The plague: a case of delusional infestation with folie à deux / A praga: um caso de delírio de infestação com folie à deux

Folie à deux or Shared psychotic disorder (SPD) is a rare condition characterized by shared psychotic symptoms between two or more individuals. Delusional parasitosis (DP) is an uncommon psychiatric illness in that patients believe they are infested by insects, without evidence to support this belief. DP occurs in 5­15% of SPD. We report a case of cutaneous DP with SPD between an elderly mother and a daughter that lived together and withdrew from other social contacts for the last three years. We aim to highlight the relationship between SPD and DP, its prognosis, and clinical implications.

Folie à deux ou Perturbação Psicótica Compartilhada (PPC) é uma condição rara caracterizada por sintomas psicóticos compartilhados entre dois ou mais indivíduos. O delírio parasitário (DP) é uma doença psiquiátrica incomum em que os pacientes acreditam estar infestados por insetos, sem evidências que sustentem essa crença. O DP ocorre em 5 a 15% das PPC. Relatamos um caso de um DP cutâneo com PPC entre uma mãe idosa e uma filha que viviam juntas e afastadas de outros contatos sociais nos últimos três anos. O nosso objetivo é destacar a relação entre PPC e o DP, o seu prognóstico e implicações clínicas

Síndrome de Ekbom o delirio parasitario: a propósito de un caso / Ekbom syndrome or parasitic delirium: a case report

RESUMEN Fundamento: el síndrome de Ekbom o delirio de parasitosis, infrecuente trastorno psiquiátrico, está caracterizado por una única idea delirante hipocondríaca de tener la piel infestada por insectos o parásitos, sin deterioro del resto de las funciones. Objetivo: tratar un caso poco infrecuente y típico, de gran interés para dermatólogos, psiquiatras y médicos generales. Presentación del caso: paciente femenina, blanca, de 51 años de edad, enfermera, con antecedentes de salud mental, quien poco después de divorciarse presentó prurito en piel de muslos, tronco y brazos, considerándose infestada por insectos e intentó extraérselos con una aguja de insulina. Acudió a consulta de Dermatología con una muestra de lo obtenido (signo de la caja de fósforos) al inicio se mostró reticente a acudir al psiquiatra. Al examen dermatológico se constataron lesiones autoinflingidas en piel de muslos, tronco y brazos. Al examen psiquiátrico: parestesias, idea delirante hipocondríaca, labilidad afectiva, disforia, hipobulia, desdoblamiento alucino delirante. Juicio crítico ausente. Funciones de relación alteradas. Llevó tratamiento con tioridazina 50 mg diarios. El caso reúne todas las características clínicas descritas. Se comparó con otros casos publicados y similares manifestaciones, y con otros que difirieron en sexo y edad. Conclusiones: el síndrome de Ekbom es una rara afección psiquiátrica de difícil tratamiento que representa un reto para el paciente y su médico. Por su poca frecuencia e inusuales características, debe ser identificado por médicos de familia y otros especialistas.

ABSTRACT Background: Ekbom syndrome is a rare psychiatric disease characterized by the unwavering conviction of having the skin infested of insects or parasites, without deterioration of the rest of the functions. Objective: to present a typical case of an uncommon disorder, of interest for dermatologists and psychiatrists. Clinical case: 51 years old white, female patient, nurse, with a history of mental health, who shortly after divorcing presented itching of the skin of the thighs, trunk and arms, considering herself infested by insects and tried to extract them with a needle of insulin. She went to the Dermatology consultation with a sample of what was obtained (matchbox sign) at the beginning, she was reluctant to go to the psychiatrist. The dermatological examination revealed self-inflicted skin lesions on the thighs, trunk and arms. On psychiatric examination: paresthesias, hypochondriac delusional idea, affective lability, dysphoria, hypobulia, delusional hallucinatory splitting. Critical judgment absent. Altered relationship functions. She was treated with thioridazine 50 mg daily. The case meets all the clinical characteristics described. It was compared with other published cases and similar manifestations, and with others that differed in sex and age. Conclusions: Ekbom syndrome is a rare psychiatric condition that is difficult to treat and represents a challenge for the patient and his doctor. Due to its infrequency and unusual characteristics, it must be identified by family doctors and other specialists.

Delirio de parasitosis o síndrome de ekbom / Dilusional parasitosis or Ekbom syndrome

El síndrome de Ekbom también llamado delirio de parasitosis es una condición psiquiátrica poco frecuente en el que los pacientes tienen una idea falsa y fija de estar infestados por parásitos o materiales inanimados. Se presenta el caso de un varón de 54 años con cuadro crónico compatible con este síndrome en el que resalta la buena respuesta a antipsicótico típico a un inicio, complicándose el mismo con discinecia tardía por síntomas extrapiramidales, por lo que se realiza el cambio de tratamiento con buena respuesta a la Risperidona.

Ekbom's syndrome also called Delusional Parasitosis is a rare mental disorder in which patients have a false and fixedidea of being infested by parasites or inanimate materials. A case of a 54-year-old man with a chronic condition compatible with this syndrome is reported. Initially, a good response to typical antipsychotic was highlighted, however it got complicated by a tardive dyskinesia due to extrapyramidal symptoms. Consequently, change of treatment with risperidone resulted in good response.

Delusional Parasitosis: An Analysis of 177 Cases from a Tertiary General Hospital.

Introduction: Delusional parasitosis (DP) is a form ofmonohypochondriacalpsychosis characterized by a feelingthat there are parasites crawling beneath the skin and is seen inrarely in psychiatric or primary carepractice. The disorder haspoor prognosis with a varied course and multiple relapses. Thepresent paper reports an analysis of 177 cases of delusionalparasitosis seen in a tertiary general hospital over the last 11years.Material and methods: The present study is an analysis of177 cases of DP that presented to the psychiatry departmentof a tertiary general hospital over the past 11 years and thedata has been analyzed using a semi-structured proforma anddescriptive statistics.Results: The mean age of the sample was 34.6 ± 21.3 yearsand the mean age of onset of the disorder was 28.3 ± 17.1years. The mean duration of illness of the sample was 3.9 ±10.3 years. 103 (58.19%) had a magnetic resonance imagingof the brain done which was within normal limits. 56(31.63%) patients had repeated neuroimaging investigationslike EEG, MRI and CT Scans done which were also all withinnormal limits. Most patients were treated with Risperidoneand Aripiprazole while few were treated with Pimozide,Haloperidol and Amisulpride. 43 (24.29%) patients received acourse of electroconvulsive therapy (ECT) as well in additionto medications.Conclusion: DP though rare is seen in clinical practice andfurther longitudinal studies are needed to establish withgreater certainty facts about the course and prognosis of thedisorder

Delusional infestation. ekbom's syndrome in a 53-year old woman. case report

ABSTRACT Introduction: Delusional infestation is a rare psychiatric disorder defined as a condition in which the patient has the unshakable belief and perception of being infested with parasites. Its treatment is difficult, and frequently includes antipsychotic medications (such as olanzapine or aripiprazole). Non-pharmacological treatment, particularly psychotherapy, can be used for less severe cases. Dermatologists and psychiatrists must take a multi-disciplinary approach (preferably in a psycodermatology dedicated clinic) since this type of patients sometimes refuse treatment. Case description: A 53-year-old female businesswoman describes a clinical history of five years of visual hallucinations, depressive symptoms, and generalized pruritus, along with the use of toxic substances to "clean" her skin and cloths. She reports similar symptoms in some relatives but they were not evaluated. Blood tests and analyses of the "specimen" brought by the patient were performed, yielding negative results. The patient had never been assessed by any specialist, and showed disoriented during the consultation. Follow-up was not possible due to the reluctance of the patient to follow the indications and seek psychiatric treatment. Moreover, the patient did not respond to further communication attempts. Discussion: Delusional infestation is an uncommon disease that endangers the patients and the people around them. Its treatment is difficult and long, and not conducting proper follow-up is a great risk. Its prevalence and incidence is variable and generally unknown. It can affect the patient, their next of kin, pets or the environment, and the "pathogen" can be a living organism or an inanimate object. Conclusion: This case is important as it shows the hardships of treatment, adequate follow-up and care, as well as the need to improve how these patients are approached. Additionally, both classical and uncommon signs and symptoms could be observed as the patient stated that her relatives were affected (possible delusional infestation by proxy).

Parasitosis ilusoria intestinal y dermatológica: casos clínicos / Delusional parasitosis intestinal and dermatological: clinical cases

Illusory parasitosis, better known as delusional parasitosis, is a neuropsychiatric syndrome in which patients have the belief of suffering a parasitic disease, that can not be demonstrated after an exhaustive medical study. These patients are characterized by being polyconsultants in different medical specialties and, many of them, have antecedents of psychiatric disorders, some of them undiagnosed. Knowing the existence of the clinical picture, diagnosing early and empathizing with the patient, could give to clinician some clues for a timely and assertive psychiatric referral, and improve patient adherence to the proposed treatment.

La parasitosis ilusoria, más conocida como delusión parasitaria, es un síndrome neuropsiquiátrico donde los pacientes tienen el convencimiento de padecer una infestación parasitaria, que no puede ser demostrada tras un exhaustivo estudio médico. Estos pacientes se caracterizan por ser policonsultantes en distintas especialidades médicas y, muchos de ellos, poseen antecedentes de trastornos psiquiátricos, algunos de ellos no diagnosticados. Conocer la existencia del cuadro, diagnosticar precozmente y empatizar con el paciente, pueden dar al médico clínico algunas claves para una derivación psiquiátrica oportuna y asertiva, y mejorar la adherencia del paciente al tratamiento propuesto. Se presentan cuatro casos clínicos que consultaron por esta extraña condición.

Síndrome de Ekbom: a propósito de un caso / Ekbom syndrome: apropos of a case

El síndrome de Ekbom o delirio de parasitosis es una condición psiquiátrica infrecuente cuyo síntoma principal es la idea delirante de estar infestado con organismos vivientes, como parásitos, bacterias, virus, insectos o gusanos. Se presenta el caso de un varón de 34 años con un cuadro compatible con este síndrome. Se revisa brevemente la literatura disponible y se realiza una correlación teórico-clínica con los síntomas del paciente, y se concluye que el paciente sufría un síndrome de Ekbom de tipo primario y mixto.

The Ekbom syndrome or delusional parasitosis is an uncommon psychiatric condition, in which the main symptom is the delusion of being infested with living organisms such as parasites, bacteria, virus, bugs or worms. The case is presented of a 34 year-old man with symptoms compatible with the syndrome. The available literature is briefly reviewed and theoretical correlation with clinical symptomatology is made. The patient had a primary and mixed Ekbom syndrome.

Cultural influence in the development of delusional parasitosis: A case report.

Delusional parasitosis is a rare condition in which the patient has a false and unshakable belief of being infested by parasites. Delusional parasitosis was classified as a subtype of monosymptomatic hypochondriacal psychosis in old literature. Though the delusion is considered to be primary, at times it is described as an elaboration of a primary pathological experience such as a tactile hallucination, paresthesia or pruritus. Although several cases of delusional parasitosis have been reported, the role of cultural belief systems and native treatments in turning an idea into a delusional disorder has not been adequately studied. This paper reports a case of delusional parasitosis in which cultural factors played a major role in shaping the delusion. The case was effectively managed with risperidone.