delusional parasitosis

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Case Presentation By Dr Aziz Mohammad PGT, Department of Psychiatry Khyber Teaching Hospital Peshawar

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Page 1: Delusional Parasitosis

Case Presentation

By

Dr Aziz Mohammad

PGT Department of Psychiatry

Khyber Teaching Hospital Peshawar

History

Mr AR a 50 years old man from JalalAbad Afghanistan married twice father of 14 children not formally educated living life as a farmer but not working for the last two years He was admitted via OPD after he failed to show significant response to treatment on outdoor basis for over two years

History (cont)

He presented with complaints of havingcentipedes in his brain for the past two yearsHe would describe the movements andnature of these centipedes in great detail asthey would crawl reaching one ear and theother the back of the neck and behind his eyeballs Over the last few months The patientwould shake his head with an attempt to stopmovements of these centipedes but in vain

He was quite distressed by these symptoms andhis social and occupational life was adverselyeffected

History (cont)

bull His mood remains low with diminishedinterest in daily activities and extremedifficulty going to sleep Every time he feelsmovements of these centipedes especiallywhen it feels behind his eye balls he fearsgetting blind In desperation he has tried tokill the centipedes by poisoning them byingesting insecticides and kerosene oil ondifferent occasions He was still intending topoison them again with something morelethal if the doctors did not help him

History (cont)

bull He gets annoyed by alternative explanation for his symptoms by doctors family or relatives and will reject the finding in CT brain which was performed an year ago by a local doctor He visited a number of local doctors and went to India for treatment one year ago after a reported fail surgical attempt to remove the centipede from his brain

History (cont)

bull The operation was reportedly performedin Quetta by ENT surgeon where thepatient was shown a dead centipede(Record not available) There was asurgical scar behind his left auricle

bull The patient believes that the surgeonfailed to remove female pregnantcentipede that has now given birth toseveral offspring

Past Hx

bull Apart from receiving treatment from multiple doctors and faith healers he was treated by psychiatrist with olanzapine 10 mg daily and fluoxtine 40 mg daily for about three months with no significant improvement in his symptoms

Family Hx

His father died 20 years ago because of asudden death with no known causes Hismother is alive and has no known medicalor psychiatric illness He has 3 brothersand 4 sisters and is 2nd in birth order Hiselder brother died because of some braintumor 4 months ago There is no othersignificant medical or psychiatric historyin the family

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 2: Delusional Parasitosis

History

Mr AR a 50 years old man from JalalAbad Afghanistan married twice father of 14 children not formally educated living life as a farmer but not working for the last two years He was admitted via OPD after he failed to show significant response to treatment on outdoor basis for over two years

History (cont)

He presented with complaints of havingcentipedes in his brain for the past two yearsHe would describe the movements andnature of these centipedes in great detail asthey would crawl reaching one ear and theother the back of the neck and behind his eyeballs Over the last few months The patientwould shake his head with an attempt to stopmovements of these centipedes but in vain

He was quite distressed by these symptoms andhis social and occupational life was adverselyeffected

History (cont)

bull His mood remains low with diminishedinterest in daily activities and extremedifficulty going to sleep Every time he feelsmovements of these centipedes especiallywhen it feels behind his eye balls he fearsgetting blind In desperation he has tried tokill the centipedes by poisoning them byingesting insecticides and kerosene oil ondifferent occasions He was still intending topoison them again with something morelethal if the doctors did not help him

History (cont)

bull He gets annoyed by alternative explanation for his symptoms by doctors family or relatives and will reject the finding in CT brain which was performed an year ago by a local doctor He visited a number of local doctors and went to India for treatment one year ago after a reported fail surgical attempt to remove the centipede from his brain

History (cont)

bull The operation was reportedly performedin Quetta by ENT surgeon where thepatient was shown a dead centipede(Record not available) There was asurgical scar behind his left auricle

bull The patient believes that the surgeonfailed to remove female pregnantcentipede that has now given birth toseveral offspring

Past Hx

bull Apart from receiving treatment from multiple doctors and faith healers he was treated by psychiatrist with olanzapine 10 mg daily and fluoxtine 40 mg daily for about three months with no significant improvement in his symptoms

Family Hx

His father died 20 years ago because of asudden death with no known causes Hismother is alive and has no known medicalor psychiatric illness He has 3 brothersand 4 sisters and is 2nd in birth order Hiselder brother died because of some braintumor 4 months ago There is no othersignificant medical or psychiatric historyin the family

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 3: Delusional Parasitosis

History (cont)

He presented with complaints of havingcentipedes in his brain for the past two yearsHe would describe the movements andnature of these centipedes in great detail asthey would crawl reaching one ear and theother the back of the neck and behind his eyeballs Over the last few months The patientwould shake his head with an attempt to stopmovements of these centipedes but in vain

He was quite distressed by these symptoms andhis social and occupational life was adverselyeffected

History (cont)

bull His mood remains low with diminishedinterest in daily activities and extremedifficulty going to sleep Every time he feelsmovements of these centipedes especiallywhen it feels behind his eye balls he fearsgetting blind In desperation he has tried tokill the centipedes by poisoning them byingesting insecticides and kerosene oil ondifferent occasions He was still intending topoison them again with something morelethal if the doctors did not help him

History (cont)

bull He gets annoyed by alternative explanation for his symptoms by doctors family or relatives and will reject the finding in CT brain which was performed an year ago by a local doctor He visited a number of local doctors and went to India for treatment one year ago after a reported fail surgical attempt to remove the centipede from his brain

History (cont)

bull The operation was reportedly performedin Quetta by ENT surgeon where thepatient was shown a dead centipede(Record not available) There was asurgical scar behind his left auricle

bull The patient believes that the surgeonfailed to remove female pregnantcentipede that has now given birth toseveral offspring

Past Hx

bull Apart from receiving treatment from multiple doctors and faith healers he was treated by psychiatrist with olanzapine 10 mg daily and fluoxtine 40 mg daily for about three months with no significant improvement in his symptoms

Family Hx

His father died 20 years ago because of asudden death with no known causes Hismother is alive and has no known medicalor psychiatric illness He has 3 brothersand 4 sisters and is 2nd in birth order Hiselder brother died because of some braintumor 4 months ago There is no othersignificant medical or psychiatric historyin the family

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 4: Delusional Parasitosis

History (cont)

bull His mood remains low with diminishedinterest in daily activities and extremedifficulty going to sleep Every time he feelsmovements of these centipedes especiallywhen it feels behind his eye balls he fearsgetting blind In desperation he has tried tokill the centipedes by poisoning them byingesting insecticides and kerosene oil ondifferent occasions He was still intending topoison them again with something morelethal if the doctors did not help him

History (cont)

bull He gets annoyed by alternative explanation for his symptoms by doctors family or relatives and will reject the finding in CT brain which was performed an year ago by a local doctor He visited a number of local doctors and went to India for treatment one year ago after a reported fail surgical attempt to remove the centipede from his brain

History (cont)

bull The operation was reportedly performedin Quetta by ENT surgeon where thepatient was shown a dead centipede(Record not available) There was asurgical scar behind his left auricle

bull The patient believes that the surgeonfailed to remove female pregnantcentipede that has now given birth toseveral offspring

Past Hx

bull Apart from receiving treatment from multiple doctors and faith healers he was treated by psychiatrist with olanzapine 10 mg daily and fluoxtine 40 mg daily for about three months with no significant improvement in his symptoms

Family Hx

His father died 20 years ago because of asudden death with no known causes Hismother is alive and has no known medicalor psychiatric illness He has 3 brothersand 4 sisters and is 2nd in birth order Hiselder brother died because of some braintumor 4 months ago There is no othersignificant medical or psychiatric historyin the family

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 5: Delusional Parasitosis

History (cont)

bull He gets annoyed by alternative explanation for his symptoms by doctors family or relatives and will reject the finding in CT brain which was performed an year ago by a local doctor He visited a number of local doctors and went to India for treatment one year ago after a reported fail surgical attempt to remove the centipede from his brain

History (cont)

bull The operation was reportedly performedin Quetta by ENT surgeon where thepatient was shown a dead centipede(Record not available) There was asurgical scar behind his left auricle

bull The patient believes that the surgeonfailed to remove female pregnantcentipede that has now given birth toseveral offspring

Past Hx

bull Apart from receiving treatment from multiple doctors and faith healers he was treated by psychiatrist with olanzapine 10 mg daily and fluoxtine 40 mg daily for about three months with no significant improvement in his symptoms

Family Hx

His father died 20 years ago because of asudden death with no known causes Hismother is alive and has no known medicalor psychiatric illness He has 3 brothersand 4 sisters and is 2nd in birth order Hiselder brother died because of some braintumor 4 months ago There is no othersignificant medical or psychiatric historyin the family

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 6: Delusional Parasitosis

History (cont)

bull The operation was reportedly performedin Quetta by ENT surgeon where thepatient was shown a dead centipede(Record not available) There was asurgical scar behind his left auricle

bull The patient believes that the surgeonfailed to remove female pregnantcentipede that has now given birth toseveral offspring

Past Hx

bull Apart from receiving treatment from multiple doctors and faith healers he was treated by psychiatrist with olanzapine 10 mg daily and fluoxtine 40 mg daily for about three months with no significant improvement in his symptoms

Family Hx

His father died 20 years ago because of asudden death with no known causes Hismother is alive and has no known medicalor psychiatric illness He has 3 brothersand 4 sisters and is 2nd in birth order Hiselder brother died because of some braintumor 4 months ago There is no othersignificant medical or psychiatric historyin the family

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 7: Delusional Parasitosis

Past Hx

bull Apart from receiving treatment from multiple doctors and faith healers he was treated by psychiatrist with olanzapine 10 mg daily and fluoxtine 40 mg daily for about three months with no significant improvement in his symptoms

Family Hx

His father died 20 years ago because of asudden death with no known causes Hismother is alive and has no known medicalor psychiatric illness He has 3 brothersand 4 sisters and is 2nd in birth order Hiselder brother died because of some braintumor 4 months ago There is no othersignificant medical or psychiatric historyin the family

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 8: Delusional Parasitosis

Family Hx

His father died 20 years ago because of asudden death with no known causes Hismother is alive and has no known medicalor psychiatric illness He has 3 brothersand 4 sisters and is 2nd in birth order Hiselder brother died because of some braintumor 4 months ago There is no othersignificant medical or psychiatric historyin the family

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 9: Delusional Parasitosis

Personal Hx

bull Normal delivery normal Developmental Milestones Reports uneventful happy early and late childhood Has received no formal education He Can read quran (Nazira)

bull Has been working as a farmer in his village until over the past 2 years Married has 2 wives 10 daughters and 4 sons living in a house which consists of 6 rooms

bull Uses snuff but denies use of any other illicit drugs There is no history of any encounter with the police or law

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 10: Delusional Parasitosis

Premorbid Personality

bull Patient describes himself as sociable withgood coping skills in stressful conditionshas no known leisure activities and givesimportance to religious and culturalvalues His cousin describes him as a bitstrict by nature with mild anger outburstsfrom time to time but there is no history ofparanoid schizotypal or schizoidpersonality traits

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 11: Delusional Parasitosis

Mental State Examination

bull A middle aged bearded man normal hight and built dressedappropriately in shalwar qamees There were no evidence ofself neglect abnormal behaviour or movements He wascooperative Rapport was established and maintained till theend of the interview

bull Mood was subjectively and objectively low with no explicitdeath wishes or suicidal thoughts

bull His speech was relevant coherent of normal tone andvolume There were no formal thoughts disorder

bull He has got delusion of being infested by centipedes along withSomatic hallucinations No obsessions auditory or visualhullucinations could be illicited

bull His cognitions was intact with normal attention andconcentration Both short term and long term memory wereintact

bull Patient did not have insight into his illness

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 12: Delusional Parasitosis

Physical Examination

bull His GPE and Systemic Examination including CNS Examination was unremarkable with

bull BP 13085 pulse 84min and temp 98 F

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 13: Delusional Parasitosis

Diagnoses

bull On the basis of history and MSE my 1st

diagnosis according to ICD-10

bull On Axis l

bull F220 Delusional disorder with comorbid mild to moderate depression

bull (F22 Persistent delusional disorders)

Monosymptomatic hypochondriacal psychosis

bull My differential diagnoses include

1 Depressive Illness with Psychotic Features

2 Schizophrenia

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 14: Delusional Parasitosis

Diagnoses (cont)

bull On axis ll ( Disabilities) Score 1-5bull Personal Care 2bull Occupation 5bull Family and House Hold 4bull Broader Social Context 4bull On Axis lll (contexual Factors)bull Wrong treatment by faith healers and other health

care providersbull Problem related to education and literacybull Inadequate social support has to look after a large

familybull Death of brother 4 months ago

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 15: Delusional Parasitosis

Management

bull Short termbull Patient was admitted to Psychiatry ward for

managementbull The patient and his family were reassured and

counseled about nature of the illness and itsmanagement Informational care was providedempathatically Initially direct confrontation wasavoided to build a therapeutic alliance with thepatient

bull He was advised baseline investigations including FBCLiver and Renal Functions tests CXR and ECG

bull He was started on on risperidone 6 mg in divideddoses fluoxetine 40 mg OD in the morning andLorazepam 2 mg at Night

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 16: Delusional Parasitosis

Management (cont)

bull Intermediate

Serial MSE were carried out

HAM-D was applied to assess severity ofdepression which showed mild tomoderate depression

He was assessed for Psychosocial support

The dose of risperidone was increased to10mg daily after 2 weeks of admission

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 17: Delusional Parasitosis

Management (cont)

Attempts were made to shake the belief of thepatient Psychodynamic formulation was wade andhe was assessed for suitability for CognitiveBehaviour Therapy

CBT sessions were started however patient was notvery keen on continuing CBT sessions and wanteda quicker relief He insisted to be discharged sothat he could go to a Neurosurgeon for removingthe centipedes completely

In view of the poor response to medications in thepast he was started on ECT along-with hisantipsychotic medication

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 18: Delusional Parasitosis

Management (cont)

bull Intermediate

The patient showed improvement withmedications and ECT with reduction in hisdistress low mood improved sleep and heno longer needed to shake his headbecause of reduction in movement of thecentipedes and healing of the woundsAlthough he was still convinced about thedormant state of centipedes and expressedfear of their reactivation after gettingdischarged from the hospital

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 19: Delusional Parasitosis

Management (cont)

bull Long Term Management

bull Patient was discharged on will afterimprovement with 3 ECTs

bull we have to assure good compliance withmedications and set realistic treatment goalswithout instilling false hopes

bull We would have continued with CBT sessions buthe could not stay longer in the ward because ofhis personal problems

bull We will monitor him for complete recovery byregular follow up to our OPD

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 20: Delusional Parasitosis

Prognosis

bull Short Term

bull In view of response to medications and ECT the shortterm prognosis seem satisfactory

bull Long Term

bull Inspite of good prognostic factors like absence of 1st ranksymptoms of schizophrenia negative family historystable and sociable pre-morbid personality and late onsetof the disorder at the age of 53 the long term prognosiswould depend on patientrsquos adherence with treatmentsocial support and health belief system and hence seemsguarded

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 21: Delusional Parasitosis

References

1) Semin Cutan Med Surg 2013 Jun32(2)73-7

Delusions of parasitosis

Levin EC Gieler U

Source

Department of Dermatology University of California 515 Spruce Street San Francisco CA 94118 USA Levinedermucsfedu

2) J Drugs Dermatol 2012 Dec11(12)1506-7

Successful treatment of patients previously labeled as having delusions of parasitosis with antidepressant therapy

Delacerda A Reichenberg JS Magid M

Source

Department of Dermatology University of Texas Southwestern Austin TX USA delacerdaashleygmailcom

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 22: Delusional Parasitosis

References (cont)

3) J Am Acad Dermatol 2000 Oct43(4)683-6

Therapeutic update use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Elmer KB George RM Peterson K

Source

Medical Service Yokota AB Japan

4) J Clin Psychiatry 1999 Aug60(8)554

Risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Cetin M Ebrinccedil S Ağarguumln MY Yiğit S

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 23: Delusional Parasitosis

References (cont)

5) Dermatol Clin 1996 Jul14(3)429-38

Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis General discussion and case illustrations

Koo J Gambla C

Source

UCSF Psonasis Treatment Center University of California San Francisco Medical Center USA

6) J Clin Psychiatry 2005 Jun66(6)800-1

Monosymptomatic hypochondriacal psychosis atypical presentation and response to olanzapine

Chand PK Anand S Murthy P

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 24: Delusional Parasitosis

References (cont)

7) The British Journal of Psychiatry Vol 153(Suppl 2) Jul 1988 37-40

Monosymptomatic hypochondriacal psychosis

Munro Alistair

8) Afr J Psychiatry (Johannesbg) 2013 Mar16(2)87 89

Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder) a report of two cases

Ajiboye PO Yusuf AD

9) Br J Psychiatry 1991 Sep159428-31

Monosymptomatic hypochondriacal psychosis in developing countries

Osman AA

Source

Jeddah Psychiatric Hospital Saudi Arabia

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 25: Delusional Parasitosis

References (cont)

10) World J Biol Psychiatry 2012 Feb13(2)96-105

Using ECT in schizophrenia a review from a clinical perspective

Zervas IM Theleritis C Soldatos CR

Source

Department of Psychiatry Athens University Medical School Athens Greece zerianvivodinetgr

11) Encephale 2008 Oct34(5)526-33

[Maintenance electroconvulsive therapy and treatment of refractory schizophrenia]

[Article in French]

Leacutevy-Rueff M Jurgens A Locirco H Olieacute JP Amado I

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 26: Delusional Parasitosis

References (cont)

12) Psychiatry Res 2001 Dec 15105(1-2)107-15

Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia prediction of outcome

Chanpattana W Chakrabhand ML

Source

Department of Psychiatry Srinakharinwirot University 681 Samsen Dusit 10300 Bangkok Thailand worchloxinfocoth

Page 27: Delusional Parasitosis