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.

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.

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: 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.

Delusional infestation: a case series from a university dermatology center in São Paulo, Brazil.

BACKGROUND: Monosymptomatic hypochondriac psychosis (MHP) patients present with a delusional ideation that revolves around one particular hypochondriac concern. Delusional infestation is the most common type of MHP seen by the dermatologist. OBJECTIVES: This study was designed to retrospectively investigate a group of patients with delusions of infestation seen in an academic medical center in São Paulo, Brazil. METHODS: A retrospective study of patients presenting with delusional infestation between 2007 and 2014 was conducted. Records were reviewed to study personal data, symptoms, and treatments. RESULTS: Thirty patients were studied (22 female, eight male). Their mean age was 58 years in men and 60 years in women. Twenty-four patients spent most of their time at home (i.e. they were housewives, retired, or unemployed). The duration of disease varied from 3 months to 20 years. Fifteen patients brought in fragments of material that they believed to be parasites ("specimen sign"). Treatment consisted of the antipsychotic drugs pimozide (1-6 mg/d) or olanzapine (5-10 mg/d). Three patients did not return for follow-up. Follow-up varying from 2 months to 7 years was recorded in 24 patients. Two patients were treated with other psychoactive drugs prescribed by psychiatrists for additional psychiatric diagnoses. Control of symptoms was achieved in the majority of patients who underwent adequate follow-up. CONCLUSIONS: Delusional infestation is an extremely chronic disease. Attempts to discontinue treatment in those patients in whom a lengthy follow-up was performed inevitably resulted in symptom relapses.

The mental health impact of bed bug infestations: a scoping review.

OBJECTIVES: We conducted a scoping review to identify and summarize the current state of knowledge regarding the mental health effects associated with bed bugs. METHODS: We employed a five-stage scoping review framework, to systematically identify and review eligible articles. Eligibility criteria included a focus on bed bug infestations and reference to mental health impacts. Descriptive information was then extracted from each article, including the specific mental health effects cited. RESULTS: An initial search yielded 920 unique articles on the topic of bed bugs. Of these, 261 underwent abstract review, and 167 underwent full-text review. Full-text review and subsequent review of reference lists yielded a final sample of 51 articles. Numerous mental health effects were linked to bed bug infestations, including severe psychiatric symptoms. However, the majority (n = 31) of the articles were commentary papers; only five original research articles were identified. CONCLUSIONS: Although significant mental health effects are often linked to bed bugs, such discussions remain largely anecdotal. Despite recognition that the impact of bed bugs constitutes an important public health concern, little empirical evidence currently exists on this topic.

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.

[Knowledge levels about some ectoparasites in owners of dairy cattle enterprises in the Kars province of Turkey]. / KarsIlindeki Süt Sigircilik Isletme Sahiplerinin Bazi Ektoparazitlere Iliskin Bilgi Durumlari.

OBJECTIVE: One of the most important problems in the livestock sector in Turkey is the failure to provide the desired yield increase in animal production. In dairy cattle enterprises owner's in Kars province in order to detect their knowledge level about recognition of some ectoparasites and protection methods from them. METHODS: In this study, a survey was conducted in 26 villages with a total of 92 producers in Kars province. RESULTS: Producers, participating in the study, are involved with livestock activity average 24.33 years, veterinary and vaccines--drug costs the average annual 161.42 TL for parasitic diseases, and the most common parasitic drug ivermectin was used with the oxfendazole-derived drugs. A total of 78.3% of producers expressed that there were lice, fleas, and ticks over animals, but only 59.8% of them gave the wrong answer to the question of "Lice, fleas, ticks, and mange. Is it a parasite?" The study also showed that among producers who have information about hypoderma infection, only 14.3% of them apply the vaccine /drug at the right time. CONCLUSION: As a result, producers in the region do not have enough knowledge about parasitic diseases, and irrational drug use was found to be common.

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: a clinical profile.

OBJECTIVE: Delusional infestation or delusional parasitosis is a form of monodelusional disorder, a condition sometimes encountered in psychiatric or primary care practice. The outcome of this condition is good when compliance can be ensured. PATIENTS AND METHODS: In the present study, a series of 50 consecutive cases of delusional infestation is reported. RESULTS: A majority of cases (94%) had insidious onset. The duration of symptoms in all but 3 cases was 6 months or more. Twenty-eight cases presented with a delusion of infestation by insects over the body and 20 cases with a delusion of insects crawling over the scalp. Two cases had associated diabetes mellitus, 3 cases had leprosy, 2 cases had dementia, 5 cases had depression, and 4 cases presented with trichotillomania. Among the second generation antipsychotics, risperidone was used in 12 cases, olanzapine in 9 cases, amisulpride in 7 cases, etc. Thirty-four cases (68%) showed complete remission while receiving pharmacotherapy, 13 cases showed partial improvement, and 3 cases did not respond to treatment. CONCLUSIONS: The study demonstrates the utility of second generation antipsychotics in the treatment of this disorder. Further studies are warranted to study the treatment and outcome of this important psychiatric disorder.

Evidence of photo manipulation in a delusional parasitosis paper.

In 2004, an article in the Journal of the New York Entomological Society claimed that individuals with delusory parasitosis actually suffer from collembola infestations. The article has been critiqued for poor methodology and results that contradict all knowledge about collembolans. Less easily accounted for has been a figure in the article purporting to show a collembolan in a skin scraping. The image appears to have been altered using photo manipulation software to an unacceptable degree, and this paper demonstrates that to be the case. The altered figure represents creation of nonexistent data, a form of scientific misconduct. Whether the deception is deliberate or a product of an otherwise well-meaning author ignorant of the limits of acceptable image manipulation is unknown, but the result is peer-reviewed support for a conclusion that complicates patient treatment. In the current era of computers, even regional entomology journals must have detailed standards for what kind of images and image manipulations are acceptable for publication.