Variable Clinical Presentations of Secondary Delusional Infestation: An Experience of Six Cases from a Psychodermatology Clinic

Altunay, İlknur Kıvanç; Ateş, Bilge; Mercan, Sibel; Demirci, Gülşen Tükenmez; Kayaoğlu, Semra

doi:10.2190/pm.44.4.d

Cited by 12 publications

(31 citation statements)

References 33 publications

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“…The mean age of onset in recent reports (Table 1) was older than 45 years. Further, in our summary of 25 individuals [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], women became ill significantly later than men which is consistent with other recent studies [2••, 7••, 12••] and some previous ones [10]. Since DD appears to be a disorder mostly seen in later stages of life, physicians and caregivers should be cautious about medication side effects and drug-drug interactions when it comes to pharmacological treatment.…”

Section: Psychopharmacological Treatment Methodssupporting

confidence: 90%

Current Treatments for Delusional Disorder

Roudsari¹,

Chun

Manschreck

2015

Curr Treat Options Psych

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Delusional disorders form part of the spectrum of psychotic disorders in psychiatry. They are poorly understood in practically every aspect of their nature, including cause, phenomenology, prevalence, comorbidity, course, treatment, and prognosis. The key symptom in delusional disorders is one or more delusions. A cardinal characteristic of delusional disorder, conviction that one is not mentally ill, contributes complexity to the treatment challenges and profoundly affects the therapeutic relationship. Diagnosis and differential diagnosis are critical tasks. Delusional conditions may arise from many sources and, only when the case conforms to the criteria and is clearly idiopathic-is a primary delusional disorder-can we feel confident that the patient suffers from delusional disorder rather than a secondary delusional condition. Adequate treatment follows principles for the treatment of delusions. First line pharmacological treatment for delusional disorder is antipsychotic medication, both first and second-generation agents, and some evidence suggests that clozapine may be effective in certain cases. The assumption in such a formulation is that the delusion(s) encountered in delusional disorders respond as a class of symptoms found in different disorders. Hence, the approach for failed interventions with these agents may be similar to that proposed for the treatment of schizophrenia or other psychotic disorders. Namely, searching for evidence of failure to take medication, inadequate dosing, a missed diagnosis of a substance disorder, medical condition, or even another psychiatric disorder should be considered. For individuals with delusional disorders who are also experiencing comorbid depression or anxiety, the addition of appropriate agents for those symptoms may provide a synergistic strategy for overall effectiveness. Psychotherapy is another important clinical tool. Cognitive behavioral therapy focusing on different aspects of delusions (i.e., anxiety, reasoning biases, faulty logic, etc.) has demonstrated some value for at least short-term improvement. Various techniques may be useful in allying with the patient and supplying means to assist in managing their thinking and approach to circumstances and factors that promote delusion formation and encourage actions taken to respond. A significant problem in applying what we know about delusional disorders to treatment is the limited available evidence. Lack of randomized controlled trials, which form the standard in most clinical disorders, is a major shortcoming. Recent observations of compromised cognitive functioning in working memory, attention, and executive function should be replicated with similar standards. Systematic case studies and large series are useful, and a growing effort to be more rigorous methodologically in all contributions including case registries and longer followup studies is promising. Nevertheless, our knowledge remains less than optimal. These comments apply not only to pharmacological observations but also to those of neuropsyc...

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Section: Psychopharmacological Treatment Methodssupporting

confidence: 90%

Current Treatments for Delusional Disorder

Roudsari¹,

Chun

Manschreck

2015

Curr Treat Options Psych

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“… 29 , 30 , 38 – 53 These do not provide any new research or clinical evidence to support the claims that MD is a delusional disorder, but they do present common discussion themes that are frequently reiterated in case studies and research papers. 54 – 76 Common discussion themes are: MD is a delusional disorder 29 , 30 , 38 – 76 MD is a variation of DOP, DP, or DI 29 , 30 , 38 – 76 MD is defined as the fixed, unshakable belief, despite lack of medical evidence, of being infested with microscopic organisms or inanimate objects 29 , 30 , 38 – 76 the presentation of specimens in or out of a container, whether it be a matchbox, small plastic bag, paper, pill container, or photographic image, etc, is diagnostic of DOP, DP, or DI 29 – 31 , 52 , 55 , 59 – 62 , 64 , 66 , 70 , 71 patients with MD tend to have psychiatric comorbidities 74 , 68 MD is a mass delusional mental illness afflicting primarily middle-aged Caucasian females 68 , 69 , 74 , 76 delusions of infestation are spread from person to person and transmitted by the Internet 30 , 39 , 41 , 51 , 52 , 54 , 58 , 60 antipsychotic drugs are the treatment of choice for MD …”

Section: Evidence Supporting the Hypothesis Of Dpmentioning

confidence: 99%

“…the presentation of specimens in or out of a container, whether it be a matchbox, small plastic bag, paper, pill container, or photographic image, etc, is diagnostic of DOP, DP, or DI 29 – 31 , 52 , 55 , 59 – 62 , 64 , 66 , 70 , 71 …”

Section: Evidence Supporting the Hypothesis Of Dpmentioning

confidence: 99%

“…Some studies reported that patients presented specimens to the health care provider as evidence – fibers, lint, hair and skin scrapings, etc – and this was interpreted as being diagnostic of DI. 55 , 59 – 62 , 64 , 66 , 70 , 71 In many of these case studies, there was no mention of any analysis of patient-supplied specimens to determine composition. 54 , 59 , 60 In a few cases, the health care provider did nothing more than a gross visual identification of patient-provided specimens.…”

Section: Evidence Supporting the Hypothesis Of Dpmentioning

confidence: 99%

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History of Morgellons disease: from delusion to definition

Middelveen¹,

Fesler²,

Stricker³

2018

CCID

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Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the condition may have a longer history, disease matching the above description was first reported in the US in 2002. Since that time, the condition that we know as MD has become a polemic topic. Because individuals afflicted with the disease may have crawling or stinging sensations and sometimes believe they have an insect or parasite infestation, most medical practitioners consider MD a purely delusional disorder. Clinical studies supporting the hypothesis that MD is exclusively delusional in origin have considerable methodological flaws and often neglect the fact that mental disorders can result from underlying somatic illness. In contrast, rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent. Recent studies from that point of view show an association between MD and spirochetal infection in humans, cattle, and dogs. These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection. Further studies of the genetics, pathogenesis, and treatment of MD are warranted.

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“… 12 , 33 2) Self-therapy with different chemicals or physical strategies aims to kill or flush away the pathogens from the body. 3 , 34 3) Repetitive and intensive self-cleaning with an obsessive trait, such as frequent changing of clothes and hair washing, reflects excessive fear of contamination. 35 4) In addition, comorbidity with psychiatric diseases or depression, secondary to DI, is associated with increased proneness to suicidal ideations and attempts.…”

Section: Introductionmentioning

confidence: 99%

Reframing delusional infestation: perspectives on unresolved puzzles

Lai

et al. 2018

PRBM

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Delusional infestation (DI), a debilitating psychocutaneous condition, featured as a false fixed belief of being infested accompanied by somatosensory abnormality, behavior alteration, and cognitive impairment. Although management of primary causes and pharmacotherapy with antipsychotics and/or antidepressants can help to alleviate symptoms in most patients, the underlying etiology of DI still remains unclear. Morgellons disease (MD), characterized by the presence of cutaneous filaments projected from or embedded in skin, is also a polemic issue because of its relationship with spirochetal infection. This review aims to discuss the following topics that currently confuse our understandings of DI: 1) the relationship of real/sham “infestation” with DI/MD; 2) behavior alterations, such as self-inflicted trauma; 3) neuroimaging abnormality and disturbance in neurotransmitter systems; and 4) impaired insight in patients with this disease. In discussion, we try to propose a multifactorial approach to the final diagnosis of DI/MD. Future studies exploring the neurobiological etiology of DI/MD are warranted.

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Variable Clinical Presentations of Secondary Delusional Infestation: An Experience of Six Cases from a Psychodermatology Clinic

Cited by 12 publications

References 33 publications

Current Treatments for Delusional Disorder

Current Treatments for Delusional Disorder

History of Morgellons disease: from delusion to definition

Reframing delusional infestation: perspectives on unresolved puzzles

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