delusional parasitosis is a rare psycho-dermatological disorder that lacks standard management guidelines. We report a case of an elderly woman with long standing multiple dermatological illnesses who later developed delusional parasitosis. We highlight the pertinent diagnostic and therapeutic challenges. We support multidisciplinary collaborative care combining effective pharmacotherapy with efficient non-pharmacological measures.

Monitoring western corn rootworm (Diabrotica v. virgifera) adults: situation in Romania 2008.

Romania is part of the southeast European expansion zone of the invasive rootworm species Diabrotica v. virgifera LeConte (Col.: Chrysomelidae) (WCR). The pest originated in North America and reached Belgrade airport with US foreign aid air shipments prior to 1992. Today, about 20 years after its introduction, WCR is a major maize pest which regionally causes economic damage to maize. However, it also can colonize secondary hosts which complicates IPM efforts. Basis for sound management is a reliable monitoring system. The easiest and cheapest way is to use Metcalf type monitoring traps for the mobile adults. Sex pheromones and plant kairomones for trapping are commercially available. Traps can be either bought or cheaply prepared. Metcalf traps with adhesive and lure cost about 15 cents per piece. So state-wide trapping is no longer a problem for less affluent countries. Results from two independent locations in 2008 report flight curves and attractively of secondary hosts like Sorghum spp. in relation to the principle host Zea mays. In addition, high capacity traps baited with pheromone are surprisingly effective, and, in combination with the chemically inert, absorptive silica powder AL 06, will be considered as future alternatives in cases where frequent monitoring is unfeasible and were a large holding capacity is indicated.

Second-generation antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy.

In the absence of controlled clinical trials, little is known about antipsychotic treatment in primary and secondary delusional parasitosis (DP). All available data on the efficacy of antipsychotics (APs) and the outcome in DP date back to the era of first-generation antipsychotics, whereas such data are lacking for second-generation antipsychotics (SGAs). To study outcome and efficacy of SGAs in all forms of DP by means of a case-based analysis, we extracted 63 cases from 434 available publications and assessed them by 2 independent raters using standardized criteria for efficacy and outcome. The time course of response and the SGA doses used in DP were also first studied. The sample was comparable to classic samples and comprised mainly secondary DP cases (56%). The median onset of effect occurred after 1.5 weeks, and the maximum effect occurred after 6 weeks (later in primary than secondary DP, 10 vs 3 weeks; P < 0.004). If a treatment of more than 8 weeks could be established, all cases responded at least partially. In the outcome analysis, partial or full remission was performed by 75% of cases (final outcome, therapy switches allowed). In the efficacy analysis, partial or full remission was reached in 69% of the situations when an SGA was introduced (without therapy switches). Secondary DP was more likely to respond to SGAs than primary DP (78% vs 59% trend). Risperidone and olanzapine were most widely used and resulted in full or partial remission in 69% and 72%, respectively. Doses were lower than those used in schizophrenia. This first retrospective case-based study provides low-level evidence that SGAs are effective in DP and that outcome is favorable, although a publication bias is likely. Our findings need to be confirmed by controlled trials.