How to approach delusional infestation

Lepping, Peter; Huber, Markus; Freudenmann, Roland W.

doi:10.1136/bmj.h1328

Cited by 42 publications

(66 citation statements)

References 16 publications

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“…The literature suggests that primary DI responds best to atypical antipsychotics, such as risperidone and olanzapine, but it also has been successfully treated with the older agents haloperidol and pimozide . There has been some reported success in treating psychosis related to AD with acetylcholinesterase inhibitors, and this could be a possible future treatment strategy for our patient .…”

Section: Discussionmentioning

confidence: 90%

“…It is defined as the fixed, false belief that one is infested with pathogens despite absence of medical evidence . It is thought that psychiatrists may underestimate the prevalence of DI cases because these patients are more often encountered by other medical specialists …”

Section: Discussionmentioning

confidence: 99%

“…Typically, DI presents in middle‐aged women, but it occurs in all age groups worldwide and is often accompanied by a tendency to collect specimens to show to their physicians, termed the ‘matchbox’ or ‘specimen’ sign . Reliable epidemiological data on DI are lacking, but its incidence is estimated to be 1.9 per 100 000 person years . Primary DI meets the Diagnostic and Statistical Manual of Mental Disorders , 5th edition, criteria for delusional disorder and is sometimes associated with tactile hallucinations .…”

Section: Discussionmentioning

confidence: 99%

“…Primary DI meets the Diagnostic and Statistical Manual of Mental Disorders , 5th edition, criteria for delusional disorder and is sometimes associated with tactile hallucinations . Sixty percent of cases, however, are secondary to underlying neurological or medical conditions or are substance‐induced …”

Section: Discussionmentioning

confidence: 99%

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Probable Alzheimer’s dementia presenting as delusional infestation

et al. 2017

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Probable Alzheimer’s dementia presenting as delusional infestation

et al. 2017

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“…Delusional infestation (DI) has been studied by generations of clinicians and researchers. Although it is a rare disorder, it has a disproportionately high impact on healthcare systems as well as the patients themselves . Patients often shop for different healthcare professionals and purchase medications and disinfectants seeking help for symptoms only to burden themselves and the healthcare systems with increasing costs .…”

Section: Introductionmentioning

confidence: 99%

Delusional infestation: a prototype of psychodermatological disease

2019

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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.

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How Should Physicians Use Their Authority to Name a Stigmatizing Diagnosis and Respond to a Patient's Experience?

Bartels

Ryan

2018

AMA Journal of Ethics

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Patients with delusional infestation are unlikely to agree to take the mainstay of treatment-antipsychotic medication. While stressing the general importance of truth telling in medicine, we suggest that, in some cases of delusional infestation, patients' lack of decision-making capacity will-provided a series of criteria are met-justify briefly withholding their diagnosis. We acknowledge this action as a kind of deception with ethical pitfalls and discuss those related to prescribing antipsychotic medication without frank disclosure. We recommend full disclosure of a delusional infestation diagnosis when the patient is recovered, despite this action's potential to exacerbate stigma. Case Ms M presents to Dr P's family medicine clinic for assessment of severe pruritus (itch) that she has been experiencing for the past 4 years. She first noted the itch in association with small bumps on her ankles and wrists. She was diagnosed with bed bugs and had her apartment cleaned and fumigated. The bumps went away, but the itching persisted. She became concerned that the infestation had returned and ultimately moved out of her apartment and into a new building. She sold all her belongings, including her bed and books, gave away her cat, and bought new furniture 3 years ago. She continues to note severe itching of her arms, legs, and back since that time. She had her new apartment fumigated 3 more times. She discusses with Dr P that, recently, she thinks she has been able to see the bugs-they are hatching eggs and she can pull them out. She brings the "eggs" with her in plastic bags for Dr P to review. She has found topical permethrin to be helpful in the past. Dr P examines her skin and notes scabbed-over bumps from repeated manipulation of the skin. He sees no signs of an infestation. He reviews the contents of her bag and notes that it is consistent with simple keratin. Dr P suspects the source of Ms M's symptoms and experiences to be delusional infestation, and he wonders how he should respond in a way that is respectful and truthful.

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How to approach delusional infestation

Cited by 42 publications

References 16 publications

Probable Alzheimer’s dementia presenting as delusional infestation

Probable Alzheimer’s dementia presenting as delusional infestation

Delusional infestation: a prototype of psychodermatological disease

How Should Physicians Use Their Authority to Name a Stigmatizing Diagnosis and Respond to a Patient's Experience?

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