Journal of Psychiatry Depression & Anxiety Category: Clinical Type: Case Report
A Case of Delusional Parasitosis
- Kodjovi Kodjo1*, Oluwaseun Ogunsakin1, Ayotomide Oyelakin1, Mohammed Khan1, Olayinka Olaniyi1, Olaolu Olalekan2, Chiedozie Ojimba2, Olusegun Popoola2, Khandaker Taher2, Amal Saha2, Jason Hershberger2
- 1 Interfaith Medical Center, 1545 Atlantic Ave, Brooklyn, NY 11213, United States
- 2 Interfaith Medical Center, 1545 Atlantic Ave, Brooklyn, Ny 11213, United States
*Corresponding Author:Kodjovi Kodjo
Interfaith Medical Center, 1545 Atlantic Ave, Brooklyn, NY 11213, United States
Tel:240 319 0421,
Received Date: Jul 04, 2019 Accepted Date: Jul 15, 2019 Published Date: Jul 22, 2019
Delusional parasitosis can be categorized into three distinct categories namely; primary, secondary, or organic. Primary delusional parasitosis comprises of a single belief of being infested by a parasite. Secondary delusional parasitosis occurs in the background of other mental disorders like depression, schizophrenia, and dementia. Organic delusional parasitosis can occur in the setting of some common organic disorders such as hypothyroidism, cerebrovascular disease, allergies, and cocaine intoxication. The patient described in this case report is a 53-year-old Caucasian male with delusional parasitosis in the context of chronic mental illness treated with a combination of risperidone and Depakote with resolution of symptoms.
Delusions of parasitosis, also known as Ekbom syndrome, is a rare psychiatric condition that is characterized by a fixed, false belief of being infested by a parasite [1,2]. Due to the paucity of publications, the prevalence of delusional parasitosis is unknown. Available studies show that delusional parasitosis is more common in white patients and its incidence is higher among female with a ratio of 2:1. However, when stratified by age, there is no gender difference in the incidence below the age of 50 years . While delusional parasitosis is usually described in middle-aged and older women, the condition has been reported in patients of all age groups . The etiology of delusional parasitosis is unknown.
The individual suffering from this condition typically reports parasites in or on the skin, around or located inside body openings, in the internal organs namely stomach or bowels, and this is usually associated with the belief that the parasites are invading his home, clothing, and surroundings . Patients may have a sensation of parasites crawling or burrowing into their skin. Individuals with this condition often scratch themselves to the point of skin damage or self-mutilation. The examination may not reveal lesions but sometimes reveal scratch marks, minor ulcers or erosions . Often, discrete bruises, scars, or ulcers are frequently produced by patients trying to extract the offending parasite(s). Individuals may present with an exhibit of skin or clothing debris wrapped in plastic or tape or matchboxes as evidence of the parasitic infestation. Usually, these do not typically contain the parasites. This phenomenon is called the matchbox sign .
The patient must be adequately evaluated about their symptoms and beliefs about the causative factors and likely etiology. The diagnosis and management of delusions of parasitosis can be tasking because many patients may resist the idea that their condition may be psychiatric and may refuse referrals for psychiatric care .
Delusional parasitosis must not have an external cause such as, skin diseases like scabies as the presence of an external cause excludes the condition. In essence, other causes of itching or pruritus must be adequately evaluated and ruled out .
In this report, we describe the case of a 53-year-old Caucasian male with delusional parasitosis in the context of chronic mental illness.
- Perform a microscopic examination of skin and hair to exclude lice or scabietic infestation.
- Exclude vitamin deficiencies that may potentially lead to neurological deficiencies.
- Perform tests to rule out other causes of pruritus like anemia, liver or kidney disease. Such tests include complete blood count; liver function tests, thyroid function tests, serum electrolytes, glucose, iron panel, folate, urine analysis, and toxicology.
In the absence of controlled trials there is limited evidence that antipsychotics are effective in primary Delusional parasitosis. Rigorous studies are needed to evaluate their effectiveness .
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Citation: Kodjo K, Ogunsakin O, Oyelakin A, Khan M, Olaniyi O, et al. (2019) A Case of Delusional Parasitosis. J Psychiatry Depress Anxiety 5: 024.
Copyright: © 2019 Kodjovi Kodjo, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.