Sanrısal Parazitoz Tanı ve Tedavisinde Güncel Gelişmeler: Bir Gözden Geçirme

Öz

Sanrısal parazitoz (SP), bireyin deri ya da mukozalarında parazit, böcek veya benzeri organizmaların bulunduğuna dair sarsılmaz inançla karakterize, nadir ancak klinik açıdan oldukça karmaşık bir psikotik bozukluktur. Hastalık genellikle yoğun kaşıntı, dokunsal halüsinasyonlar ve “kibrit kutusu işareti” olarak tanımlanan sahte kanıt sunumlarıyla ortaya çıkar. Hastaların dermatoloji ve enfeksiyon hastalıkları gibi branşlara tekrarlayan başvurularda bulunması, buna karşın psikiyatrik değerlendirmeyi reddetmesi tanıda gecikmeye ve sekonder cilt lezyonları, işlev kaybı ve sosyal izolasyon gibi ciddi sonuçlara yol açabilir. SP çoğunlukla ileri yaşta ve özellikle kadınlarda görülür; bazı olgularda paylaşılan sanrısal bozukluk (folie à deux) şeklinde de seyredebilir. Primer SP’de altta yatan bir psikiyatrik ya da organik neden bulunmazken, sekonder form depresyon, demans, Parkinson hastalığı, madde kullanımı ve bazı ilaçlarla ilişkilidir. Etiyopatogenezde dopaminerjik sistemde bozulma ve somatik uyaranların yanlış yorumlanması önemli rol oynar. Tanı, gerçek paraziter enfestasyonların dışlanması ve psikiyatrik değerlendirmenin birlikte yürütülmesiyle konur. Tedavide ikinci kuşak antipsikotikler (risperidon, aripiprazol, olanzapin) ön plandadır; Bilişsel Davranışçı Terapi (BDT) tedaviye uyumu ve içgörüyü artırabilir. Multidisipliner yaklaşım, empatik iletişim ve güvene dayalı terapötik ilişki, SP yönetiminin temelini oluşturur. Bu derleme, klinik zorlukları ve güncel tanı-tedavi stratejilerini özetleyerek sağlık profesyonellerine bütüncül bir bakış açısı sunmayı amaçlamaktadır.

Anahtar Kelimeler

• Antipsikotik ajanlar
• Morgellon hastalığı
• paylaşılan paranoid bozukluk
• sanrısal parazitoz

Recent Advances in the Diagnosis and Treatment of Delusional Parasitosis: A Review

Öz

Delusional parasitosis (DP) is a rare yet clinically challenging psychotic disorder characterized by the unwavering belief that parasites, insects, or similar organisms inhabit the skin or mucosal surfaces. The condition typically manifests with intense pruritus, tactile hallucinations, and the submission of pseudoevidence, commonly referred to as the “matchbox sign.” Patients frequently present to dermatology or infectious diseases clinics while persistently declining psychiatric evaluation, which may delay diagnosis and result in secondary skin lesions, functional impairment, and social withdrawal. DP is more commonly observed in older individuals, particularly women, and may occasionally occur as shared psychotic disorder (folie à deux). The disorder is classified into primary and secondary forms: primary DP lacks identifiable psychiatric or organic etiologies, whereas secondary DP is associated with depression, dementia, Parkinson’s disease, substance use, and certain medications. Pathophysiologically, dysregulation within the dopaminergic system and the misinterpretation of somatic stimuli are considered central mechanisms. Diagnosis requires the exclusion of true parasitic infestation and the integration of dermatological and psychiatric assessments. Second-generation antipsychotics, including risperidone, aripiprazole, and olanzapine, constitute first-line pharmacological therapy; Cognitive Behavioral Therapy (CBT) may further enhance insight and adherence. A multidisciplinary approach, empathetic communication, and a strong therapeutic alliance are essential to successful management. This review synthesizes current evidence on the diagnosis, treatment, and follow-up of DP, aiming to provide healthcare professionals with a comprehensive and clinically relevant overview of this complex condition.

Anahtar Kelimeler

• Antipsychotic agents
• delusional parasitosis
• Morgellons disease
• shared paranoid disorder

Kaynakça

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