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Kobayashi R, Iwata-Endo K, Fujishiro H. Clinical presentations and diagnostic application of proposed biomarkers in psychiatric-onset prodromal dementia with Lewy bodies. Psychogeriatrics 2024. [PMID: 38837629 DOI: 10.1111/psyg.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
Research criteria for the diagnosis of prodromal dementia with Lewy bodies (DLB) include three clinical subtypes: mild cognitive impairment with Lewy bodies (MCI-LB), delirium-onset prodromal DLB, and psychiatric-onset prodromal DLB. Late-onset psychiatric manifestations are at a higher risk of developing dementia, but its relation to prodromal DLB remains unclear. In addition to the risk of severe antipsychotic hypersensitivity reactions, accurate discrimination from non-DLB cases is important due to the potential differences in management and prognosis. This article aims to review a rapidly evolving psychiatric topic and outline clinical pictures of psychiatric-onset prodromal DLB, including the proposed biomarker findings of MCI-LB: polysomnography-confirmed rapid eye movement sleep behaviour disorder, cardiac [123I]metaiodobenzylguanidine scintigraphy, and striatal dopamine transporter imaging. We first reviewed clinical pictures of patients with autopsy-confirmed DLB. Regarding clinical reports, we focused on the patients who predominantly presented with psychiatric manifestations and subsequently developed DLB. Thereafter, we reviewed clinical studies regarding the diagnostic applications of the proposed biomarkers to patients with late-onset psychiatric disorders. Clinical presentations were mainly late-onset depression and psychosis; however, other clinical manifestations were also reported. Psychotropic medications before a DLB diagnosis may cause extrapyramidal signs, and potentially influences the proposed biomarker findings. These risks complicate clinical manifestation interpretation during the management of psychiatric symptoms. Longitudinal follow-up studies with standardised evaluations until conversion to DLB are needed to investigate the temporal trajectories of core features and proposed biomarker findings. In patients with late-onset psychiatric disorders, identification of patients with psychiatric-onset prodromal DLB provides the opportunity to better understanding the distinct prognostic subgroup that is at great risk of incident dementia. Advances in the establishment of direct biomarkers for the detection of pathological α-synuclein may encourage reorganising the phenotypic variability of prodromal DLB.
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Affiliation(s)
- Ryota Kobayashi
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Kuniyuki Iwata-Endo
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mindru FM, Radu AF, Bumbu AG, Radu A, Bungau SG. Insights into the Medical Evaluation of Ekbom Syndrome: An Overview. Int J Mol Sci 2024; 25:2151. [PMID: 38396826 PMCID: PMC10889746 DOI: 10.3390/ijms25042151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Ekbom syndrome, also known as delusional parasitosis (DP) or delusional infestation, is an uncommon psychiatric disorder distinguished by an enduring conviction of parasitic infestation, persisting notwithstanding the presence of medical evidence to the contrary. Primarily affecting middle-aged women, DP can manifest either as isolated psychological distress or as a component within a more intricate psychiatric framework, substantially influencing the quality of life for affected individuals. Its pathophysiological mechanism involves uncertain dopaminergic imbalances and dysfunction in the dopamine transporter system. Dermatologists often play a pivotal role in diagnosis, as patients first seek dermatological assessments of their signs and symptoms. However, DP frequently originates from underlying psychiatric disorders or medical variables, manifesting with neurological and infectious causative factors. The diagnostic complexity is attributed to patients' resolute convictions, leading to delayed psychiatric intervention. First-line DP treatment involves antipsychotics, with newer agents demonstrating promising prospects, but the lack of standardized protocols poses a significant therapeutic challenge. In this narrative review, both a comprehensive approach to this uncommon pathology and an update on the state of knowledge in this medical subfield focused on optimizing the management of DP are provided. The complexity of DP underlying its uncommon nature and the incomplete understanding of its pathophysiology highlight the need for further research through multicenter studies and multidisciplinary teams to enhance therapeutic efficacy and safety.
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Affiliation(s)
- Florina Madalina Mindru
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Adrian Gheorghe Bumbu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Ada Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
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Watanabe M, Araki W, Takao C, Maeda C, Tominaga R, Kimura Y, Nayanar G, Tu TTH, Asada T, Toyofuku A. A case with burning mouth syndrome followed by dementia with Lewy bodies: a case report. Front Psychiatry 2024; 14:1329171. [PMID: 38260804 PMCID: PMC10800443 DOI: 10.3389/fpsyt.2023.1329171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Burning mouth syndrome (BMS) is characterized by persistent oral burning sensations without corresponding organic findings. Dementia with Lewy bodies (DLB) is a common type of dementia and generally presents visual hallucination and parkinsonism as motor dysfunction besides cognitive decline. In this case report, we present a case in which DLB emerged during the treatment for BMS, with a relatively positive outcome for BMS. A 74 years-old female complained of burning pain in her mouth and a subsequent decrease in food intake. Following a diagnosis of BMS, pharmacotherapy was initiated. BMS was much improved with mirtazapine 15 mg and aripiprazole 1.0 mg, leading to the restoration of her food intake by day 180. However, BMS flared up again triggered by deteriorating physical condition of herself and that of her husband. With aripiprazole 1.5 mg and amitriptyline 25 mg, her BMS gradually improved by day 482. However, by day 510, an increase in anxiety was noted, accompanied by the occasionally misidentification of her husband on day 566. Her cognitive impairment and disorientation were also reported by her husband on the day 572, she was then immediately referred to a neurologist specialized dementia and diagnosed with DLB on the day 583. Her treatment was adjusted to include the prescription of rivastigmine which was titrated up to 9.0 mg. Considering the potential impact of amitriptyline on cognitive function, it was reduced and switched to mirtazapine; however, her oral sensations slightly got worse. Following the consultation with her neurologist, amitriptyline 10 mg was reintroduced and aripiprazole was discontinued on day 755. Remarkably, BMS gradually improved without deteriorating DLB. This case indicated the reaffirmed necessity of careful interviews for changes in daily life not only with the patients but also with their families through the medical assessments. It highlights the vigilance regarding potential cognitive decline underlying or induced as an adverse event especially when treating elderly patients with BMS. While the interaction between BMS and DLB remains unclear, this case underscores the importance of prudent diagnosis and constructing collaboration with specialists in managing BMS with the early phase of DLB.
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Affiliation(s)
- Motoko Watanabe
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Wataru Araki
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Memory Clinic Ochanomizu, Tokyo, Japan
| | - Chihiro Takao
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chizuko Maeda
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Risa Tominaga
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuyuki Kimura
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gayatri Nayanar
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Trang Thi Huyen Tu
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Basic Dental Sciences, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Cressot C, Vrillon A, Lilamand M, Francisque H, Méauzoone A, Hourregue C, Dumurgier J, Marlinge E, Paquet C, Cognat E. Psychosis in Neurodegenerative Dementias: A Systematic Comparative Review. J Alzheimers Dis 2024; 99:85-99. [PMID: 38669539 DOI: 10.3233/jad-231363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background Psychosis, characterized by delusions and/or hallucinations, is frequently observed during the progression of Alzheimer's disease (AD) and other neurodegenerative dementias (ND) (i.e., dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD)) and cause diagnostic and management difficulties. Objective This review aims at presenting a concise and up-to-date overview of psychotic symptoms that occur in patients with ND with a comparative approach. Methods A systematic review was conducted following the PRISMA guidelines. 98 original studies investigating psychosis phenotypes in neurodegenerative dementias were identified (40 cohort studies, 57 case reports). Results Psychosis is a frequently observed phenomenon during the course of ND, with reported prevalence ranging from 22.5% to 54.1% in AD, 55.9% to 73.9% in DLB, and 18% to 42% in FTD. Throughout all stages of these diseases, noticeable patterns emerge depending on their underlying causes. Misidentification delusions (16.6-78.3%) and visual hallucinations (50-69.6%) are frequently observed in DLB, while paranoid ideas and somatic preoccupations seem to be particularly common in AD and FTD, (respectively 9.1-60.3% and 3.10-41.5%). Limited data were found regarding psychosis in the early stages of these disorders. Conclusions Literature data suggest that different ND are associated with noticeable variations in psychotic phenotypes, reflecting disease-specific tendencies. Further studies focusing on the early stages of these disorders are necessary to enhance our understanding of early psychotic manifestations associated with ND and help in differential diagnosis issues.
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Affiliation(s)
- Coralie Cressot
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Agathe Vrillon
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Matthieu Lilamand
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Service de Gériatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Hélène Francisque
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Aurélie Méauzoone
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Hourregue
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Julien Dumurgier
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Université Paris Cité, Inserm U1153, Paris, France
| | - Emeline Marlinge
- Département de Psychiatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Paquet
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Emmanuel Cognat
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
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Gunawardana CW, Matar E, Lewis SJG. The clinical phenotype of psychiatric-onset prodromal dementia with Lewy bodies: a scoping review. J Neurol 2024; 271:606-617. [PMID: 37792074 PMCID: PMC10769927 DOI: 10.1007/s00415-023-12000-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Recent consensus research criteria have identified a 'psychiatric onset' form of prodromal dementia with Lewy bodies (DLB) characterised by prominent late-onset psychiatric symptoms. Although recognised as important to raise the index of diagnostic suspicion, evidence regarding this cohort was deemed too limited to impose formal criteria. We reviewed the published literature on psychiatric-onset DLB to identify key clinical characteristics and evidence gaps to progress our understanding of this entity. METHODS Medline, PubMed and Embase were searched for relevant articles containing longitudinal follow-up of patients initially presenting with a psychiatric illness who subsequently developed DLB according to the diagnostic criteria available at the time. RESULTS Two cohort studies (18 and 21 patients) along with 12 case series (13 cases) were identified totalling 52 patients (63% female). Initial psychiatric presentation occurred at a mean of 63 years (range 53-88), with depression being the most frequently reported psychiatric presentation (88%). Psychotic presentations were less common on presentation (11%) but became more prevalent throughout the prodromal period before the diagnosis of DLB (83%). Relapses of the psychiatric disease were common occurring in 94% (32/34) of patients. Parkinsonism, cognitive fluctuations, visual hallucinations, and REM sleep behaviour disorder were uncommonly reported at initial presentation (3.8%). CONCLUSIONS Psychiatric-onset DLB is characterized by a female predominant relapsing-remitting psychiatric illness presenting with affective symptoms but later developing psychotic features prior to the onset of DLB. Additional prospective studies including other neurodegenerative cohorts with harmonised assessments are required to inform definitive diagnostic criteria for this condition.
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Affiliation(s)
- Chaminda Withanachchi Gunawardana
- Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Level 2, M02G, 100 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Elie Matar
- Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Level 2, M02G, 100 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Simon J G Lewis
- Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Level 2, M02G, 100 Mallett St, Camperdown, Sydney, NSW, 2050, Australia.
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Seritan AL. Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review. J Geriatr Psychiatry Neurol 2023; 36:435-460. [PMID: 36941085 PMCID: PMC10578041 DOI: 10.1177/08919887231164357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background: Approximately 15% of older adults may experience psychotic phenomena. Primary psychiatric disorders that manifest with psychosis (delusions, hallucinations, and disorganized thought or behavior) account for less than half. Up to 60% of late-life psychotic symptoms are due to systemic medical or neurological conditions, particularly neurodegenerative diseases. A thorough medical workup including laboratory tests, additional procedures if indicated, and neuroimaging studies is recommended. This narrative review summarizes current evidence regarding the epidemiology and phenomenology of psychotic symptoms encountered as part of the neurodegenerative disease continuum (including prodromal and manifest stages). Results: Prodromes are constellations of symptoms that precede the onset of overt neurodegenerative syndromes. Prodromal psychotic features, particularly delusions, have been associated with an increased likelihood of receiving a neurodegenerative disease diagnosis within several years. Prompt prodrome recognition is crucial for early intervention. The management of psychosis associated with neurodegenerative diseases includes behavioral and somatic strategies, although evidence is scarce and mostly limited to case reports, case series, or expert consensus guidelines, with few randomized controlled trials. Conclusion: The complexity of psychotic manifestations warrants management by interprofessional teams that provide coordinated, integrated care.
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Affiliation(s)
- Andreea L. Seritan
- University of California, San Francisco Department of Psychiatry and UCSF Weill Institute for Neurosciences, CA, USA
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Suparmanian A, Cardona NJ. A Longitudinal Perspective Case Study of Delusional Parasitosis in a Geriatric Psychiatry Unit. Cureus 2023; 15:e39434. [PMID: 37362467 PMCID: PMC10288899 DOI: 10.7759/cureus.39434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Delusional parasitosis is not a common presentation in hospital-based geriatric units. Our aim was to review the presentation of a sudden onset of parasitosis in an older patient who had no prior psychiatric history, and its management. This case report describes an 82-year-old man who presented with delusions of parasitosis for the past three years of his life. The report includes a longitudinal description of the patient's symptoms, signs, and manifestations during his stay at an inpatient senior mental health service center, emergency department (ED) visits, and medical floor stay along with medication management of his psychiatric symptoms with concomitant medical issues. Presentation of delusional parasitosis poses a special challenge not only psychiatrically but also medically and dermatologically. The unique difficulty of finding appropriate antipsychotics for not only the symptoms of parasitosis but also the compulsive behavior that follows a deeply ingrained belief of being infested must be carefully managed, especially in the elderly. Somatic delusions that resemble a plausible but inaccurate reality of infestations could delay treatment as well.
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Affiliation(s)
- Anisa Suparmanian
- Psychiatry, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Nathan J Cardona
- Research, The Wright Center for Graduate Medical Education, Scranton, USA
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Alsafwani Z, Aljishi M, Shiboski C, Jordan R, Villa A. Oral manifestations of delusional infestation: a case series. BMC Oral Health 2022; 22:652. [PMID: 36581857 PMCID: PMC9799679 DOI: 10.1186/s12903-022-02664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Delusional infestation (DI) is a rare psychotic disorder characterized by a patient's false belief that the body is infested with living or non-living organisms in the absence of clinical evidence of disease. Based on the underlying etiology, DI can be classified into primary and secondary forms based on the presence or absence of an underlying condition or previously diagnosed psychiatric disorder. This paper discusses a condition that is not commonly reported in the literature. CASE PRESENTATION Here, we describe four patients diagnosed with DI of the oral cavity. In each case, the patients' intraoral examinations revealed either traumatic lesions or no signs of mucosal disease. Management involved symptom management, medical therapy, and/or a referral to the primary care provider. CONCLUSION Because oral health care providers may encounter patients with DI, they should familiarize themselves with this unusual condition in order to recognize the condition and initiate prompt referral to a psychiatrist.
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Affiliation(s)
- Zahra Alsafwani
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Morooj Aljishi
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA ,grid.411975.f0000 0004 0607 035XDepartment of Biomedical Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, IAU, Dammam, Saudi Arabia
| | - Caroline Shiboski
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Richard Jordan
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Alessandro Villa
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA ,grid.418212.c0000 0004 0465 0852Miami Cancer Institute, Baptist Health South Florida, Miami, FL USA
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Orsolini L, Corona D, Salvi V, Volpe U. Long-acting paliperidone in Ekbom’s syndrome in Lewy body dementia: A case report. Transl Neurosci 2022; 13:201-210. [PMID: 35975126 PMCID: PMC9334881 DOI: 10.1515/tnsci-2022-0230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Ekbom Syndrome (ES) is characterised by fixed, delusional beliefs that one’s body is infested by parasites or other vermin in absence of supporting clinical evidence. Antipsychotic (AP) treatment, including long-acting injectable (LAI) AP in subjects with poor compliance, is prescribed to manage behavioural and psychotic symptomatology. Objectives We describe a 70-year-old woman who was hospitalised after experiencing new-onset delusions of infestation with visual and tactile hallucinations that led to bizarre behaviours and progressive social withdrawal. Methods She was diagnosed with ES and was initially treated with risperidone 3 mg; however, due to poor compliance and a lack of insight, she was switched to LAI palmitate paliperidone (LAI-PP). She was followed up for 8 months, administering Positive and Negative Syndrome Scale, Montreal Cognitive Assessment, Global Assessment of Functioning, Brief Psychiatric Rating Scale, neurocognitive assessment, and neuroimaging. Results After a progressive cognitive deterioration, she was diagnosed with an ES secondary to Lewy body dementia (DLB). Conclusion The LAI-PP treatment determined a complete clinical remission of psychotic symptoms despite the emergence of an iatrogenic akinetic-rigid syndrome. The delay of confirmatory neurological diagnosis, the associated risky behaviours of the patient, and poor treatment adherence led clinicians to prescribe LAI-PP following a good clinical response to oral paliperidone. However, in the case of a suspected DLB diagnosis, the prescription of an LAI-PP as a first-line strategy should be carefully evaluated.
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Affiliation(s)
- Laura Orsolini
- Department of Clinical Neurosciences/DIMSC, Unit of Clinical Psychiatry, Polytechnic University of Marche , 60126 , Ancona , Italy
| | - Diana Corona
- Department of Clinical Neurosciences/DIMSC, Unit of Clinical Psychiatry, Polytechnic University of Marche , 60126 , Ancona , Italy
| | - Virginio Salvi
- Department of Clinical Neurosciences/DIMSC, Unit of Clinical Psychiatry, Polytechnic University of Marche , 60126 , Ancona , Italy
| | - Umberto Volpe
- Department of Clinical Neurosciences/DIMSC, Unit of Clinical Psychiatry, Polytechnic University of Marche , 60126 , Ancona , Italy
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Taomoto D, Kanemoto H, Satake Y, Yoshiyama K, Iwase M, Hashimoto M, Ikeda M. Case report: Delusional infestation in dementia with Lewy bodies. Front Psychiatry 2022; 13:1051067. [PMID: 36440429 PMCID: PMC9686401 DOI: 10.3389/fpsyt.2022.1051067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Delusional infestation is characterized by delusions of being infested with parasites, vermin, or small insects and is frequently accompanied by tactile and visual hallucinations. Herein, we report two cases of dementia with Lewy bodies (DLB) with delusional infestation. CASE PRESENTATION Case 1 was an 83-year-old man. At the age of 75, he began to show symptoms of rapid eye movement sleep behavior disorder. At the age of 83, he began to complain of visual hallucinations of people and delusional infestation with tactile and visual hallucinations of insects, resulting in the use of insecticides for non-existent insects. He also complained of mild amnesia and was admitted to our psychiatric ward for evaluation and treatment. After admission, the delusional infestation disappeared without any new medication. Based on our examinations, he was diagnosed with probable DLB with delusional infestation. He was treated with 5 mg/day of donepezil hydrochloride; his visual and tactile hallucinations disappeared, and the delusional infestation had not recurred at the 1-year follow-up. Case 2 was a 69-year-old woman. At the age of 60, she underwent clipping for subarachnoid hemorrhage (SAH). At the age of 65, she began to have visual hallucinations of people. At the age of 67, she began to complain of visual illusions in which she mistook lint for insects. At the age of 69, she developed delusional infestation and mild amnesia. She took various actions to get rid of these non-existent insects, including insecticide use, consulting an exterminator, and visiting several dermatologists. She eventually burnt her leg in an attempt to kill the non-existent insects. Based on our examinations, she was diagnosed with prodromal DLB in addition to SAH sequelae. We determined that her delusional infestation was caused by DLB rather than SAH sequelae based on the course of her symptoms. She was treated with a combination of 3 mg/day of donepezil hydrochloride and 12.5 mg/day of quetiapine. Thereafter, the delusional infestation partially improved, and she took no further action against non-existent insects. CONCLUSION Delusional infestation may be caused by DLB. Acetylcholinesterase inhibitors (AChEI) may be effective for delusional infestation in DLB, although antipsychotics may also be needed in severe cases.
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Affiliation(s)
- Daiki Taomoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masao Iwase
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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Suehiro T, Satake Y, Hashimoto M, Ikeda M. Case Report: De Clerambault's Syndrome in Dementia With Lewy Bodies. Front Psychiatry 2021; 12:665868. [PMID: 34177653 PMCID: PMC8222603 DOI: 10.3389/fpsyt.2021.665868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Erotomania, also known as de Clerambault's syndrome, is characterized by the delusion that a person has fallen in love with the patient. It occasionally appears secondary to psychiatric disorders and organic brain diseases. However, there have been no reports on cases secondary to dementia with Lewy bodies (DLB). Case Presentation: The patient was an 83-year-old woman who lived alone. Mild cognitive impairment appeared at the age of 82 years. Soon after, she had the delusional conviction that her family doctor was in love with her. Her symptoms, such as gradually progressive cognitive impairment, cognitive fluctuations, and parkinsonism, indicated DLB. She was treated with a small dose of antipsychotic agents. Conclusions: This case report suggests the possibility of de Clerambault's syndrome during the early stages of DLB. Further investigations are required to clarify the mechanism and treatment of de Clerambault's syndrome in patients with DLB.
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Affiliation(s)
- Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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Abstract
Ekbom's syndrome represents a relatively uncommon neuropsychiatric condition characterized by the recurrent and bizarre fixed delusional belief to be infested by small organisms or even unanimated materials ('Morgellons disease'), without any objective evidence of infestation/parasitosis. The condition, mainly diagnosed in a nonpsychiatric setting, is supposed to be largely underestimated and, hence, undermanaged. The present comprehensive review aims at investigating Ekbom's syndrome, from a historical, epidemiological, clinical and therapeutic perspective, by providing diagnostic-treatment strategies in managing this condition in routine psychiatric clinical settings. The prototypical patient is a middle-aged woman (or a younger subject in those cases in which substance and/or alcohol abuse is implicated), often single, divorced or widowed (loneliness component and social withdrawal), who has already consulted several specialists due to skin lesions associated with a firm and delusional belief to be infested. The identification and diagnosis are challenging due to poor patient's insight, poor knowledge and collaboration between specialists and differential diagnoses to be considered before asking for a psychiatric referral. Management and treatment strategies mainly derive from isolated case reports or observational studies with a small sample size. Further randomized clinical trials should be performed to evaluate the efficacy of newer antipsychotic drugs, including long-acting injectable formulations.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Alessia Gentilotti
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Giordani
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
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