Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-15T07:26:33.663Z Has data issue: false hasContentIssue false

Primary delusional parasitosis treated with olanzapine

Published online by Cambridge University Press:  05 March 2007

Roland W. Freudenmann*
Affiliation:
Department of Psychiatry, University Clinic of Ulm, Ulm, Germany
Carlos Schönfeldt-Lecuona
Affiliation:
Department of Psychiatry, University Clinic of Ulm, Ulm, Germany
Peter Lepping
Affiliation:
Llwyn Y Groes Psychiatric Unit, North East Wales NHS Trust, Wrexham Maelor Hospital, Wrexham, Wales
*
Correspondence should be addressed to: Dr. R. Freudenmann, University of Ulm, Dept. of Psychiatry, Leimgrubenweg 12–14, 89075 Ulm, Germany. Phone: +49 731 500 61558; Fax: +49 731 500 61402. Email: roland.freudenmann@uni-ulm.de.

Abstract

Delusional parasitosis (DP) is a rare psychiatric disorder, predominantly observed in middle aged and elderly patients. It can manifest itself as an isolated delusional disorder (primary DP), as a symptom of another psychiatric disorder or as an organic or toxic psychosis. The typical antipsychotic pimozide was traditionally considered to be the gold standard for treating DP. Compared with pimozide, atypical antipsychotics have many advantages in terms of tolerability, but their effectiveness has only been shown in a few case reports, which do not differentiate between primary and other forms of DP.

We present the case of a 77-year-old woman with primary DP who responded markedly to the atypical antipsychotic olanzapine (2.5 mg daily). She was treated in a psychiatric outpatient department with a follow-up period of 3.5 years. This is the first report of a successful olanzapine mono-therapy in primary DP in such a setting and the longest follow-up period ever reported. The need for maintenance treatment was demonstrated. Olanzapine in age-adapted doses should be considered as an alternative treatment. This paper also provides a review of all published cases in which primary DP was treated with atypical antipsychotics.

Type
Case Reports
Copyright
Copyright © International Psychogeriatric Association 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arnold, L. M. 2000. Psychocutaneous disorders. In Sadock, B. J. and Sadock, V. A. (eds.), Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 7th edition on CD-ROM. (Chapter 25.7), Philadelphia, PA: Lippincott Williams and Wilkins.Google Scholar
AwD. C., D. C., Thong, J. Y. and Chan, H. L. 2004. Delusional parasitosis: case series of 8 patients and review of the literature. Annals of the Academy of Medicine, Singapore, 33, 8994.CrossRefGoogle ScholarPubMed
DriscollM. S., M. S., RotheM. J., M. J., Grant-Kels, J. M. and Hale, M. S. 1993. Delusional parasitosis: a dermatologic, psychiatric, and pharmacologic approach. Journal of the American Academy of Dermatology, 29, 10231033.CrossRefGoogle ScholarPubMed
Freudenmann, R. W. 2002. Delusions of parasitosis: an up-to-date review. Fortschritte der Neurologie Psychiatrie, 70, 531541.CrossRefGoogle ScholarPubMed
Freudenmann, R. W. 2003. A case of delusional parasitosis in severe heart failure. Olanzapine within the framework of a multimodal therapy. Der Nervenarzt, 74, 591595.CrossRefGoogle ScholarPubMed
Freudenmann, R. W. and Schönfeldt-Lecuona, C. 2005. Delusional parasitosis: treatment with atypical antipsychotics [Letter]. Annals of the Academy of Medicine, Singapore, 34, 141142.Google ScholarPubMed
FreyneA., A., Kenny, E. and Cooney, C. 1999. Delusions of infestation: a case report of response to risperidone. Irish Medical Journal, 92, 435.Google ScholarPubMed
Frithz, A. 1979. Delusions of infestation: treatment by depot injections of neuroleptics. Clinical and Experimental Dermatology, 4, 485488.CrossRefGoogle ScholarPubMed
Gallucci, G. and Beard, G. 1995. Risperidone and the treatment of delusions of parasitosis in an elderly patient. Psychosomatics, 36, 578580.CrossRefGoogle Scholar
Hamann, K. and Avnstorp, C. 1982. Delusions of infestation treated by pimozide: a double-blind crossover clinical study. Acta Dermato-Venereologica, 62, 5558.CrossRefGoogle ScholarPubMed
KimC., C., KimJ., J., Lee, M. and Kang, M. 2003. Delusional parasitosis as “folie à deux.” Journal of Korean Medical Science, 18, 462465.CrossRefGoogle ScholarPubMed
Kumbier, E. and Kornhuber, M. 2002. Delusional ectoparasitic infestation in multiple system atrophy. Der Nervenarzt, 73, 378381.Google ScholarPubMed
Le, L. and Gonski, P. N. 2003. Delusional parasitosis mimicking cutaneous infestation in elderly patients. Medical Journal of Australia, 179, 209210.CrossRefGoogle ScholarPubMed
LeppingP., P., Gil-Candon, R. and Freudenmann, R. W. 2005. Delusional parasitosis treated with amisulpride. Progress in Neurology and Psychiatry, 9, 1216.Google Scholar
Makhija, M. and Bhalerao, S. 2004. Reconsidering pimozide for new-onset delusions of parasitosis. Canadian Journal of Psychiatry, 49, 643644.CrossRefGoogle ScholarPubMed
Munro, A. 1982. Delusional Hypochondriasis. A Description of Monosymptomatic Hypochondriacal Psychosis (MHP). Clarke Institute of Psychiatry Monograph Series. Toronto: Department of Psychiatry, University of Toronto.Google Scholar
NicolatoR., R., CorreaH., H., Romano-Silva, M. A. and TeixeiraA. L., Jr. A. L., Jr. 2006. Delusional parasitosis or Ekbom syndrome: a case series. General Hospital Psychiatry, 28, 8587.CrossRefGoogle ScholarPubMed
PacanP., P., Reich, A. and Szepietowski, J. C. 2004. Delusional parasitosis successfully controlled with risperidone – two case reports. Dermatology and Psychosomatics, 5, 193195.CrossRefGoogle Scholar
SlaughterJ. R., J. R., ZanolK., K., Rezvani, H. and Flax, J. 1998. Psychogenic parasitosis: a case series and literature review. Psychosomatics, 39, 491500.CrossRefGoogle ScholarPubMed
Trabert, W. 1995. 100 years of delusional parasitosis. Meta-analysis of 1,223 case reports. Psychopathology, 28, 238246.CrossRefGoogle Scholar
Ungvari, G. 1984. Behandlung des Dermatozoenwahns durch Neuroleptika. Psychiatrische Praxis, 11, 116119.Google Scholar
Ungvari, G. and Vladar, K. 1986. Pimozide treatment for delusion of infestation. Activitas Nervosa Superior (Prague), 28, 103107.Google ScholarPubMed
van Vloten, W. A. 2003. Pimozide: use in dermatology. Dermatology Online Journal, 9, 3.Google ScholarPubMed
WenningM. T., M. T., DavyL. E., L. E., Catalano, G. and Catalano, M. C. 2003. Atypical antipsychotics and the treatment of delusional parasitosis. Annals of Clinical Psychiatry, 15, 233239.CrossRefGoogle ScholarPubMed