DELUSIONAL PARASITOSIS (EKBOM SYNDROME)

DELUSIONAL PARASITOSIS

Delusional parasitosis (DP) is a mental condition in which the person, even in the absence of actual infestation believes that he/she is being infested by pathogens. It is also known as Ekbom syndrome after the Swedish neurologist who pioneered in the research of this disorder, Karl Axel Ekbom. Such people experience a sensation of insects crawling on them. In most cases, it is asymptomatic ie. exhibiting only one particular symptom.

 

PREVALENCE: DELUSIONAL PARASITOSIS

The disorder is quite rare and is observed mostly in women than in men. It is most common in middle-aged or older individuals. Yet it is seen in individuals of both genders of any age and race. The condition also stands out because it involves both the fields of psychiatry, parasitology, and dermatology. The overall prevalence is a long shot because the disorder is addressed differently by different medical professionals.

 

COMMON MYTHS AND FACTS: DELUSIONAL PARASITOSIS

• Though the disorder is termed rare, researches have shown that the occurrence is much greater than the expected rates.
• There are chances of misdiagnosis since the symptoms of both the disorder and other underlying organic disorders are almost the same, for example, it can be mistaken for schizophrenia which is a serious mental condition in which the individual perceives reality abnormally.
• The disorder can be mistaken for paranoia, a disorder in which the patients are aware that their fears are irrational. But individuals with DP firmly believe that they are infested.
• Patients with DP only have issues with their misbelief that they are being infested. Other than that they behave in a perfectly normal manner in other aspects of their lives. But it is often misconceived that they behave abnormally usually.
• The frequency of hospitalization of individuals with DP is very less in number and even if they are hospitalized, it will be only for a short period.
• It is misconceived that all the patients with DP later develop other serious mental disorders, but it is true only for a small percent of DP patients.

 

SIGNS AND SYMPTOMS: DELUSIONAL PARASITOSIS

• Itching and burning feelings
• Numb feelings
•  The tendency to scratch and pick one’s skin
•  The occurrence of skin lesions and ulcers due to prior constant scratching.
• In some rare cases, gastrointestinal tract uneasiness is also reported

Though these are the general signs and symptoms, an individual can be diagnosed with DP only if he/she meets the following criteria:

• The individual  should have experienced the delusion for at least one month
• The individual should not have any prior history of schizophrenia
• The individual’s psychosocial function system should not be affected by other factors than the delusion itself
• If there is the coexistence of DP and a mood disorder, the disturbance of the delusion must be longer than the mood disorder.
• The reason behind the delusion should not be the usage of substance usage ie. the usage of drugs, alcohol, etc. or due to preexisting medical conditions

 

The condition is observed and diagnosed in two forms: primary and secondary forms

1. The primary form in which the delusion is caused by the marking of the onset of any mental disorder
2. The secondary form in which pre-existing mental disorders, medical conditions, or substances cause the occurrence of delusional disorder.
3. They can be categorized into:

~Functional: caused mainly due to mental conditions

~Organic: caused due to underlying, pre-existent organic medical conditions.

1. The occurrence of secondary organic DP can be linked to factors like the deficiency of vitamin B12, anemia, diabetes, etc.

Though there are many symptoms, this disorder goes undetected because most patients, due to their negligence, visit dermatologists and not visit psychiatrists and hence there is an absolute necessity for dermatologists to be prepared to handle such patients and refer such individuals to experienced and professional psychiatrists or other mental health professionals.

 

ETIOLOGY/CAUSES/TRIGGERING FACTORS: DELUSIONAL PARASITOSIS

• The accurate cause for the occurrence of DP is still unknown and vague
• But researches have shown that the condition can be related to the excess of dopamine( a natural drug that is present in the form of a neurotransmitter that has several salient functions in the body) in the brain structure called striatum(the major component of the motor and reward systems of the body).
• Over usage of drugs that contain cocaine and methamphetamine can also cause the condition
• The sudden pause to prolonged usage of alcohol can also lead to the disorder.

 

TREATMENT AND MANAGEMENT: DELUSIONAL PARASITOSIS

• Psychotherapy

~ It is the initial, primary, and most uncomplicated  treatment for delusional disorders

~ It provides the required space and thus facilitates the patients to feel safe and comfortable.

~This helps them to express their problems and discomforts more freely.

• Pimozide treatment

~ It is a classic antipsychotic agent and a traditional dermatologic option

~But it has many negative effects and requires periodic electrocardiographic monitoring

~ All these shortcomings make this treatment quite impractical

• Olanzapine

~ It is an uncommon accepted antipsychotic agent

~  It has  more benign unpleasant effects than other agents

~ It does not require periodic electrocardiographic monitoring

~ Overall its a safe option among others

• Cognitive Behavioral Therapy (CBT)

~ A psychotherapeutic treatment that facilitates patients to observe their thoughts and correct the ones that harm their state of mind and behavior.

~ Then they are guided to substitute these negative patterns with more positive and lighter ones

~ Many strategies like journaling, role-playing, etc. are applied in the process.

 

COPING METHODS: DELUSIONAL PARASITOSIS

• Though the condition is considered to be incurable, methods like antipsychotic drugs, mood-stabilizing medications, and antidepressants are employed to help patients cope with the condition
• Having open talks with closed ones, psychologists, psychiatrists, and other medical professionals can also help in the coping process
• Having people who accept, understand, and support such people can pave way for a much better and healthier state of mind for such people
• Having people who do not judge or misconceive the sensitive information that such individuals reveal can also help such people to cope with the difficulties of contracting the disease