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Case series of delusional parasitosis in an emergency department: Sociodemographic features and clinical outcomes

Published online by Cambridge University Press:  13 August 2021

A. Guàrdia*
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Sabadell, Spain
A. González-Rodríguez
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Sabadell, Spain
M. Betriu
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Sabadell, Spain
F. Estrada
Affiliation:
Department Of Mental Health., Parc Tauli University Hospital. Sabadell, Barcelona (Spain), Sabadell, Spain
M.V. Seeman
Affiliation:
Psychiatry, University of Toronto, Toronto, Canada
I. Parra Uribe
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Sabadell, Spain
J. Labad
Affiliation:
Mental Health, Hospital of Mataró. Consorci Sanitari del Maresme. CIBERSAM., Mataró, Spain
D. Palao Vidal
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT. CIBERSAM, Sabadell, Spain
*
*Corresponding author.

Abstract

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Introduction

A delusion of parasitosis is defined as the fixed, false belief of infestation by invisible organisms or fibrous material of unknown origin. The differential diagnosis is true infection, substance use disorder, dementia or other neuropsychiatric disease.

Objectives

Our goal was to characterize delusions of parasitosis, classically named Ekbom syndrome, among individuals attending our emergency department (ED).

Methods

Over a four-year period (2017-2020), we carried out a retrospective case-register study of patients with DSM-5 Ekbom syndrome attending an ED that provides mental health services to an area of nearly 450.000 inhabitants in Sabadell (Barcelona, Spain).

Results

There were 13 eligible patients: 7 were diagnosed for the first time and 6 had multiple episodes. Female-to-male ratio was 1.6:1; average age was 56.9. The most common diagnosis was delusional disorder (n=5;8.5%), followed by schizophrenia (n=3;23.1%) and organic disorders (n=2;15.4%). Origin: Africa (n=5;38.5%), South-America (n=4;30.8%) and Spain (n=4;30.8%). Fifty percent showed poor treatment compliance. Antipsychotics used: risperidone (n=8;61.54%), olanzapine (n=4;30.8%). Five patients received antidepressants. Most patients had previously been seen by other medical specialties (internal medicine, dermatology and hematology). ‘’Match box sign’’: 7 patients (53.8%). Cerebral atrophy was present on brain scan in 4 patients. After discharge: acute psychiatric unit (n=7), outpatient appointments (n=4), day hospital (n=1) and 1 to a psychogeriatric unit.

Conclusions

Delusions of parasitosis are rare in our emergency department. The typical patient is a postmenopausal woman, a visitor or immigrant to Spain. Effective treatment requires a focus on cultural, gender, and age aspects, with close cooperation between psychiatry and other relevant specialties.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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