What is Delusions of Parasitosis (Delusion of parasites)?
“Delusions of parasitosis” is a term used for rare mental disorders, also known as delusional infestation, psychogenic parasitosis, or Ekbom syndrome. These appear in the medical guide DSM V as types of delusional disorders. People dealing with this disorder strongly believe that they are infected with living organisms like parasites, worms, mites, bacteria, or fungus, even when it’s not true. These individuals tend to be resistant and hard to convince otherwise about their false belief.
The first mentions of this disease started appearing in literature in 1948. There are two types of delusions of parasitosis: primary and secondary. The primary form is a mental health disorder where the false belief of a parasitic infection is the only symptom. On the other hand, secondary delusions of parasitosis occur along with another mental disorder like schizophrenia or as a result of drug abuse or a different medical illness.
What Causes Delusions of Parasitosis (Delusion of parasites)?
Delusions of parasitosis, where people feel they are infested with parasites, often occur as part of a mental health condition. Common ones include schizophrenia, bipolar disorder, depression, anxiety, obsessive-compulsive disorder, and illness anxiety disorder.
The condition can also be triggered by a range of physical health issues. It can be due to some medical conditions such as hyperthyroidism, B12 and folate deficiencies, nerve damage, and diabetes. It can be triggered by neurological issues like dementia, stroke, multiple sclerosis, inflammation of the brain or spinal cord, meningitis, or complications after brain surgery.
Substance abuse, including the use of methamphetamines, alcohol withdrawal, and cocaine (also known as “cocaine bugs”) could result in this condition. Certain infectious diseases such as HIV, tuberculosis, leprosy, and syphilis can also induce these delusions.
Lastly, some side effects from certain medicines like topiramate, ciprofloxacin, amantadine, steroids, ketoconazole, and phenelzine could potentially cause delusions of parasitosis.
Risk Factors and Frequency for Delusions of Parasitosis (Delusion of parasites)
Delusions of parasitosis, where a person believes they have parasites when they don’t, is a fairly rare condition. Most people suffering from this condition tend not to visit psychiatrists or dermatologists as they believe their symptoms are real and not imagined. According to previous studies, the number of new cases each year varies widely, possibly being as many as 1.9 to 27.3 per 100,000 people. Typically, people are diagnosed with this condition when they are between 57 and 61 years old, indicating that it’s more prevalent in older individuals. While some research suggests women might have this condition more often than men, other studies do not support this finding.
- Delusions of parasitosis is a relatively rare condition.
- People with this condition believe their false symptoms are real, and thus, they seldom seek help from psychiatrists or dermatologists.
- The rate of new cases every year ranges between 1.9 and 27.3 cases per 100,000 individuals according to previous studies.
- The average age of diagnosis falls between 57 to 61 years, suggesting a higher prevalence with aging.
- While some research suggests a higher incidence in females, this finding is not consistent across all studies.
Signs and Symptoms of Delusions of Parasitosis (Delusion of parasites)
Delusions of parasitosis is a condition where the patient feels like they are infested with parasites, even though no actual parasites are found. Some typical symptoms include itchiness, rashes, a sensation of insects crawling on the skin, and/or stinging feelings. These symptoms usually persist for six months or longer without any visible evidence. Many patients with this condition have tried using skin creams or antibiotics to relieve symptoms and may even have had their pets checked for fleas or mites, fearing that they caught the parasites from their pets.
Patients often share detailed stories about their perceived parasites, including when they believe the infestation started, and efforts they’ve made to exterminate these “bugs” from their homes. In some cases, patients might even persuade their close friends or family members to believe in the existence of these imagined parasites – a phenomenon known as ‘folie à deux’, which happens in 15 to 25 percent of the cases. These patients often still function quite normally in their day-to-day lives, but severe feelings of frustration and helplessness are common.
During a physical examination, some patients may have scratch marks or scars. These are usually self-inflicted during an attempt to remove the alleged “organisms” by using different objects or even their own nails. They may also have an inflamed skin condition resulting from the use of alternative products or home remedies in their quest to rid of the “organisms”. However, it’s important to note that there won’t be any physical signs, such as bites, stings, specific rashes, or puncture wounds, that would suggest the presence of real parasites or other illness-causing organisms.
Testing for Delusions of Parasitosis (Delusion of parasites)
When a patient is suspected to harbor false beliefs of having parasitic infections, often known as delusions of parasitosis, a comprehensive medical background check is important. This includes understanding when the symptoms first appeared and any previous tests and consultations that might have ruled out infection.
The next step typically involves ensuring that the patient doesn’t actually have a parasitic infection. Doctors tend to look at recent travel history, exposure to others with similar symptoms, and pet interaction, as these factors might lead to actual parasitic infections. Special attention may be given to the possible presence of bed bugs, as these critters can cause similar symptoms.
General lab tests might be ordered, particularly for a complete blood count, focusing specifically on a type of white blood cell called eosinophils. If these cells are high in number, it could signal that the body is dealing with a parasitic or similar type of infection.
It’s also crucial to check for other health conditions that could give rise to such symptoms. The patient may be assessed for conditions like thyroid disorders, vitamin deficiencies, neurological disorders, and specific infectious diseases like HIV, tuberculosis, syphilis, and leprosy.
As a final step, referral to a skin specialist (dermatologist) may be made. This helps in confirming the diagnosis and also building trust with the patient, by showing that their concerns are being taken seriously and dealt with carefully.
Treatment Options for Delusions of Parasitosis (Delusion of parasites)
After a diagnosis of delusions of parasitosis, it’s important for healthcare providers to establish and maintain a trusting relationship with the patient. If patients feel unheard or misunderstood, they may be less likely to continue their treatment or may seek assistance elsewhere. It’s crucial therefore, for a healthcare provider to be objective and emphatic, and not to dismiss a patient’s symptoms or feelings. Taking a balanced approach is helpful; while it’s essential not to dismiss patients’ worries, it’s also important not to feed their delusions.
It’s common for patients to resist the idea that their symptoms are psychological in nature. Because of this, they may reject the use of medications typically associated with mental health treatments. To build agreement, it could be helpful to explain that the symptoms are due to altered brain chemicals and that medications can help correct this. Reassuring patients that this doesn’t mean they have conditions such as schizophrenia can also be beneficial. Explaining the working mechanism of these medications, and citing the success rate in similar cases, can improve patient compliance.
In terms of treatment options, first-generation antipsychotics like pimozide were previously used widely, but are now not recommended due to the risk of side effects. Instead, antipsychotics are the primary treatment method, typically used in small doses to limit side effects. If symptoms return after ending medication, re-starting the treatment might be necessary. Recommended medications include quetiapine, olanzapine, risperidone, and aripiprazole.
Newer antipsychotics like lurasidone, paliperidone, and brexpiprazole, could be worth considering due to their lower side effects. However, there’s not yet substantial evidence supporting their use for treating delusions of parasitosis, and their cost could be a hurdle. It’s essential to start with the lowest possible dose to minimize side effects.
What else can Delusions of Parasitosis (Delusion of parasites) be?
When diagnosing the condition known as delusions of parasitosis (where one feels like they are infested with bugs or parasites), doctors have to consider many possible causes.
Firstly, the doctors have to check if actual parasites are causing the symptoms. This can be done by conducting a detailed examination and laboratory tests.
At times, patients who worry excessively about their health (known as illness anxiety disorder) can mistakenly believe that they’re infested with parasites. This also needs to be ruled out.
It’s crucial for the doctors to consider if the parasitosis delusion could be a symptom of other medical conditions, such as psychiatric disorders, substance abuse, or even other physical illnesses.
Sometimes, a skin infection can lead to a false diagnosis of parasitic infestation.
Delusions of parasitosis can also be linked with major psychiatric conditions. These include schizophrenia, bipolar disorder, post-traumatic stress disorder, obsessive-compulsive disorder, major depressive disorder, and generalized anxiety disorder. But a someone presenting primarily with parasitosis delusions wouldn’t show symptoms of these psychiatric disorders.
Substance abuse can also induce symptoms similar to delusions of parasitosis. Examples include the use of drugs like cocaine, alcohol, and amphetamines.
Being deficient in certain nutrients, like vitamin B12 and folate, might also trigger these delusions.
Moreover, neurological disorders, including head trauma, strokes, multiple sclerosis, brain shrinking, brain inflammation, infections of the brain or its coverings, and changes after brain surgery may cause delusion of parasitosis symptoms.
Certain infections like HIV, leprosy, and tuberculosis, as well as some conditions affecting the thyroid and pancreas such as diabetes, can lead to parasitosis delusions too.
Lastly, these delusions could be a side effect of certain medications like topiramate, ciprofloxacin, amantadine, steroids, ketoconazole, and phenelzine, as these can trigger sensations of insects crawling on the skin.
What to expect with Delusions of Parasitosis (Delusion of parasites)
Delusions of parasitosis typically don’t interfere with a patient’s daily life, but they can be both frustrating and persistent. In some cases, these delusions can substantially lower the quality of their life. Despite this, patients often respond well to certain treatments such as atypical antipsychotics.
Usually, patients can stop taking these medications over a span of several weeks, and should symptoms come back, they generally react positively to resuming treatment. Research shows that between 60 to 100 percent of patients with delusions of parasitosis respond well to antipsychotic treatment.
If there are other conditions causing the delusions, treatment should focus on addressing these underlying issues. There might be situations where using antipsychotic medication alongside the main treatment may be beneficial for managing symptoms, if necessary.
Possible Complications When Diagnosed with Delusions of Parasitosis (Delusion of parasites)
Delusions of parasitosis, or the false belief of being infested by parasites, can cause some common problems. Delaying treatment can result in scarring on the skin and may reduce the skin’s ability to function normally. Research has found that individuals with this condition often suffer from self-inflicted eye inflammation, known as keratoconjunctivitis, at a higher rate than others. Another major challenge is dealing with the side effects of the antipsychotic drugs used for treatment, which could lead to issues such as movement disorders, changes in the heart’s rhythm, weight gain, and other metabolism-related effects. Doctors tend to prefer second generation, or atypical, antipsychotic drugs due to their generally milder side effects.
Potential issues:
- Delayed treatment might lead to skin scarring and decreased function.
- Possibility of increased episodes of self-inflicted keratoconjunctivitis.
- Side effects of antipsychotic drugs such as movement disorders, heart rhythm changes, weight gain and other metabolic effects.
Preventing Delusions of Parasitosis (Delusion of parasites)
Delusions of parasitosis is a condition where a person firmly believes they are infected with parasites or other unseen organisms, even when this isn’t true. This condition falls under mental health disorders and is considered a type of delusional disorder. It can appear in two forms: primary and secondary.
Primary delusions of parasitosis is a separate mental health diagnosis. It occurs when a person continues to believe they’re infected with some organism, despite medical tests showing otherwise and no other physical or mental health condition being responsible for these symptoms.
On the other hand, secondary delusions of parasitosis are not a diagnosis on their own, but rather a symptom of another mental health disorder, physical illness, or substance abuse.
Establishing a trusting relationship between the patient and healthcare professional is crucial in treating delusions of parasitosis, as patients are often hesitant to accept the diagnosis. The main treatment for this condition typically involves the use of certain medications called atypical antipsychotics.