Delusional Parasitosis: Clinical Features, Diagnosis and Treatment

Abstract

Delusional parasitosis is a delusional disorder in which the patient has the false and persistent belief that he is infested by some type of parasite or small living creatures. The disease has been called under different names such as "Ekbom syndrome" or psychogenic parasitosis in the last century. Delusional parasitosis is divided into primary, secondary functional and secondary organic groups. The female-to-male ratio in delusional parasitosis is approximately 2:1.Delusional parasitosis is associated in 5-15% of shared psychotic disorder and can run within a family (folie a familie). The diagnosis is one of exclusion, and other diseases that can also cause a sensation of itching should be considered, investigated, and treated if present. Lack of treatment might cause delusional symptoms to gain chronicity, and might further complicate treatment response. Antipsychotics, antidepressants, electroconvulsive therapy, and in the presence of dermatological lesions some topical dermatological agents and antihistaminics are used in the treatment of this disorder.

Keywords

• Delusional Parasitosis, Ekbom Syndrome, Delusional Disorder

Delüzyonel Parazitoz: Klinik Özellikleri, Tanı ve Tedavi

Öz

Delüzyonel parazitoz tıbbi bir kanıt olmamasına rağmen kişinin parazit ya da yaşayan küçük yaratıklar tarafından enfekte olduğu yanlış ve ısrarlı inancı ile seyreden sanrısal bir bozukluktur. Yüzyıldan uzun zamandır Ekbom hastalığı, psikojenik parasitoz gibi çeşitli isimlerle adlandırılmıştır. Delüzyonel parazitoz birincil veya ikincil olarak gelişebilir. Delüzyonel parazitoz patofizyolojisini açıklamada kognitif ve duyusal yaklaşımlardan bahsedilmektedir. Kadınlar erkeklerden daha fazla etkilenmektedir. DP genellikle tek kişide görülmesine rağmen bazen birden fazla kişide (folie a deux, folie a trois) hatta ailenin tüm bireylerinde (folie a famille) görülebilmektedir. Özellikle gerçek parazitozlarla ayırıcı tanısının yapılması gereklidir. Delüzyonel parazitoz olgularının çoğunda semptom bir kez yerleştikten sonra genellikle tedaviye yanıt düşüktür. Uzun sürelerle tedavisiz kalan hastalarda sanrısal sistem yerleşmekte ve kronikleşmektedir. Tedavisinde antipsikotikler, antidepresanlar, elektrokonvulsif tedavi; cilt lezyonları varsa topikal dermatolojik ajanlar ve antihistaminikler kullanılmaktadır.

Anahtar Kelimeler

• Delüzyonel Parazitoz, Ekbom Sendromu, Sanrısal Bozukluk

Kaynakça

1. Lepping P, Freudenmann RW. Delusional parasitosis:a new pathway for diagnosis and treatment. Clin Exp Dermatol 2008; 33:113-117.
2. Mercan S, Öğütcen Ö, Altunay İK, Karamustafalıoğlu O. Folie a famille ve delüzyonal parazitoz: olgu sunumu ve literatürün gözden geçirilmesi. Klinik Psikofarmakoloji Bülteni 2005; 15:71-78.
3. Milia A, Mascia MG, Pilia G, Paribello A, Murgia D, Cocco E et al. Efficacy and safety of quetiapine treatment for delusional parasitosis: Experience in elderly patient. Clin Neuropharmacol 2008; 31:310-312.
4. Freudenmann RW, Lepping P. Second-generation antipsychotics in primary and secondary delusional parasitosis: Outcome and efficacy. J Clin Psychopharmacol 2008; 28:500-508.
5. Huber M, Kirchler E, Karner M, Pycha R. Delusional parasitosis and the dopamine transporter. A new insight of etiology? Med Hypotheses 2007; 68:1351-1358.
6. Lepping P, Russel I, Freudenmann W. Antipsychotic treatment of primary delusional parasitosis:systematic review. Br J Psychiatry 2007; 191:198-205.
7. American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders- 4th ed text revision: DSM-IV-TR. Washington, DC, APA, 2000.
8. Özkan AT, Mumcuoğlu KY. Entomofobi ve delüzyonel parazitoz. Türkiye Parazitoloji Dergisi 2008; 32:366-370.

9. Szepietowski JC, Salomon J, Hrehorow E, Pacan P, Zalewska A. Delusional parasitosis in dermatological practice. J Eur Acad Dermatol Venereol 2007; 21:462-465.
10. Mercan S, Altunay IK, Taskintuna N, Ogutcen O, Kayaoglu S. Atypical antipsychotic drugs in the treatment of delusional parasitosis. Int J Psychiatry Med 2007; 37:29-37.
11. Fleury V, Wayte J, Kiley M. Topiramate-induced delusional parasitosis. J Clin Neurosci 2008; 15:597-599.
12. Steinert T, Studemund H. Acute delusional parasitosis under treatment with ciprofloxacin. Pharmacopsychiatry 2006; 39:159-160.
13. Mowla A, Asadipooya K. Delusional parasitosis following heroin withdrawal: a case report. Am J Addict 2009; 18:334-335.
14. Ford EB, Calfee DP, Pearson RD. Delusions of intestinal parasitosis. South Med J 2001; 94:545-547.
15. Maeda K, Yamamoto Y, Yasuda M, Ishii K. Delusions of oral parasitosis. Prog Neuro- Psychopharmacol Biol Psychiatry 1998; 22:243-248.
16. Sherman MD, Holland GN, Holsclaw DS, Weisz JM, Omar OH, Sherman RA. Delusions of ocular parasitosis. Am J Ophthalmol 1998; 125:852-856.
17. Geddes ERC, Rashid RM. Delusional tinea: A novel subtype of delusional parasitosis. Dermatol Online J 2008; 14:16.
18. Berrios GE. Delusional parasitosis and physical disease. Compr Psychiatry 1985; 26:395–402.
19. Leon J, Antelo RE, Simpson G. Delusion of Parasitosis or chronic tactile hallucinosis: hypothesis about their brain physiopathology. Compr Psychiatry 1992; 33:25-33.
20. Suh KN, Keystone JS. Delusional Parasitosis. http://www.uptodate.com/ patients/content/topic.do?topicKey=~55lK_gUwtZN62/z 15 Mayıs 2010’da erişildi.
21. Nagaratnam N, O'Neile L. Delusional parasitosis following occipito-temporal cerebral infarction. Gen Hosp Psychiatry 2000; 22:129-132.
22. Enoch D, Ball H. Uncommon psychiatric syndromes, 4th ed. London, Arnold, 2001.
23. Aw DCW, Thong JY, Chan HL. Delusional parasitosis: case series of 8 patients and review of the literature. Ann Acad Med Singapore 2004; 33:89-94.
24. Nicolato R, Correa H, Romano-Silva MA, Teixeira AL. Delusional parasitosis or Ekbom syndrome: a case series. Gen Hosp Psychiatry 2006; 28:85-87.
25. Gönül M, Kılıç A, Soylu S, Gül Ü, Aydemir Ç, Koçak O. Folie a deux, diagnosed by delusional parasitosis. Eur J Dermatol 2008; 18:95-96.
26. Friedmann AC, Ekeowa-Anderson A, Taylor R, Bewley A. Delusional parasitosis presenting as folie a trois: successful treatment with risperidone. Br J Dermatol 2006; 155:841-842.
27. Ünsalver BÖ, Uygunoğlu U, Ertan T, Eker E. Hezeyani Parazitoz tedavisinde ketiyapin. Yeni Symposium 2007; 47:34-36.
28. Poyraz BÇ, Ekmen SŞ, Doksat MK. Bir vaka sebebiyle Hezeyani Parazitoz. Yeni Symposium 2005 ;43:114-117.
29. Çayköylü A, Ekinci O, Albayrak Y, Kuloğlu M. Delüzyonel Parazitoz: Düşük doz risperidon ile tedavi edilen bir olgu. Anadolu Psikiyatri Dergisi 2009; 10(Ek 1):68-69.
30. Lee CS. Delusions of parasitosis. Dermatologic Therapy 2008;21:2-7.
31. Kim C, Kim J, Lee M, Kang M. Delusional parasitosis as Folie a Deux. J Korean Med Sci 2003; 18:462-466.
32. Gould WM, Gragg TM. Delusions of parasitosis. Arch Dermatol 1976; 112:1745-1748.
33. Bhatia MS, Jagawat T, Choudhary S. Delusional parasitosis: a clinical profile. Int J Psychiatry Med 2000; 30:83-91.
34. Bosmans A, Verbanck P. Successful treatment of delusional disorder of the somatic type or “delusional parasitosis” with olanzapine. Pharmacopsychiatry 2008; 41:121- 122.
35. Freudenmann R, Schönfeldt-Lecuona C, Lepping P. Primary delusional parasitosis treated with olanzapine. Int Psychogeriatr 2007; 19:1161-1168.
36. Rocha FL, Hara C. Aripiprazole in delusional parasitosis:case report. Prog Neuro- psychopharmacol Biol Psychiatry 2007; 31:784-786.
37. Yorston G. Treatment of delusional parasitosis with sertindole. Int J Geriatr Psychiatry 1997; 12:1127-1128.
38. Altunay İK, Köşlü A. Psikojenik pruritus. Türk Dermatoloji Dergisi. 2008; 2:116-120.
39. Slaughter JR, Zanol K, Rezvani H, Flax J. Psychogenic parasitosis. A case series and literature review. Psychosomatics 1998; 39:491-500.