Delusional infestation: Clinical presentations, diagnosis, and management

Torales, Júlio; García, Oscar; Barrios, Iván Domingo González; O’Higgins, Marcelo; Castaldelli-Maia, João Maurício; Ventriglio, Antonio; Jafferany, Mohammad

doi:10.1111/jocd.13786

Cited by 10 publications

(21 citation statements)

References 38 publications

(76 reference statements)

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“…These were all noted in the patient’s case presented previously. In addition, the patient’s maternal aunt evinced features of both orificial delusional infestation and delusory cleptoparasitosis, which are considered to be clinical variants of delusional parasitosis [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, underlying anxiety may also be a discernible feature in secondary cases of folie communiquée [ 11 ]. A thorough personality assessment might have yielded useful supplementary information as the patient in this scenario displayed anankastic personality characteristics and delusional infestation is more frequently encountered in persons with anankastic and paranoid traits [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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A Case of Delusional Parasitosis With Folie à Deux Treated With Low-Dose Quetiapine

Kalovidouri¹,

Kowalewski²,

Mos³

et al. 2022

Cureus

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A patient with a three-month history of persistent delusions of infestation presented to the emergency department with suicidal ideation secondary to complaints of worsening pruritus. Routine investigations failed to disclose any underlying organic cause for her pruritic sensations. The patient ascribed these to a parasitic infestation acquired following a brief stay at her maternal aunt’s residence. Following a thorough psychiatric assessment and collateral history obtained from her aunt, it became clear that both the patient and her aunt held similar delusions of infestation. Her aunt was found to be the main inducer. The patient was admitted, successfully treated with low-dose quetiapine, and eventually deemed fit for discharge. Delusional parasitosis and folie à deux are both rare conditions that may sometimes co-occur.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case of Delusional Parasitosis With Folie à Deux Treated With Low-Dose Quetiapine

Kalovidouri¹,

Kowalewski²,

Mos³

et al. 2022

Cureus

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“…11 Typically, those with delusions of parasitosis have complaints of severe pruritis and intense itching. 12 Researchers explain that pimozide's unique binding profile provides anti-delusional benefits along with itching and paresthesia relief via dopamine and 5-HT2 serotonin blockades respectively, which together allow for better alleviation of false bodily sensations. 5 Moreover, it has been proposed that pimozide may still provide relief in the absence of pruritus and formication through 5-HT2 receptor antagonism.…”

Section: Discussionmentioning

confidence: 99%

Delusions of Glass Under Skin: An Unusual Case of Somatic-Type Delusional Disorder Treated with Olanzapine

Comardelle

Edinoff

Fort

2022

Health Psychology Research

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Introduction The management of delusional disorder (DD) remains difficult due to poor patient insight and a lack of definitive treatment guidelines. For the somatic subtype specifically, prior studies have shown successful treatment with the first-generation antipsychotics (FGA) pimozide, but these studies did not specify the nature of the delusions. It has been theorized that pimozide effectiveness is due to its unique ability to relieve itching sensations, which are commonly associated with somatic delusions (e.g., delusions of parasitosis). The use of FGAs is not without risk, however, and should be avoided when possible due to the significant side-effect profile. Thus, there is a need for safer alternatives for the treatment of somatic-type DD. This manuscript discusses a case of DD characterized by painful sensations of glass under the skin managed with the second-generation antipsychotic olanzapine. Case A 67-year-old female with a past medical history including depression presented to the ED with complaints of glass in her hands and fingernails bilaterally. The patient has been evaluated by several physicians in the past without any evidence of glass being found. She was able factually able to describe that others viewed her complaints as irrational, but she refused to accept this as truth. Cognitive screening testing was normal, and a physical exam showed several areas of excoriation on the hands and arms bilaterally, a removed left thumbnail, and a thin frame (BMI: 18.02). The patient was admitted to the psychiatry service, where organic causes were ruled out (infection, metabolic abnormalities, drug use). The patient received olanzapine 5mg PO nightly treatment with adjunctive psychotherapy and experienced acute psychotic relief after a two-day admission period. She did not endorse any side effects from the medication. Discussion To our knowledge, there haven’t been prior studies exploring treatment efficacy in somatic-type DD subdivided by the nature of false bodily sensation. Despite this limitation, it was found that most cases of somatic-type DD characterized by foreign bodies under the skin were treated with pimozide. Although this drug appears to be a reasonable option for the more common presentation involving false pruritis, it might not be recommended for rare presentations that don’t involve itchiness due to the high risk of adverse symptoms. Accordingly, clinicians should consider the nature of the delusions along with the unique side effect profile of the pharmacological therapy as any harm might outweigh the potential benefit. This was highlighted in the current presentation as clinicians determined olanzapine to be the most appropriate treatment despite no similar cases of DD described in the literature. Furthermore, this case exemplified the utility of second-generation antipsychotics in the treatment of somatic-type DD.

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“…Concerned about the observation that delusional parasitosis leads to self-induced cutaneous lesions, Torales and collaborators [ 49 ] conducted a review of the topic with the aim of updating clinical aspects and treatment strategies for both dermatologists and psychiatrists. Their conclusion was that differential diagnosis, which includes medical conditions and substance use disorders, is crucial to effective treatment, outcome, and prognosis.…”

Section: Collaboration With Dermatologistsmentioning

confidence: 99%

Collaboration between Psychiatrists and Other Allied Medical Specialists for the Treatment of Delusional Disorders

et al. 2022

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Background: There is increasing evidence that individuals with psychosis are at increased risk for cardiovascular disease, diabetes, metabolic syndrome, and several other medical comorbidities. In delusional disorder (DD), this is particularly so because of the relatively late onset age. Aims: The aim of this narrative review is to synthesize the literature on the necessity for medical collaboration between psychiatrists and other specialists. Methods: A non-systematic narrative review was carried out of papers addressing referrals and cooperation among specialists in the care of DD patients. Results: Psychiatrists, the primary care providers for DD patients, depend on neurology to assess cognitive defects and rule out organic sources of delusions. Neurologists rely on psychiatry to help with patient adherence to treatment and the management of psychotropic drug side effects. Psychiatrists require ophthalmology/otolaryngology to treat sensory deficits that often precede delusions; reciprocally, psychiatric consults can help in instances of functional sensory impairment. Close collaboration with dermatologists is essential for treating delusional parasitosis and dysmorphophobia to ensure timely referrals to psychiatry. Conclusions: This review offers many other examples from the literature of the extent of overlap among medical specialties in the evaluation and effective treatment of DD. Optimal patient care requires close collaboration among specialties.

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Delusional infestation: Clinical presentations, diagnosis, and management

Cited by 10 publications

References 38 publications

A Case of Delusional Parasitosis With Folie à Deux Treated With Low-Dose Quetiapine

A Case of Delusional Parasitosis With Folie à Deux Treated With Low-Dose Quetiapine

Delusions of Glass Under Skin: An Unusual Case of Somatic-Type Delusional Disorder Treated with Olanzapine

Collaboration between Psychiatrists and Other Allied Medical Specialists for the Treatment of Delusional Disorders

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