Insights into the Medical Evaluation of Ekbom Syndrome: An Overview.

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.

[Delusional Parasitosis associated with diabetes mellitus treated in outpatient care during COVID-19 pandemic - case report].

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.

Drug-induced Delusional Infestation.

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.

A comprehensive entomological survey and evaluation of the efficacy of different therapies on a suspected delusional parasitosis case.

OBJECTIVE: Delusional parasitosis (DP) is one type of psychotic disorders. It is a multifactorial disorder with different etiologies. Given that very little attention is paid to entomological survey in these cases, a comprehensive study was designed and performed for the first time in Iran on a suspected DP case and its home from Shiraz during 2018-2019. METHODS: In this study, entomological survey, dermatological studies, and psychological and psychiatric interventions were done respectively on a 40-year-old man who was referred to as a suspected case of DP. RESULTS: No medical importance arthropods were collected from the patient's home. He was not infected with lice and other ectoparasites. Skin samples were negative for scabies, but he was infected with Demodex folliculorum at low level. Psychiatric studies showed that he was a secondary DP case with depression. No effect and partial remission were reported after treatment with risperidone (2-6 mg/d) and olanzapine (5 mg/d), respectively. Therapeutic effects of hypnotism were also not satisfactory. CONCLUSIONS: In Iran, the most important challenges these patients faced with are as follows: the absence of a specific referral center, patients resort to self-treatment or traditional methods, and lack of a certain duration and dosage of antipsychotic for these cases. Comprehensive clinical trials should be done on this rare syndrome at the national level for better understanding the epidemiological profile of DP and finding the best method of treatment for Persian community.

A case series of shared delusional infestation: folie à deux revisited.

Delusional infestation describes the unshakeable belief that one's skin is infected or infested with an external organism or inanimate material, in the absence of supportive medical evidence. It is one of the most challenging psychodermatological conditions to manage, given the rigidity of patients' physically focused health beliefs, and the competing need to introduce antipsychotic therapy to bring about resolution. This is rendered exponentially more complex when partners or family members are similarly afflicted. This situation is known as shared delusional infestation, shared psychotic disorder (SPD), or folie à deux. We present a series of three couples with SPD who were referred to our tertiary psychodermatology service during the same year. On examining the literature we were intrigued to discover that subtly different subtypes of SPD have been recognized since the late 1800s. These include folie simultanée, imposée, communiquée and induite. Our cases neatly demonstrate three of these variants, and highlight the difficulties in facilitating effective treatment.

Current Understanding and Approach to Delusional Infestation.

Delusional infestation is a psychiatric condition defined by a fixed belief of infestation despite contrary evidence. Diagnosis includes exclusion of organic etiologies. Treatment with antipsychotics is effective and safe in the majority of patients. Patients are characteristically reluctant to pursue psychiatric evaluation and may resist discussing their disease in psychiatric terms. Strategies to strengthen the provider-patient therapeutic alliance facilitate communication around appropriate treatment. Without antipsychotic medications, patients can become heavy utilizers of care and practice self-destructive behaviors in attempts to clear their perceived infestation.