Delusions of Parasitosis: An Update

Delusional parasitosis, also known as delusional infestation or Ekbom syndrome, is a relatively infrequent psychotic disorder characterized by an unwavering false belief that there is a parasitic infestation of the skin, despite the absence of any medical evidence that could support this claim. Delusional parasitosis can be categorized into primary, secondary, and organic forms. Sometimes, close relatives also experience identical delusions. This phenomenon was reported to occur in 5-15% of cases, and is known as shared psychotic disorder-delusional parasitosis with folie à deux. Patients with delusional parasitosis frequently seek help from many physicians. Close multidisciplinary cooperation between clinicians is often key to shortening the time taken to diagnose this disorder. Initiation of psychopharmacological therapy is a challenge, as many patients refuse any psychiatric treatment because of the stigma associated with mental illness and because of their firm belief that they have a parasitic infestation, not a psychiatric condition. For many patients, a sense of a lack of understanding leads to isolation and the development of depression symptoms, which is why it is crucial to earn the trust of such patients while taking care of them.

Psychodynamic group psychotherapy reduces severity of depressive symptoms indepedently of personality trait neuroticism

This study assessed whether decrease in depressive symptoms after group psychodynamic psychotherapy was due to change in neuroticism score.

Patients were treated with group psychodynamic psychotherapy lasting 12 weeks. Every working day patients had 2 therapeutic sessions of 1,5 hour each. Personality trait neuroticism was measured with Eysenck Personality Questionnaire - Revised (EPQ-R), depressive symptoms with Depression Scale of Symptoms Checklist 90 - Revised (SCL-90-R) questionnaire.

Of 139 patients included in the study, 110 patients (79.1%) completed it. They were 37 men and 78 women, all with mean age of 34.25 years old. 64 patients were diagnosed with a neurotic disorder (ICD-10/F4), 28 with a personality disorder (F6), 15 with both a personality and a neurotic disorder and 3 with depression (F32) with personality disorder. In total 53 patients were on medication, mainly selective serotonin reuptake inhibitors.

Initial mean neuroticism score was 18.9, and after treatment it was 17.6. This difference is statistically significant as a change (t = 2.88, p = 0.005), but not as an independent mean value (t = 1.9, p = 0.06). Difference in severity of depressive symptoms is far more considerable: before treatment 2.08, after treatment 1.61, and it is statistically significant in comparison as dependent (t = 5.29, p = 0.000001), as well as independent (t = 3.53, p = 0.0005).

Looking at proportion of the change, neuroticism score dropped by 7%, whereas depressive symptoms score dropped by 22.6%. We can say that change of depressive symptoms severity is caused mainly by other factors than change in personality trait neuroticism score.

Body dysmorphic disorder and dermatologists

The aim of this study was to determine the frequency of body dysmorphic disorder (BDD) identified by Polish dermatologists and to evaluate the treatment modalities applied by them.

METHODS

A specially designed questionnaire was distributed to 172 dermatologists. A total of 118 doctors responded (68.6%). The dermatologists were asked regarding demographic data, frequency of BDD in their everyday practice and methods of treatment they used in managing BDD patients.

RESULTS

During the whole working period, over the half of dermatologists (64%) had observed at least one BDD patient in their practice. One fifth (20%) of the respondents observed 1 or 2 BDD cases during the past 5 years, 14% observed 3 to 5 such patients, 7% observed 5 to 10 BDD cases, and 5% of the doctors reported seeing more than 10 BDD patients within this period. Almost 18% of dermatologists were currently treating a BDD patient. Our data show that 40.7% of the respondents always ask and 28.8% often ask for a psychiatric opinion. More experienced dermatologists statistically more frequently (P < 0.05) obtained a psychiatric opinion about their patients. Only a small group of dermatologists (15.3%) use their own pharmacological treatment. If they do so, they first use anxiety-relieving drugs and placebo.

CONCLUSION

BDD is a quite common disorder; however, not all dermatologists are sufficiently prepared to treat it. There is an urgent need for training of dermatologists on the effective approach to psychodermatoses.

Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis-specific questionnaire

BACKGROUND

Onychomycosis is the most frequent nail disease, which could impair the patient's quality of life.

OBJECTIVE

The present study was undertaken to evaluate the impact of toenail onychomycosis on quality of life among Polish population.

PATIENTS AND METHODS

Three thousand nine-hundred and four (3904: 2269 females and 1635 males) individuals fulfilled an international onychomycosis-specific quality-of-life questionnaire consisting of statements regarding social, emotional and symptoms problems. All patients had toenail onychomycosis confirmed by the positive direct microscopic examination and/or by the positive mycologic culture. Seven hundred and sixty-seven patients simultaneously had fingernail onychomycosis. All patients were divided into subgroups according to sex, age, education level, place of living, type of onychomycosis, number of involved toenails, fingernails involvement, duration of illness and previously used antimycotic therapy.

RESULTS

Most of the patients demonstrated significantly reduced quality of life. The degree of life impairment varied between analysed subgroups. Patients with more advanced toenail onychomycosis and with fingernail involvement were more seriously affected. Both social and emotional impairments were more pronounced in female than in male patients, although there were no differences according to symptoms. Moreover, patients with better educational level and people living in towns or cities were more emotionally and socially affected by onychomycosis, although people living in the country or with poorer education level presented with significantly more severe symptoms.

CONCLUSIONS

Toenail onychomycosis is still a serious medical problem, which can significantly reduce the patient's quality of life.

Delusional parasitosis in dermatological practice

BACKGROUND

The accurate incidence of delusional parasitosis (DP) is difficult to assess. The aim of this study was to analyse the frequency of DP treated by dermatologists, and to evaluate the treatment modalities they applied.

MATERIAL AND METHODS

A specially designed questionnaire was distributed to 172 dermatologists. A total of 118 doctors responded (68.6% of all subjects). The dermatologists were asked to answer questions concerning demographic data of the respondents and the frequency of DP observed in their everyday practice. Finally, methods of treatment used by the dermatologists to help patients suffering from DP were evaluated.

RESULTS

During the whole working period the majority of dermatologists participating in the survey (84.7%) had seen at least one patient with DP in their practice. About one-third of the respondents (33%) had seen one or two cases of DP during the past 5 years, and 28% of the doctors treated from three to five such patients. Twenty-three per cent of dermatologists declared that they had diagnosed no cases of DP during the past 5 years. The rest of our respondents had seen more than five cases of DP during the past 5 years, and 7% of the doctors reported seeing more than 10 patients with DP within this period. Almost 20% of the dermatologists were currently treating a patient with DP. Our data show that 40.7% of the respondents always ask and 28.8% often ask for a psychiatric opinion about their patients with DP. More experienced dermatologists statistically more frequently (P<0.05) obtained a psychiatric opinion about their patients. Only a small group of dermatologists (15.3%) use their own pharmacological treatment. If they do so, they first use sedatives and anxiety-relieving drugs.

CONCLUSION

DP is a quite common disorder, however not all dermatologists are sufficiently prepared to treat it. There is an urgent need for training on the dermatological approach to psychodermatoses.

[An estimate of family doctor's knowledge of diagnosis and treatment of depression and anxiety disorders]

Depression is more widespread than hypertension. Nevertheless, physicians specialized in family medicine did not have knowledge necessary to diagnose and treat depression and anxiety disorders. Only six persons out of fifty five who filled in the questionnaire could recognize depression correctly (ICD-10 criteria). Doctors knew antidepressant drugs, but they did not know therapeutic doses. We can try to explain this situation through doctor's pre and postgraduate education.

[Trichotillomania]

Trichotillomania is the recurrent pulling out of one's own hair, which results in noticeable hair loss, classified in DSM IV and ICD 10 as an impulse control disorder. Trichotillomania can occur as an isolated symptom or may be associated with affective disorders, schizophrenia, substance abuse, borderline personality, obsessive-compulsive disorder. Its onset is usually in childhood and females are more affected than males.