delusional parasitosis
TRANSCRIPT
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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