Description, Causes and Risk Factors:
Delusional parasitosis is a form of psychosis whose victims acquire a strong delusional belief that they are infested with parasites, whereas in reality no such parasites are present.
Delusional parasitosis may result from physiological causes such as allergies, nutritional deficiencies, drug reactions, and other medical conditions. Allergies can include inhalant allergies, ingestant reactions, and contact dermatitis. Nutritional deficiencies or overdoses may produce both systemic and dermal reactions. Drug reactions include responses to single drugs as well as multiple drug interactions.
Secondary functional: Secondary functional delusional parasitosis occurs when the delusions are associated with a psychiatric condition such as schizophrenia or clinical depression.
Primary: In primary delusional parasitosis, the delusions comprise the entire disease entity, there is no additional deterioration of basic mental functioning or idiosyncratic thought processes. The parasitic delusions consist of a single delusional belief regarding some aspect of health. This is also referred to as "monosymptomatic hypochondriacal psychosis", and sometimes as "true" delusional parasitosis. In the DSM-IV, this corresponds with "delusional disorder, somatic type".
Social isolation is one predisposing feature of delusory parasitosis. Some delusory parasitosis cases involve lonely people who need interactions with other humans. Elderly people who live alone, seldom get out, seldom have visitors, or feel they have no purpose in life are prone to fixating on themselves and their health. For many of these people, the illness itself is an important security factor, allowing them to seek attention and evoke sympathy.
Patients with delusions of parasitosis create their rash. They can present with no findings, erosions or ulcers with or without crusts or prurigo nodularis. They may evidence a dermatitis related to attempted treatments, which may include irritating or corrosive cleansers or harsh abrasive devices. Delusions of parasitosis involving the eyelids has been reported.
The diagnosis of delusional parasitosisis a lengthy process involving the following steps:
Perform a complete physical examination and laboratory evaluation, including skin scrapings and/or biopsies, blood counts, chemistry profile, thyroid function tests, and vitamin B12 levels.
Rule out other medical conditions (e.g., diabetes, atopic dermatitis, and lymphoblastomas) with skin manifestations that can appear to be caused by arthropods.
Work with entomologists or parasitologists to rule out true infestations (e.g., scabies mites, animal mites, lice, fleas, and bed bugs).
Rule out other organic causes (e.g., allergies and contact dermatitis).
Rule out history of drug abuse (especially in younger or male patients).
Take a careful case history.
Treatment of secondary forms of delusional parasitosis are addressed by treating the primary associated psychological or physical condition. The primary form is treated much as other delusional disorders and schizophrenia. In the past, pimozide was the drug of choice when selecting from the typical antipsychotics. Currently, atypical antipsychotics such as olanzapine or risperidone are used as first line treatment.
However, it is also characteristic that sufferers will reject the diagnosis of delusional parasitosis by medical professionals, and very few are willing to be treated, despite demonstrable efficacy of treatment.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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