|Year : 2020 | Volume
| Issue : 1 | Page : 58-59
Delusional parasitosis in a 69-year-old male in relation to COVID-19
Avinash De Sousa
Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
|Date of Submission||14-Apr-2020|
|Date of Decision||03-May-2020|
|Date of Acceptance||12-Jun-2020|
|Date of Web Publication||29-Jun-2020|
Dr. Avinash De Sousa
Carmel, 18 St. Francis Road, Off S.V. Road, Santacruz West, Mumbai - 400 054, Maharashtra
Source of Support: None, Conflict of Interest: None
Delusional parasitosis (DP) is a type of delusional disorder which poses a challenge to psychiatrists worldwide. We present a case report of a patient who was diagnosed with DP and was treated and had recovered and developed a re-emergence of symptoms with causation blamed on COVID-19. The patient responded well to risperidone.
Keywords: COVID-19, delusional parasitosis, risperidone
|How to cite this article:|
De Sousa A. Delusional parasitosis in a 69-year-old male in relation to COVID-19. J Geriatr Ment Health 2020;7:58-9
| Introduction|| |
Delusional parasitosis (DP) is a form of the delusional disorder where the patient usually has a firm, fixed, and false belief that the body or some body parts are infested or infected by parasites. Many of these patients first present to a family physician or dermatologist as they are convinced of having a dermatological problem and are then referred to psychiatry for an opinion. There are a number of case series of patients with DP and numerous anecdotal case reports of the condition as well as reviews., The largest case series on DP is from India and shows that DP may be seen with disorders such as depression, substance abuse, obsessive-compulsive disorder, and schizophrenia. Although rare DP has been reported in geriatric psychiatry as well. We present herewith a case report of a 69-year-old patient with DP for many years that had improved totally but had a relapse of DP themed around the COVID-19 pandemic.
| Case Report|| |
A 69-year-old married retired teacher, presented to the outpatient psychiatry department with the complaints of insects crawling under his skin. When he was confronted and told that no insects were visible under the skin, he mentioned that insects were in the form of tracks under the skin and were hidden. He also mentioned that the insects were electronically tagged by China, and he was controlled by them as a result. On inquiry, the patient gave a history that a week before presentation, he suddenly felt an electrical jolt after which he realized that there are insects under his skin and he tried on many occasions to remove them by scrapping his skin but was unable to do so. He said that China had spread these insects in the air, and because he was Indian at heart and did not use Chinese products, he was the first to get infected. Gradually, the patient felt that the insect was making multiple tracks under the skin, which were pink and that these insects were electronically tagged and now that his body was bugged. He said that this was done as China wanted to control his mind during the COVID-19 pandemic, and he mentioned that these insects were spread just like the COVID virus. He could hear electronic beeps and transmission, which no one else could hear. He described the insects to be about 1 inch long, silver in color having multiple legs and red lights in them (this may have been the imagination of the patient as the insects were never visible to him). The patient started using sanitizer multiple times a day to get rid of the insect and bathed thrice a day with hot water for both DP and COVID as he thought that killing the virus would kill the insects (this also could have been a false belief of the patient). The patient had reduced sleep, anxiousness, and even felt that his end was near. The patient was then brought for treatment to the psychiatry department by his wife. On inquiry, his wife mentioned that he had similar complaints of DP when he was 47-year-old and felt that there were worms in his head. He was taken to a private psychiatrist for treatment and he responded well to Haloperidol as mentioned by the wife. The patient remained well thereafter and followed up with his psychiatrist for 2–3 years (details of treatment course were unavailable), there was no family history suggestive of psychiatric illness, and on cognitive assessment he had an mini-mental state examination score of 29. We started him on risperidone 2 mg/day which was later increased to 4 mg/day and trihexyphenydyl 2 mg/day. He was also prescribed clonazepam 0.25 mg if needed for anxiety. At night for sleep. Within 2 weeks of treatment, he was 75% better and felt that the insects had reduced. He felt that their batteries did not function, and hence they died. He is currently well maintained on the same dosage. His symptoms have reduced by 75% and he is currently on risperidone 4 mg/day in divided doses, trihexyphenidyl 2 mg at night, and clonazepam 0.25 mg if needed for anxiety. He has been asked to follow-up fortnightly with us and has been psychoeducated about DP.
| Discussion|| |
DP may present as a distressing psychiatric symptom and may the sole presenting symptom with no cause, as in our case. Numerous case reports of various facets of DP have been reported fromworld wide. The main unique features of the case were the re-emergence of the symptoms of DP at the 69 years after being symptom-free for over 2 decades. The symptoms were triggered in the wake of China being blamed for the start of the COVID pandemic, and the patient blamed his symptoms on the same. Our patient showed shades of bizarreness and a feeling of control whereby bizarre delusions or delusions of control could be part of the differential diagnosis, but the main focus was on the insects crawling which made diagnose the patient as a case of DP. Some patients with DP becoming irritable, aggressive, self-injurious, and may feel suicidal as well. Risperidone and Pimozide are agents that have been most documented in the treatment of DP., Our patient responded very well and quite quickly to risperidone alone but attributed the improvement to other reasons. To the best of our knowledge, there are no reports of DP being aggravated or re-emerging in patients post the start of the COVID pandemic. It is interesting to note, as in this case, that the emergence of the COVID-19 pandemic can cause a relapse of psychopathology themed on the pandemic in some patients with a previous history of psychiatric disorder.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Trabert W. 100 years of delusional parasitosis. Meta-analysis of 1,223 case reports. Psychopathology 1995;28:238-46.
Lombardi C, Belli D, Passalacqua G. When allergology meets psychiatry: Delusional parasitosis (Ekbom's syndrome). Eur Ann Allergy Clin Immunol 2011;43:89-91.
Freudenmann RW, Kölle M, Schönfeldt-Lecuona C, Dieckmann S, Harth W, Lepping P. Delusional parasitosis and the matchbox sign revisited: The international perspective. Acta Derm Venereol 2010;90:517-9.
Bhatia MS, Jagawat T, Choudhary S. Delusional parasitosis: A clinical profile. Int J Psychiatry Med 2000;30:83-91.
Bhatia MS, Jhanjee A, Srivastava S. Delusional infestation: A clinical profile. Asian J Psychiatr 2013;6:124-7.
Jafferany M, Huynh TV, Silverman MA, Zaidi Z. Geriatric dermatoses: A clinical review of skin diseases in an aging population. Int J Dermatol 2012;51:509-22.
Ramirez-Bermudez J, Espinola-Nadurille M, Loza-Taylor N. Delusional parasitosis in neurological patients. Gen Hosp Psychiatry 2010;32:294-9.
Monk BE, Rao YJ. Delusions of parasitosis with fatal outcome. Clin Exp Dermatol 1994;19:341-2.
Levin EC, Gieler U. Delusions of parasitosis. Semin Cutan Med Surg 2013;32:73-7.
Generali JA, Cada DJ. Pimozide: Parasitosis (delusional). Hosp Pharm 2014;49:134-5.