Topiramate-induced delusional parasitosis

Drug-induced Delusional Infestation

It is considered that certain drugs might induce delusional infestation, yet, to date, no studies have been performed to identify the pharmacodynamics associated with these treatments. The aim of this review is to summarize current available knowledge of drug-induced delusional infestation. A literature search was performed for primary studies on suspected drugs reported to induce delusional infestation. Included articles were evaluated systematically using the Naranjo criteria. In addition, drug mechanisms of action were compared. The final selection included 31 studies, in which a total of 26 classes of drugs were identified. Anti-Parkinson drugs were most frequently associated with delusional infestation, followed by antidepressants, antiepileptics, antibiotics, prescription stimulants, and a few other drug groups. The current available literature suggests that the onset of delusional infestation is initiated by drug-induced alterations in neurotransmitter levels, predominantly dopamine, in the central nervous system.

Delusional infestation. Ekbom´s syndrome in a 47-year-old woman. Case report

Introduction: Delusional infestation is a rare psychiatric disorder defined as a condition in which the patient has the unshakable belief and perception of being infested with parasites. Its treatment is difficult, and frequently includes antipsychotic medications (such as olanzapine or aripiprazole). Non-pharmacological treatment, particularly psychotherapy, can be used for less severe cases. Dermatologists and psychiatrists must take a multi-disciplinary approach (preferably in a psycodermatology dedicated clinic) since this type of patients sometimes refuse treatment.Case description: A 53-year-old female businesswoman describes a clinical history of five years of visual hallucinations, depressive symptoms, and generalized pruritus, along with the use of toxic substances to “clean” her skin and cloths. She reports similar symptoms in some relatives but they were not evaluated. Blood tests and analyses of the “specimen” brought by the patient were performed, yielding negative results. The patient had never been assessed by any specialist, and showed disoriented during the consultation. Follow-up was not possible due to the reluctance of the patient to follow the indications and seek psychiatric treatment. Moreover, the patient did not respond to further communication attempts.Discussion: Delusional infestation is an uncommon disease that endangers the patients and the people around them. Its treatment is difficult and long, and not conducting proper follow-up is a great risk. Its prevalence and incidence is variable and generally unknown. It can affect the patient, their next of kin, pets or the environment, and the “pathogen” can be a living organism or an inanimate object.  Conclusion: This case is important as it shows the hardships of treatment, adequate follow-up and care, as well as the need to improve how these patients are approached. Additionally, both classical and uncommon signs and symptoms could be observed as the patient stated that her relatives were affected (possible delusional infestation by proxy).

Delusional Infestation

Although the practice of infectious diseases involves a broad range of surgical and medical disciplines, interactions with psychiatry are infrequent. Delusional infestation is a condition where an individual has a firmly fixed false belief that they have an infection. Delusional infestation challenges the infectious diseases specialist who must diligently rule out the presence of a true infection. However, perhaps, more importantly, we may need to initiate therapy with neuroleptic medications for which we may have little specific knowledge and experience. In this note we review the diagnosis and management of patients with delusional infestation.

Uncommon and/or bizarre features of dementia

This study aimed at describing uncommon or bizarre symptoms observed in patients suffering from dementia. Medline and Google scholar searches were conducted for relevant articles, chapters, and books published since 1967. Search terms used included uncommon presentation, behavioural and psychological symptoms, dementia, Alzheimer's disease, and fronto-temporal dementia. Publications found through this indexed search were reviewed for further relevant references. The uncommon symptoms are described as case-reports and there are no systematic investigations. Bizarre behaviours arising late in life should be thoroughly investigated as symptoms of dementia.

Hallucinations and comorbid renal tubular acidosis caused by topiramate in a patient with psychiatric history

Few studies have shown that topiramate may induce psychiatric symptoms and metabolic disorders, respectively. Here, we reported a 13-year-old female who presented with topiramate-induced hallucinations and comorbid renal tubular acidosis. She had a history of psychiatric illness and had been taking the medication for 3 months without prior side effects. After the discontinuation of topiramate, she was treated with supplementary potassium and sodium bicarbonate. Subsequently, her psychiatric symptoms and biochemical findings improved. Recognition of drug-induced psychotic symptoms and renal tubular acidosis is important during concomitant topiramate therapy in psychiatric clinic.

Delusional infestation

This papers aims at familiarizing psychiatric and nonpsychiatric readers with delusional infestation (DI), also known as delusional parasitosis. It is characterized by the fixed belief of being infested with pathogens against all medical evidence. DI is no single disorder but can occur as a delusional disorder of the somatic type (primary DI) or secondary to numerous other conditions. A set of minimal diagnostic criteria and a classification are provided. Patients with DI pose a truly interdisciplinary problem to the medical system. They avoid psychiatrists and consult dermatologists, microbiologists, or general practitioners but often lose faith in professional medicine. Epidemiology and history suggest that the imaginary pathogens change constantly, while the delusional theme "infestation" is stable and ubiquitous. Patients with self-diagnosed "Morgellons disease" can be seen as a variation of this delusional theme. For clinicians, clinical pathways for efficient diagnostics and etiology-specific treatment are provided. Specialized outpatient clinics in dermatology with a liaison psychiatrist are theoretically best placed to provide care. The most intricate problem is to engage patients in psychiatric therapy. In primary DI, antipsychotics are the treatment of choice, according to limited but sufficient evidence. Pimozide is no longer the treatment of choice for reasons of drug safety. Future research should focus on pathophysiology and the neural basis of DI, as well as on conclusive clinical trials, which are widely lacking. Innovative approaches will be needed, since otherwise patients are unlikely to adhere to any study protocol.