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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 Delirium of parasitosis was first described by Karl Ekbom in Sweden in 1938. It is a hallucinatory monothematic delirium characterized by the unwavering conviction of having the skin infested with insects or parasites. Multiple etiologist has been described such as psychiatric and neurological disorders, substance intoxication or other medical conditions. We present a case of debut of Ekbom’s syndrome in an individual recently diagnosed with acute urethritis on antibiotic treatment. Objectives To report a case of a patient with a debut of Ekbom’s syndrome and acute urethritis. Methods A 40-year-old man with no previous psychiatric history is admitted psychiatric emergency room accompanied by his wife for intense anxiety and isolation at home. During the examination, the patient explains a lot of fear of a series of bugs such as bees and small parasites that invade him. The onset of symptomatology coincides with a diagnosis of chlamydia urethritis and the initiation of treatment with ceftriaxone 500mg IM + Azithromycin 1g VO. Complete physical examination is performed without alterations. Toxicological, biochemistry, hormonal and vitamin study did not show any alterations. Results Antipsychotic treatment was started with Olanzapine up to 10mg/day and supportive treatment with benzodiazepines. The patient showed rapid improvement. At discharge, he is asymptomatic from the urological and psychopathological point of view. Conclusions Ekbom’s syndrome is a multifactorial disorder. The patient was diagnosed of an acute psychotic disorder due to another medical condition and/or treatment with antibiotics. Disclosure No significant relationships.

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.

Introduction: Patients presenting with cutaneous symptomatology may in fact suffer from underlying psychiatric conditions. Individuals diagnosed with delusional infestation (DI) have a fixed false belief of being infested with certain organisms or objects. Aim: To analyse clinical features of subjects with DI who were admitted to the tertiary dermatology ward. Material and methods: A retrospective analysis concerning DI patients hospitalized between 1997 and 2019 was carried out. The emphasis was put on the duration of symptoms, psychiatric symptomatology (including the "specimen sign"), comorbidities as well as therapy. Results: We gathered data regarding 21 consecutive patients with DI. The mean age of subjects was 65.2 ±13.3 years, the majority were females (76.2%). The mean time span between the disease onset and diagnosis was 1.9 ±1.7 years. Previous psychiatric consultations were attended by 57.0% of patients. The specimen sign was present in 47.6% of cases, whereas the most common suspected causative factors were described as worms (52.4%), unspeci- fied parasites (42.9%), "something" (33.3%) and flies (19.0%). Primary delusional disorder was diagnosed in 76.2%, followed by shared delusional disorder and secondary delusional disorder of organic origin (9.5% each). Risperidone monotherapy was initiated in 61.9% of patients. In total, only 33.3% of patients attended the follow-up visit. Conclusions: DI features a wide spectrum of clinical signs and symptoms. Risperidone remains the drug of choice in the majority of cases. Successful management of each DI case requires collaboration between dermatologists and psychiatrists and still remains a major challenge. [ABSTRACT FROM AUTHOR]

Background: Visual hallucinations (VH) are one of the most common psychological symptoms of dementia with Lewy bodies (DLB). It is generally considered that the VH that occur in DLB usually disappear when patients try to touch imaginary objects. However, DLB patients also sometimes experience tactile hallucinations (TH). To the best of my knowledge, this is the first report to comprehensively describe the TH experienced by DLB patients. Methods: I searched the literature for case reports that described TH in Parkinson's disease (PD), PD dementia, or DLB. There were four reports regarding TH in PD, one of which was a review article published in 2017. I described the clinical courses of five representative cases of DLB in which TH were associated with VH, and then compared the characteristics of the TH experienced in DLB with those of the TH encountered in previously reported cases of PD. Results: The TH experienced by the DLB patients had very similar characteristics to the TH experienced by PD patients. However, the TH of the DLB patients differed from those of PD patients in the following respects: (i) when the DLB patients tried to touch the imaginary objects, they often did not disappear; (ii) the imaginary objects experienced by the DLB patients sometimes exhibited characteristic hardness and temperature; and (iii) the imaginary objects experienced by the DLB patients were often influenced by the patients' behaviour, which in turn led to further hallucinations. Conclusions: Based on the abovementioned characteristics of the hallucinations of DLB patients, I propose that these phenomena represent a novel psychopathological entity, which I shall temporarily refer to as, 'strengthening of VH by TH'. [ABSTRACT FROM AUTHOR]

Delusional parasitosis (DP) or Ekbom's disease is a rare psychiatric condition where the sufferers have a firm-fixed belief of insects crawling over their skin. The condition may be primary monosymptomatic hypochrondrical delusion or secondary to an underlying psychiatric or organic condition. We present two cases of elderly men presenting with classical symptomatology of DP, which is found to be secondary to postherpetic neuralgia following an acute episode of shingles or herpes zoster infection. One patient responded to a combination of antipsychotic, olanzapine, and pregabalin, used for neuropathic pain, and the other patient responded completely with medications used for neuropathic pain only without any antipsychotic use.

Taking care of patients with delusional parasitosis can be challenging. This report illustrates the added management complexity and ethical dilemmas surrounding a patient who was newly diagnosed with an incurable lung cancer, while at the same time was suffering from delusional parasitosis. Her delusion was so profound that she blamed flukes for her respiratory failure and refused treatment of her cancer. This paper emphasizes making the right decision with the greater good in mind, even if this meant “yielding„ to a patient’s delusion and treating the non-existing parasitosis in order for her to allow us to also treat the cancer.

The literature on chronic pruritus, paresthesia and delusional infestation indicates that a wide variety of conditions ranging from AIDS to vitamin deficiencies may cause these symptoms. In many, or perhaps most of these cases, activation of itch pathways seems to be the underlying cause of the skin sensations and perhaps even the visual hallucinations characteristic of delusional infestation. The principle difference between diagnoses of chronic pruritus and delusional infestation appears to lie in the patient's interpretation of the cause of the symptoms, rather than underlying physiological differences. Delusional infestation, paresthesia and chronic pruritus must be considered symptoms of underlying conditions. [ABSTRACT FROM AUTHOR]

Quadros de transtorno psiquiátrico induzido (folie à deux) são raros. Porém, sua prevalência pode ser de 5-25% nos casos de delírio de infestação parasitária. Relatamos o caso de uma paciente de 62 anos de idade com sintomas psicóticos que, há cerca de 15 anos, está vivendo com sua irmã mais nova. Como a paciente não estava mais apresentando sintomas, sua irmã decidiu não administrar-lhe mais antipsicótico. A paciente voltou a apresentar quadro psicótico marcado por delírio de infestação parasitária, acompanhado por alucinações visuais. Sua irmã, que não tinha história de qualquer transtorno psiquiátrico prévio, passou a acreditar que realmente a paciente estava infestada e que ela mesma fora contaminada. Esse relato de caso objetiva discutir a associação existente entre folie à deux e delírio de infestação parasitária.Shared psychiatric disorder (folie à deux) is a rare condition. But its prevalence can be 5-25% in patients with delusional parasitic infestation. We report the a case of a 62 years-old female with psychotic symptoms. For 15 years, she has lived with her younger sister. Since the patient was well-controled, her sister interrupted her antipsychotic drug administration. So, the patient initiated delusional parasitic infestation accompanied by visual hallucinations. Her sister, who did not have psychiatric history, initiated to believe that the patient was really infested. Moreover, she started to believe that was infested by the patient. This case report aims to discuss the relation between folie à deux and delusional parasitic infestation.

Dermatology is a complex area of medicine that requires knowledge of skin biology, pathophysiology, chemistry, diagnostic tests, and physical examination. Although the skin may be the primary focus of a disease process, systemic disease processes may present with manifestation in the skin. This nurse perspective focuses on delusions of parasitosis or Ekbom's syndrome. Ekbom's syndrome is a psychocutaneous disorder in which patients believe they are infested with bugs, in the absence of actual infestation. This disorder needs multidisciplinary collaboration to aid treatment. [ABSTRACT FROM AUTHOR]

Delusional parasitosis (DP) or Ekbom's disease is a rare psychiatric condition where the sufferers have a firm-fixed belief of insects crawling over their skin. The condition may be primary monosymptomatic hypochrondrical delusion or secondary to an underlying psychiatric or organic condition. We present two cases of elderly men presenting with classical symptomatology of DP, which is found to be secondary to postherpetic neuralgia following an acute episode of shingles or herpes zoster infection. One patient responded to a combination of antipsychotic, olanzapine, and pregabalin, used for neuropathic pain, and the other patient responded completely with medications used for neuropathic pain only without any antipsychotic use. [ABSTRACT FROM AUTHOR]

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Ekbom's syndrome, also known as delusional parasitosis and many other synonyms, is a psychiatric disease in which patients have a false, fixed idea of being infested by parasites. This is a review of delusional parasitosis, its history, classification, epidemiology, clinical presentation and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Amongst delusional disorders, delusional parasitosis or Ekbom's syndrome is relatively infrequent. These patients report an unwavering false belief of skin infestation due to sensoperceptive hallucinations, despite the absence of any medical evidence. There are two forms of delusional parasitosis: in the primary form the delusion of parasitic infection is the only symptom present, whereas in the secondary form it occurs alongside another psychiatric disorder, such as schizophrenia, drug abuse or an organic cause. Antipsychotics are the most usen treatment. Objectives: Presentation of a case and discussion of first approach to delusional parasitosis. Methods: Presentation of a case and a small review of the scientific literature available in PubMed. Results: Caucasian, 49-year-old woman reported a not-confirmed toe nail fungic infection one year prior, progressing with the subjective sensation of spreading to the rest of the body. Consequently, she employed diverse topical and oral remedies without medical supervision. One month prior she got medical assessment in a different medical centre, being evaluated by Dermatology and Psychiatry, getting the diagnosis of delusional parasitosis despite a lack of a battery of tests. She is given treatment, with no adherence. She escalated into more aggresive compulsions of cleasing, resulting in excoriations and scaldings, with increasing difficulties to lead her life. Conclusions: We illustrate the relevance of close multidisciplinary cooperation and the use of an adequate battery of tests to rule out an organic cause. An early diagnosis is key, as a therapeutic alliance prevents the patients from isolation and the development of depression symptoms, or else, of self-harm. [ABSTRACT FROM AUTHOR]

Restless legs syndrome (RLS) is a disorder of the part of the nervous system that affects movements of the legs. RLS is often unrecognised or misdiagnosed. In many people the condition is not diagnosed until 10-20 years after symptoms begin. Once correctly diagnosed, RLS can often be treated successfully. It is important that physicians are familiar with this condition to avoid delay in diagnosis and management. [ABSTRACT FROM AUTHOR]

Taking care of patients with delusional parasitosis can be challenging. This report illustrates the added management complexity and ethical dilemmas surrounding a patient who was newly diagnosed with an incurable lung cancer, while at the same time was suffering from delusional parasitosis. Her delusion was so profound that she blamed flukes for her respiratory failure and refused treatment of her cancer. This paper emphasizes making the right decision with the greater good in mind, even if this meant "yielding" to a patient's delusion and treating the non-existing parasitosis in order for her to allow us to also treat the cancer. [ABSTRACT FROM AUTHOR]

Restless legs syndrome (RLS) is one of the commonest movement disorders affecting sleep and also daytime functioning. The prevalence may be 8%-10% of the white Caucasian population. The diagnosis is simple and is based on a well-validated clinical questionnaire, yet misdiagnosis is common and the condition remains underdiagnosed and consequently inappropriately treated, often causing great distress to the sufferers. In spite of robust evidence for effective treatment of RLS, patients may often be told to "put up with the symptoms" and suffer the consequence of years of poor sleep which may lead to major lifestyle changes. This review addresses the diagnostic issues, the differential diagnosis, and the evidence base for treatment of the common condition.