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Delusional parasitosis is a psychotic disorder where the patient has the delusion of being infested with some insect or parasite. In contrast, shared paranoid disorder or folie à deux is described when the same delusions affect two or more closely related people. It is common for these two situations to cause comorbidity in the family unit. This case report concerns a couple married for 37 years. The husband described that 2 years ago, he began with a tingling sensation throughout his body, related to the presence of parasites coming out from all his body orifices, with no evidence of self‐harm. Likewise, the wife reported symptoms of formication and the feeling that there were invisible animals, as mentioned by her husband, and that she felt the parasites running throughout her body. The husband was diagnosed with endoparasitic delusional parasitosis, which caused folie à deux in his wife due to ectoparasitic parasitosis. The patient's treatment included sertraline and risperidone in oral dosage lasting 3 months reducing delirium, later biperidene was prescribed due to main treatment's side effects such as akathisia and sialorrhea, however the patient could not take the medication due to economic reasons. The wife was asked to sleep in a separate room, and she reported that the sensory hallucinations disappeared as soon as she slept in a different room. We conclude that the pharmacological approach, the intervention in the family life, and the gradual reintegration of marital habits once the patient improves are crucial in the therapy of delusional disorder. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Delusional parasitosis is a psychiatric condition where individuals believe they are infested with parasites despite lacking medical evidence. This often leads to underestimation within psychiatric settings. Three patients with delusional parasitosis, aged above and below 50, presented with symptoms lasting from 1 to 6 months. Two had consulted specialists before, and one had primary delusional parasitosis while two had secondary due to schizophrenia and depression. Tablet Olanzapine showed partial response in one patient before admission. Tablet Risperidone resulted in complete symptom resolution within 10 days in two patients and within 1 month in one patient. Randomized controlled trials on antipsychotics for delusional parasitosis treatment are lacking. Further research is needed to assess treatment recommendations. Psychiatrists should report cases to provide clinical evidence supporting treatment decisions.

BackgroundDelusional infestation (DI) is a rare psychotic disorder characterized by a patient's false belief that the body is infested with living or non-living organisms in the absence of clinical evidence of disease. Based on the underlying etiology, DI can be classified into primary and secondary forms based on the presence or absence of an underlying condition or previously diagnosed psychiatric disorder. This paper discusses a condition that is not commonly reported in the literature.Case presentationHere, we describe four patients diagnosed with DI of the oral cavity. In each case, the patients' intraoral examinations revealed either traumatic lesions or no signs of mucosal disease. Management involved symptom management, medical therapy, and/or a referral to the primary care provider.ConclusionBecause oral health care providers may encounter patients with DI, they should familiarize themselves with this unusual condition in order to recognize the condition and initiate prompt referral to a psychiatrist.

Delusional parasitosis is a psychiatric condition where individuals believe they are infested with parasites despite lacking medical evidence. This often leads to underestimation within psychiatric settings. Three patients with delusional parasitosis, aged above and below 50, presented with symptoms lasting from 1 to 6 months. Two had consulted specialists before, and one had primary delusional parasitosis while two had secondary due to schizophrenia and depression. Tablet Olanzapine showed partial response in one patient before admission. Tablet Risperidone resulted in complete symptom resolution within 10 days in two patients and within 1 month in one patient. Randomized controlled trials on antipsychotics for delusional parasitosis treatment are lacking. Further research is needed to assess treatment recommendations. Psychiatrists should report cases to provide clinical evidence supporting treatment decisions. [ABSTRACT FROM AUTHOR]

Dermatillomania often coexists with delusional parasitosis (DP) and can cause extreme patient morbidity. The standard treatment for DP has been conventional antipsychotic drugs; however, their use is limited by potential adverse effects and monitoring requirements. Guanfacine, an alpha-2 adrenergic receptor agonist, has emerged as a promising alternative for patients with attention deficit hyperactivity disorder with concurrent tics. Although no current research supports guanfacine's efficacy in managing DP or dermatillomania, its pharmacological profile hints at potential benefits. A 58-year-old woman presented to our clinic for DP causing dermatillomania and was started on guanfacine. She reported fewer beliefs about parasites infesting her body and had fewer excoriating lesions on this medication. Additionally, her Patient Health Questionnaire-9 score peaked with a score of 23 at diagnosis and significantly decreased to 13 three months after starting guanfacine. However, further research is needed to ascertain if guanfacine is an effective treatment for DP. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Delusional parasitosis (DP) is a type of delusional disorder which is characterised by single hypochondriacal delusion in which patient believes that he/she is infested with insects/worms/parasite. The authors present a case series of four cases of DP which were assessed in the outpatient department of psychiatry of a tertiary care hospital in Western Maharashtra. The patients with DP were predominantly women around 50 years of age who were treated successfully with Tab Olanzapine and psychotherapy with favourable response. [ABSTRACT FROM AUTHOR]

Little is known about the pathophysiology of delusional infestation (DI), a psychodermatologic condition in which patients have a fixed, false belief of being infested with parasites or inanimate material in their skin, despite lack of objective evidence. Because some delusional states, such as schizophrenia and psychotic state in bipolar disorder have been found to be associated with brain structural and functional abnormalities, a literature review was conducted to summarize available data on structural and functional abnormalities that are found to be associated with DI. A review of the literature found cases of brain imaging studies in patients with primary DI, as well as patients with secondary DI. Accumulating evidence from the studies reviewed suggests that dysfunction of the fronto-striato-thalamo-parietal network may explain how delusions manifest in DI and suggest that DI has an organic etiology. Abnormalities in the striato-thalamo-parietal network may cause false sensations of infestation through dysfunction in visuo-tactile regulation, whereas abnormalities in the frontal region may impair judgement. Delusional infestation patients also exhibit increased activation of brain structures implicated in itch processing. Furthermore, patients at high risk for cerebrovascular disease who present with secondary DI may benefit from brain imaging studies to rule out brain ischemic insult.

Delusional parasitosis (DP) is a type of delusional disorder which is characterised by single hypochondriacal delusion in which patient believes that he/she is infested with insects/worms/parasite. The authors present a case series of four cases of DP which were assessed in the outpatient department of psychiatry of a tertiary care hospital in Western Maharashtra. The patients with DP were predominantly women around 50 years of age who were treated successfully with Tab Olanzapine and psychotherapy with favourable response.

Abstract Background Delusional infestation (DI) is a rare psychotic disorder characterized by a patient’s false belief that the body is infested with living or non-living organisms in the absence of clinical evidence of disease. Based on the underlying etiology, DI can be classified into primary and secondary forms based on the presence or absence of an underlying condition or previously diagnosed psychiatric disorder. This paper discusses a condition that is not commonly reported in the literature. Case presentation Here, we describe four patients diagnosed with DI of the oral cavity. In each case, the patients’ intraoral examinations revealed either traumatic lesions or no signs of mucosal disease. Management involved symptom management, medical therapy, and/or a referral to the primary care provider. Conclusion Because oral health care providers may encounter patients with DI, they should familiarize themselves with this unusual condition in order to recognize the condition and initiate prompt referral to a psychiatrist.

Background: The lack of clinical guidelines for the treatment of primary psychodermatologic disorders (PPDs) hinders the delivery of optimal care to patients. The review aimed to identify, appraise, and summarize the currently available evidence about the safety and effectiveness of pharmacological management of PPDs through randomized controlled trials (RCTs). Methods: The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRIMSA) statement and the Global Evidence Mapping Initiative guidance were followed. Medline, Embase, PsycInfo, Cochrane and Scopus were searched, and two reviewers independently completed article review, data extraction, and quality assessment. Results: Among 2618 unique studies, full texts of 83 were reviewed and 21 RCTs were included. Five PDDs were identified: trichotillomania (n = 12), pathologic skin picking (n = 5), nail biting (n = 2), delusional parasitosis (n = 1), and dermatitis from compulsive hand washing (n = 1). Seven different classes of medications were investigated: SSRIs (i.e., fluoxetine, sertraline, and citalopram), tricyclic antidepressants (i.e., clomipramine and desipramine), antipsychotics (i.e., olanzapine and pimozide), anticonvulsant (i.e., lamotrigine), N-acetylcysteine, inositol, and milk thistle. RCT-derived evidence supports the use of antidepressants in trichotillomania (sertraline and clomipramine), pathologic skin picking (fluoxetine), pathologic nail biting and dermatitis from compulsive hand washing (clomipramine or desipramine); antipsychotics in trichotillomania (olanzapine) and delusional parasitosis (pimozide); N-acetyl cysteine in trichotillomania and skin picking. Conclusion: Few pharmacotherapies for primary psychodermatologic disorders are assessed through controlled trials in the literature. This review serves as a roadmap for researchers and clinicians to reach informed decisions with current evidence, and to build on it to establish guidelines in the future. [ABSTRACT FROM AUTHOR]

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.

Ekbom Syndrome (ES) is characterised by fixed, delusional beliefs that one’s body is infested by parasites or other vermin in absence of supporting clinical evidence. Antipsychotic (AP) treatment, including long-acting injectable (LAI) AP in subjects with poor compliance, is prescribed to manage behavioural and psychotic symptomatology.

The article provides a framework for infectious disease clinicians in the evaluation and management of patients with delusional infestation. Topics discussed include initial workup in a clinical visit, reason that the treatment of delusional infestation is notable challenging, and the mainstay of delusional infestation management.

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Delusional parasitosis (DP) is a false, persistent belief that an individual is infested with organisms, especially arthropods, of a parasitic nature. It is a complex and challenging problem that impacts healthcare, the pest management industry, state-led agriculture and health agencies, Extension professionals, and academia because of time burdens and frustration associated with interactions. To address the handling of suspected DP cases, we assembled a University of Tennessee One Health Initiative Working Group with individuals representing diverse disciplines and professions. The Working Group developed and conducted an online needs assessment of pest management, Extension, and health professionals to (i) understand their interactions with suspected DP cases and (ii) determine the educational resources used and needed. Of the pest management professionals and Extension personnel, 72.7% (n  = 112) of the respondents indicated they had encountered someone with suspected DP within the last year. Those responding to suspected DP cases spent significantly more time and interactions than what was required for general inquiries. Seventy-three percent of respondents received specimens of which more were human derived (54.4%) than nonhuman derived (41.5%), potentially putting these nonhealthcare professionals at risk of potential contagion. We confirmed a lack of available resources, including protocols, training materials, and resources for expert medical referrals. Additionally, the staff responsible for handling these cases were concerned for their safety. After identifying the most pressing needs, the One Health Working Group members collaborated to produce comprehensive resources to assist professionals in identifying DP cases more quickly and efficiently routing them to essential care. [ABSTRACT FROM AUTHOR]

Background: Delusional infestation is characterized by delusions of being infested with parasites, vermin, or small insects and is frequently accompanied by tactile and visual hallucinations. Herein, we report two cases of dementia with Lewy bodies (DLB) with delusional infestation. Case presentation: Case 1 was an 83-year-old man. At the age of 75, he began to show symptoms of rapid eye movement sleep behavior disorder. At the age of 83, he began to complain of visual hallucinations of people and delusional infestation with tactile and visual hallucinations of insects, resulting in the use of insecticides for non-existent insects. He also complained of mild amnesia and was admitted to our psychiatric ward for evaluation and treatment. After admission, the delusional infestation disappeared without any new medication. Based on our examinations, he was diagnosed with probable DLB with delusional infestation. He was treated with 5 mg/day of donepezil hydrochloride; his visual and tactile hallucinations disappeared, and the delusional infestation had not recurred at the 1-year follow-up. Case 2 was a 69-year-old woman. At the age of 60, she underwent clipping for subarachnoid hemorrhage (SAH). At the age of 65, she began to have visual hallucinations of people. At the age of 67, she began to complain of visual illusions in which she mistook lint for insects. At the age of 69, she developed delusional infestation and mild amnesia. She took various actions to get rid of these non-existent insects, including insecticide use, consulting an exterminator, and visiting several dermatologists. She eventually burnt her leg in an attempt to kill the non-existent insects. Based on our examinations, she was diagnosed with prodromal DLB in addition to SAH sequelae. We determined that her delusional infestation was caused by DLB rather than SAH sequelae based on the course of her symptoms. She was treated with a combination of 3 mg/day of donepezil hydrochloride and 12.5 mg/day of quetiapine. Thereafter, the delusional infestation partially improved, and she took no further action against non-existent insects. Conclusion: Delusional infestation may be caused by DLB. Acetylcholinesterase inhibitors (AChEI) may be effective for delusional infestation in DLB, although antipsychotics may also be needed in severe cases. [ABSTRACT FROM AUTHOR]

Clogmia albipunctata, known as drain fly, is a non-hematophagous insect of the Psychodidae family with worldwide distribution, particularly in tropical and temperate areas. It can be found near sewer drains, sewage treatment plants, plant pots, swamps, and any other place containing decaying or moist organic matter. It has been introduced in several publications as the causative agent of myiasis in humans. A case presentation, together with a compilation of findings from a database, including 51 scientific publications in the literature, allowed us to overview critically in detail the variable aspects of epidemiology, life cycle, biology, and medical importance of this insect and its probable role in human myiasis. The absence of a precise definition of myiasis and the lack of incontestable epidemiological, entomological, and clinical evidence in the articles introducing C. albipunctata as a causative agent led us to interrogate its role in human myiasis. It is necessary to take into account this misinterpretation and make an accurate diagnosis based on the isolation of insect larvae from the corresponding lesion. [ABSTRACT FROM AUTHOR]

Delusional parasitosis is a psychotic disorder that manifests as a belief that the skin is infested with parasites. This case report documents the association between COVID-19 infection and new-onset delusional parasitosis superimposed on preexisting psychosis, which has not been previously documented in the current literature. A 28-year-old male presented with new-onset delusional parasitosis superimposed on existing psychosis following COVID-19 infection. Computed tomography scan of the head was unremarkable. He was treated with olanzapine, which appeared to lessen the intensity of the delusions. This case report should encourage increased monitoring of COVID-positive patients with psychosis.

Delusional parasitosis is a rare psychiatric disorder characterized by the persistent belief of infestation by parasites, despite the absence of medical evidence. This case series describes four patients with delusional parasitosis who were successfully treated with olanzapine. The patients showed a significant improvement in symptoms with no adverse effects. The effective use of olanzapine in these cases suggests that it could be a useful first-line treatment option for patients with delusional parasitosis. [ABSTRACT FROM AUTHOR]

Introduction Antipsychotics are the mainstream treatment of delusional disorder. However, limited therapeutic effect was recognized due to side effect and lack of insight. Objectives This article presents a case with Ekbom’s syndrome, also known as delusional parasitosis, who has significant response with Brexpiprazole. Methods A 58-year-old female developed her very first episode of psychosis 3 weeks before she visited our emergency department. Delusion of spiders laying eggs and bitsy spiders crawling over her body was claimed, followed by depressed mood and insomnia. The patient denied any substance use in recent months. Examination including biochemical studies, complete blood count, vitamin, and endocrine during admission were all normal. Brain image revealed senile cortical atrophy without apparent acute infarction. Cognitive abilities screening instrument (CASI) revealed total score 75, indicating borderline cognitive function. Ophthalmologist and dermatologist were consulted, and no specific abnormality was found. Results Brexpiprazole 2mg was prescribed. After 3 weeks of treatment, the delusion improved with less parasitosis content. We discharged the patient, and kept following her at outpatient department with Brexpiprazole 2mg for 2 months. We tried to taper Brexpiprazole to 1mg at clinic, but her delusional parasitosis relapsed within 1 month. Therefore, we titrated the medication back to 2mg, and kept some dosage for 4 months. No more relapse of psychosis or significant movement dysfunction was observed. The total treatment course was 7 months. Conclusions Brexpiprazole, with its D2 partial agonism, shows impressive antipsychotic effect to Ekbom’s syndrome. Little side effect was observed in clinical practice, making Brexpiprazole a worth-trying psychopharmacological management of delusional parasitosis. Disclosure No significant relationships.

Introduction Delusional parasitosis, first documented in 1946, is a rare psychiatric illness described as both a stand-alone diagnosis, as well as a secondary condition to an underlying psychiatric or medical pathology, or substance use. Interestingly, the fixed false belief of being infested has also been identified in partners of individuals with the disease, and in some cases the delusion permeated families and was thus given the name “folie en famille”. Objectives To describe the first reported case of delusional disorder, somatic type, with similar delusional symptoms in the patient’s husband, in the State of Qatar. Methods Patient and her husband were interviewed. Her file was reviewed for past history and medications. Results 34-year-old female with no past psychiatric history, 5 months post-partum, reported fixed beliefs of insect infestation in her baby’s skin, hers, and her husband’s, of 2 months duration. She reports a pruritic rash, and perceives proliferating insects in different life stages. The family relocated 5 times in 2 months. They bathe in vinegar several times a day to exterminate the insects. Husband mirrors her account of infestation with milder symptoms. Repeated medical investigations were insignificant. OCD, mood disorder, and other psychotic illnesses were ruled out. Conclusions Delusional parasitosis presents a unique therapeutic challenge to psychiatrists. It is necessary to build rapport with patients, rule out comorbidities, and conduct randomized controlled trials to evaluate the effectiveness of psychotropic drugs in its treatment. In cases of shared delusions, identifying the primary patient is crucial for treatment of all the individuals that share the delusion. Disclosure No significant relationships.

Delusional infestation (DI) is a rare delusional disorder in which individuals have a false belief that they are infested with bugs, parasites, or insects, despite the lack of medical evidence that such an infestation exists. Data on the effectiveness of antipsychotics for DI are limited. We conducted a systematic review using EMBASE, MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials from inception of the databases up until July 20, 2018. Studies examining typical or atypical antipsychotics for primary DI were included. A total of 51 relevant articles were identified, primarily case reports/series. Overall response was favorable for both typical and atypical antipsychotics, but there was no strong evidence to suggest that any one antipsychotic agent was preferable to other agents. Pimozide (1–16 mg/day) and risperidone (0.5–8 mg/day) were the most commonly studied typical and atypical antipsychotics, respectively. Inconsistent reporting of treatment outcomes and variability in study designs limited the overall evaluation of the data. There remains a lack of sound data supporting the effectiveness of antipsychotic treatment for primary DI. Further research is required to establish more definitive conclusions about the relative clinical utility of antipsychotic agents for DI. [ABSTRACT FROM AUTHOR]

Copyright of Psychiatria Hungarica is the property of Hungarian Psychiatric Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Delusional parasitosis is an uncommon psychiatric illness, and patients usually seek treatment from non-psychiatric medical care. Seen more in women than in men, with usual age of presentation being their 60s. Treatment is by antipsychotics to which patients respond minimally. Here we report a case of a 55 year old male who responded exceptionally well to typical antipsychotic. [ABSTRACT FROM AUTHOR]

Introduction: Ekbom syndrome is a rare condition in which the patient believes that his or her body is infested by worms or other parasites.This condition is associated to mental ilness in 81% of cases. There is not a final statement about the best psychofarmacological treatment of this condition. Objective: The present study presents a case report on which an elderly woman with bipolar disorder has shown Ekbom syndrome. Method: This study lists a case report of a 69 yerar-old woman with bipolar disorder. This patient had presented the belief that worms were walking under her skin during the past few months. She had a previous diagnosis of bipolar disorder. Depressive symptoms were intense. The patient was followed up in an outpatient psychiatric service for 120 days. Lurasidone was introduced and some drugs were discontinued. Result: One month after starting treatment with lurasidone, there was a significant improvement of delusional beliefs of Ekbom syndrome. Such improvement was associated with the improvement of the bipolar depressive condition in this case. Conclusion: Ekbom syndrome is a rare kind of delusion. Its etiology is not fully understood. We presented a case of an elderly woman with previous diagnosis of bipolar disorder with Ekbom syndrome. To our knowledge, there are no other case reports informing the use of lurasidone in bipolar depression associated with Ekbom syndrome.

Clogmia albipunctata, known as drain fly, is a non-hematophagous insect of the Psychodidae family with worldwide distribution, particularly in tropical and temperate areas. It can be found near sewer drains, sewage treatment plants, plant pots, swamps, and any other place containing decaying or moist organic matter. It has been introduced in several publications as the causative agent of myiasis in humans. A case presentation, together with a compilation of findings from a database, including 51 scientific publications in the literature, allowed us to overview critically in detail the variable aspects of epidemiology, life cycle, biology, and medical importance of this insect and its probable role in human myiasis. The absence of a precise definition of myiasis and the lack of incontestable epidemiological, entomological, and clinical evidence in the articles introducing C. albipunctata as a causative agent led us to interrogate its role in human myiasis. It is necessary to take into account this misinterpretation and make an accurate diagnosis based on the isolation of insect larvae from the corresponding lesion.

Ekbom syndrome is the clinical term for delusional parasitosis and is characterized by the patient’s fixed and false conviction of being infested with parasites without any objective evidence. Patients with Ekbom syndrome often consult dermatologists, however, sometimes they might try to heal themselves by “removing” the parasites, which may lead to a skin-picking disorder or excoriation. The patient’s obsessive treatment of such skin lesions ultimately leads to a vicious cycle that further distances them from psychiatry. Patients with poor adherence to psychiatric treatment may become chronic if left untreated. Although the benefit of antipsychotics in Ekbom syndrome is well-known, a chronic patient who has insufficient social support is not expected to comply with oral therapy. Antipsychotic long-acting injection should be considered as an option for such patients. In this case report, we present a male patient with delusional disorder who showed a symptomatic improvement after being treated with antipsychotic long-acting injection.

Abstract Background Dementia with Lewy bodies (DLB) is characterized by fluctuating cognitive impairments, recurrent visual hallucinations, the motor symptoms of parkinsonism and REM sleep behavior disorder. Various neuropsychiatric symptoms including hallucination and delusions occur frequently; however, delusional parasitosis is rare in DLB. Here, we report a case of DLB patient with delusional parasitosis. Case presentation The patient was an 89-year-old woman. At the age of 88, she began to complain her oral cenesthopathy, and developed cognitive decline, delusional parasitosis and parkinsonism. As a result of examination, she was diagnosed as DLB and treated with combination of donepezil 5 mg/day and aripiprazole 1.5 mg/day, and her complaint was disappeared. Conclusions Further studies are needed to investigate the association between delusional parasitosis and underlying pathophysiology of DLB, and the utility of antipsychotics for delusional parasitosis in DLB has to be examined through more cases.

OBJECTIVE: Delusional parasitosis (DP), also known as Ekbom’s Syndrome, is a rare, generally monosymptomatic disorder that characterizes with the fixed belief of being infected by parasites without any evidence of medical or microbiological proof. These patients are examined in dermatology and infection clinics with symptoms and signs of pruritus, skin and subcutaneous scars secondary to itching. Primary DP is diagnosed when no etiological factor is detected while secondary DP arises from underlying physical or mental disorder. Formerly, pimozide was the commonly preferred choice of treatment with cases of DP. However, there is growing evidence that second-generation antipsychotics and antidepressants can be used in the treatment of DP. In this study, the usage of aripiprazole in the treatment of DP cases is presented. METHODS: 8 patients with the diagnosis of primary DP were evaluated in terms of demographic data, clinical variables and responses to treatment. A psychiatric diagnosis was made based on a clinical interview performed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) SCID-I. The patients were followed for six months. Three patients were female, five patients were male. The average age of the patients was 57.5. Four patients had essential hypertension as comorbidity. The duration of the symptoms ranged from 6 to 48 months with an average of 24.75 months. All of our 8 cases were consulted by the dermatology department. The patients were performed Hamilton Depression Scale (HDS) and Mini-Mental Status Examination (MMSE). Eight patients were treated with aripiprazole 10 or 15 mg/day, and no dose alteration was made. RESULTS: From the patients who were treated with aripiprazole, seven (87.5%) patients had complete remission after three months, eight (100%) patients achieved complete remission after six months. DISCUSSION: The earliest drug choice for patients with DP was pimozide, but because of the extrapyramidal side effects and cardiac side effects like QTc prolongation, second-generation antipsychotics are being investigated for treatment. Various researches are available related to the usage of second-generation antipsychotics like risperidone, olanzapine, paliperidone, ziprasidone, quetiapine, and aripiprazole in the cases with DP. This study shows that aripiprazole can be a successful treatment choice for DP, but further studies are needed for this topic.

Abstract Delusional parasitosis, also known as delusional infestation or Ekbom syndrome, is a relatively infrequent psychotic disorder characterized by an unwavering false belief that there is a parasitic infestation of the skin, despite the absence of any medical evidence that could support this claim. Delusional parasitosis can be categorized into primary, secondary, and organic forms. Sometimes, close relatives also experience identical delusions. This phenomenon was reported to occur in 5–15% of cases, and is known as shared psychotic disorder–delusional parasitosis with folie à deux. Patients with delusional parasitosis frequently seek help from many physicians. Close multidisciplinary cooperation between clinicians is often key to shortening the time taken to diagnose this disorder. Initiation of psychopharmacological therapy is a challenge, as many patients refuse any psychiatric treatment because of the stigma associated with mental illness and because of their firm belief that they have a parasitic infestation, not a psychiatric condition. For many patients, a sense of a lack of understanding leads to isolation and the development of depression symptoms, which is why it is crucial to earn the trust of such patients while taking care of them.

Introduction Delusional infestation (DI), also known as delusional parasitosis or Ekbom syndrome, is a rare disorder, characterised by fixed belief that the skin, body or immediate environment is infested by small pathogens, despite the lack of any medical evidence for it. Objectives To describe and discuss two clinical cases of DI, in order to show two different ways of presenting in this entity. Methods Two case report and non-systematic review. Results We present the case of a 76-year-old woman, without psychiatric history, with an DI with 5 years of evolution, referred to a psychiatric consultation by a dermatologist. The second case, is a 41-year-old woman with a history of multiple substance use disorder, with an DI with a month of evolution, who resorted to the emergency department. DI is not a single diagnostic entity. The classic form, as represented in the first case,is a primary form, which develops without any known cause or underlying disease, corresponding to a persistent delusional disorder. However, about 60% of patients have secondary forms of DI, in the context of substance misuse, some medications or in the course of physical or psychiatric diseases (e.g. stroke, delirium, dementia, depression, schizophrenia). Conclusions DI can occur as a primary delusional disorder or secondary to several other medical conditions. An in-depth clinical history is essential in order to make the correct diagnosis. A multidisciplinary approach is also important, to exclude any possible organic etiology, not forgetting that many patients may turn to other medical specialities first. Disclosure No significant relationships.

Introduction Delusional parasitosis/infestation or Ekbom syndrome is an uncommon psychotic disorder characterized by a false belief that there is a parasitic infestation of the skin - the delusion that insects are crawling underneath the skin. Objectives This work aims to summarize and evaluate the currently available evidence regarding Delusional parasitosis, and for this purpose, we will illustrate a case report of a patient admitted in the emergency room. Methods The authors have conducted online research in PubMed with the words “Delusional parasitosis” “delusional infestation”, “Ekbom syndrome”, from the outcome, the articles considered to be relevant were collected and analyzed. Results Delusional parasitosis can be classified into primary delusional parasitosis without other psychiatric or organic disorders present, secondary – functional (secondary to several mental disorders such as schizophrenia, depression, dementia, anxiety, and phobia), and organic forms (associated with hypothyroidism, anaemia, vitamin B12 deficiency, hepatitis, diabetes, infections (e.g., HIV, syphilis), and cocaine abuse. It is most commonly seen in middle-aged women. The patients became frequently socially isolated, prone to the development of depression symptoms. Conclusions This syndrome often presents a high level of psychosocial morbidity. Patients often seek dermatologists help in the first place, although there is no medical evidence. Psychiatrists play a major role in the diagnosis and treatment of these patients. Psychopharmacological therapy is quite challenging because of the patient’s belief that they have a parasitic infestation and not a psychiatric condition.

Introduction Antipsychotics have been classically considered the treatment of choice for delusional disorder (DD) and antidepressant medications have been restricted to patients with comorbid depression. Objectives Our aim is to describe the case of a patient with DD with delusions of parasitosis, who responded to paroxetine as monotherapy. We also aimed to review the recent literature on the potential use of antidepressants as the main treatment for somatic type DD. Methods After the case report, we present a narrative review on the use of antidepressants in DD, somatic type (DSM-criteria) by using PubMed database from inception until 2020. Results Case: 74 year-old woman without previous psychiatric diagnosis who suffered from long-term cutaneous and vulvar pruritus. She was referred to psychiatry from dermatology to assess thought content and sensoperceptive disturbances. In the past, she had received unsuccessful treatment with antihistamines. The patient brought a collection of “the identified parasite” (matchbox sign) to our first appointment. On assessment, she was diagnosed with DD with delusions of parasitosis. Risperidone 1mg/day was poorly tolerated (excessive sedation). She refused further antipsychotic treatment, so we started paroxetine up to 20mg/day. The patient went into total remission of her pruritus and delusions of parasitosis. Review. In line with our case, 6 studies reported on the successful use of antidepressants as monotherapy for DD, somatic type. Most of studies report the successful use of an antipsychotic/antidepressant combination (case-series, case reports). Conclusions Although antipsychotics are the treatment of choice, antidepressant medications may be an effective alternative in somatic type DD when patients refuse antipsychotics.

Introduction Delusional parasitosis (DP), also know as Ekbom syndrome and in some cases as Morgellons, was first described in the late 17th century in France. It is an obsessive phobic state in which the patient believes that the is infested by parasites. In the hallucinatory state, they frequently remove parts of the skin, identifying them as parasites. The cause of DP is unknown. Evidence supporting the dopamine theory defend that the inhibition of dopamine reuptake (for example cocaine and amphetamines) induce symptoms such as formication. Objectives Through the description of the following clinical case, we emphasize its clinical features and complexities. Methods Review of DP in light of a clinical case Results A 48-year-old woman was brought to the psychiatric emergency due to psychotic symptoms following cocaine use. She had a history of drug abuse. She was apparently asymptomatic until October 2019, when, in the background of vague sensation of something crawling under his skin, she developed a sudden onset belief that she had been infested by insects that crawled under his skin. Previous medical observation found no reason for a skin infection or infestation. Skin examination revealed itch marks and skin excoriations in the abdomen. Mental status examination revealed anxious and depressive affect, delusion of parasitosis, tactile hallucination and impaired insight. Routine hemogram and urinalysis was unremarkable, except for the detection of cocaine. Conclusions Delusional parasitosis often presents to nonpsychiatric medical professionals. An awareness of such ilness, with an early recognition and timely referral are management cornerstones in order to successfully diagnose and treat patients. Disclosure No significant relationships.

Introduction A delusion of parasitosis is defined as the fixed, false belief of infestation by invisible organisms or fibrous material of unknown origin. The differential diagnosis is true infection, substance use disorder, dementia or other neuropsychiatric disease. Objectives Our goal was to characterize delusions of parasitosis, classically named Ekbom syndrome, among individuals attending our emergency department (ED). Methods Over a four-year period (2017-2020), we carried out a retrospective case-register study of patients with DSM-5 Ekbom syndrome attending an ED that provides mental health services to an area of nearly 450.000 inhabitants in Sabadell (Barcelona, Spain). Results There were 13 eligible patients: 7 were diagnosed for the first time and 6 had multiple episodes. Female-to-male ratio was 1.6:1; average age was 56.9. The most common diagnosis was delusional disorder (n=5;8.5%), followed by schizophrenia (n=3;23.1%) and organic disorders (n=2;15.4%). Origin: Africa (n=5;38.5%), South-America (n=4;30.8%) and Spain (n=4;30.8%). Fifty percent showed poor treatment compliance. Antipsychotics used: risperidone (n=8;61.54%), olanzapine (n=4;30.8%). Five patients received antidepressants. Most patients had previously been seen by other medical specialties (internal medicine, dermatology and hematology). ‘’Match box sign’’: 7 patients (53.8%). Cerebral atrophy was present on brain scan in 4 patients. After discharge: acute psychiatric unit (n=7), outpatient appointments (n=4), day hospital (n=1) and 1 to a psychogeriatric unit. Conclusions Delusions of parasitosis are rare in our emergency department. The typical patient is a postmenopausal woman, a visitor or immigrant to Spain. Effective treatment requires a focus on cultural, gender, and age aspects, with close cooperation between psychiatry and other relevant specialties.