Delusional parasitosis associated with phenelzine

Article Abstract:

Patients who have the false belief that their bodies are infested with parasites are said to suffer from delusional parasitosis. Most often such delusions do not occur with other psychiatric illnesses, but sometimes depression is present. Delusional parasitosis is generally considered rare. In the present case, a 77-year-old Israeli woman with a history of depression dating back to age 62 was treated with phenelzine at 45 milligrams per day, a relatively low dose. The dosage was reduced to 30 mg/day because of low blood pressure. After two months, during which time the patient was relatively free of symptoms, she began to feel itching sensations all over her body. This was followed by severe scratching and frequent washing and the woman began to speak of being infested with lice and 'mysterious' parasites. Upon admission to the hospital for evaluation, phenelzine was gradually stopped, and she was started on haloperidol at 1 mg/day for 10 days. Within several days, she was symptom-free and returned home. It is possible that the patient's age contributed to her sensitivity to phenelzine. Sensitivity to the drug is suspect in this case, because the delusions remitted once the drug was stopped, and the patient's depression responded to 30 mg/day, a very low dose. Due to the nature of the disorder, dermatologists should be especially aware of conditions suggestive of delusional parasitosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Complications and side effects, Antidepressants, Pruritus, Itching

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Delusional infestation

Article Abstract:

Delusional infestation refers to the conviction that one is infested with small organisms or parasites. Often the cases are discovered when affected patients seek the services of a dermatologist in their search for a clinician that will find something wrong with them. Often patients go from doctor to doctor looking for treatment of their itching. Psychiatric help is often resisted by the patient. Delusional infestation can occur along with a wide variety of physical and psychiatric illnesses. These include diabetes, hypothyroidism, organic brain syndromes, schizophrenia, and affective disorders. In some cases, there is no underlying disorder, in which case a diagnosis of monosymptomatic hypochondriacal psychosis (MHP) is made. MHP is viewed as a type of paranoia and treated as such. Treatment for delusional infestation varies by the type of specialist consulted. Dermatologists often prescribe topical medications; psychiatrists may prescribe antipsychotic medications; and others may prescribe psychotherapy. All seem to have some success, but due to the rarity of delusional infestation, clinical trials to test treatment efficacy are difficult. The prognosis of delusional infestation varies with the type of delusion and form of treatment, as well as the degree of patient compliance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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Olfactory delusional syndrome with various aetiologies

Article Abstract:

Olfactory reference syndrome (ORS) is characterized by a pervasive delusional belief that one has a bad odor. This condition is thought to be a subtype of monosymptomatic hypochondriacal psychosis (MHP), a condition in which the patient has a single delusional symptom of illness for which no organic cause can be found. MHP may persist for a lengthy period, and has been associated with depression and schizophrenia. ORS tends to predominate in males, usually has an early onset, and may be accompanied by signs of depression. Six cases of patients with ORS are presented. Though the patients had similar symptoms, they may have had different causes and different illnesses. While the debate continues on how to best characterize this condition and its symptoms, pimozide, a drug, has been a successful treatment, as have antidepressant and anti-anxiety medications in combination and alone. It is important for physicians to be aware of the current literature on ORS so that patients can be properly evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects

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