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Current Psychiatry Reports
Published in: Current Psychiatry Reports 3/2011

01-06-2011

Ekbom Syndrome: A Delusional Condition of “Bugs in the Skin”

Author: Nancy C. Hinkle

Published in: Current Psychiatry Reports | Issue 3/2011

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Abstract

Entomologists estimate that more than 100,000 Americans suffer from “invisible bug” infestations, a condition known clinically as Ekbom syndrome (ES), although the psychiatric literature dubs the condition “rare.” This illustrates the reluctance of ES patients to seek mental health care, as they are convinced that their problem is bugs. In addition to suffering from the delusion that bugs are attacking their bodies, ES patients also experience visual and tactile hallucinations that they see and feel the bugs. ES patients exhibit a consistent complex of attributes and behaviors that can adversely affect their lives.
Literature
1.
Ekbom KA. Der präsenile dermatozoenwahn. Acta Psychiatr Neurol Scand. 1938;33:227–59 [reprinted as “The Pre-senile Delusion of Infestation,” Classic Text No. 54, History of Psychiatry 2003, 14:232–56].CrossRef
2.
•• Freudenmann RW, Lepping PL. Delusional infestation. Clin Microbiol Rev. 2009;22:690–732. This extensive review covers ES diagnosis, characteristics, and treatment, with excellent discussions of the literature regarding all aspects of the condition. PubMedCrossRef
3.
Aw DCW, Thong JY, Chan HL. Delusional parasitosis: case series of 8 patients and review of the literature. Ann Acad Med Singapore. 2004;33:89–94.PubMed
4.
Murray WJ, Ash LR. Delusional parasitosis. Clin Microbiol Newsl. 2004;26:73–7.CrossRef
5.
Huber M, Kirchler E, Karner M, Pycha R. Delusional parasitosis and the dopamine transporter. A new insight of etiology? Med Hypotheses. 2007;68:1351–8.PubMedCrossRef
6.
Reichenberg JS, Magid M, Drage LA. A cure for delusions of parasitosis. J Eur Acad Dermatol Venereol. 2007;21:1423–4.PubMedCrossRef
7.
Bak R, Tumu P, Hui C, et al. A review of delusions of parasitosis, part 1: presentation and diagnosis. Cutis. 2008;82:123–30.PubMed
8.
Bury JE, Bostwick JM. Iatrogenic delusional parasitosis: a case of physician-patient folie a deux. Gen Hosp Psychiatry 2010, 32:210–212.
9.
Dunn J, Murphy MB, Fox KM. Diffuse pruritic lesions in a 37-year-old man after sleeping in an abandoned building. Am J Psychiatry. 2007;164:1166–72.PubMedCrossRef
10.
Robles DT, Romm S, Combs H, et al. Delusional disorders in dermatology: a brief review. Dermatol Online J. 2008;14:2.PubMed
11.
12.
13.
14.
Bourgeois ML, Duhamel P, Verdoux H. Delusional parasitosis: Folie à deux and attempted murder of a family doctor. Br J Psychiatry. 1992;161:709–11.PubMedCrossRef
15.
• Boggild AK, Nicks BA, Yen L, et al. Delusional parasitosis: six-year experience with 23 consecutive cases at an academic medical center. Int J Infect Dis. 2010;14:e317–21. This study compared 23 ES cases presenting to a university medical center. PubMedCrossRef
16.
• Healy R, Taylor R, Dhoat S, et al. Management of patients with delusional parasitosis in a joint dermatology/liaison psychiatry clinic. Brit J Dermatol. 2009;161:187–218. This paper illustrates the benefits of having dermatologists and psychiatrists treat ES patients in conjunction. CrossRef
17.
Poorbaugh JH. Cryptic arthropod infestations: Separating fact from fiction. Bull Soc Vector Ecol. 1993;18:3–5.
18.
Colombo G, Caimi M, Donà GP. Shared Ekbom’s syndrome. A case study. Eur Psychiatry. 2004;19:115–6.PubMedCrossRef
19.
Ramirez-Bermudez J, Espinola-Nadurille M, Loza-Taylor N. Delusional parasitosis in neurological patients. Gen Hosp Psychiatry. 2010;32:294–9.PubMedCrossRef
20.
Wenning MT, Leigh ED, Catalano MD, Catalano MC. Atypical antipsychotics in the treatment of delusional parasitosis. Ann Clin Psychiatry. 2003;15:233–9.PubMed
21.
Fellner MJ, Majeed MH. Tales of bugs, delusions of parasitosis, and what to do. Clin Dermatol. 2009;27:135–8.PubMedCrossRef
22.
Hinkle NC. Ekbom Syndrome: the challenge of invisible bugs. Ann Rev Entomol. 2010;55:77–94.CrossRef
23.
Vila-Rodriguez F, MacEwan BG. Delusional parasitosis facilitated by web-based dissemination. Am J Psychiatry. 2008;165:12.CrossRef
24.
Nel M, Schoeman JP, Lobetti RG. Delusions of parasitosis in clients presenting pets for veterinary care. J S Afr Vet Assoc. 2000;72:167–9.
25.
Bellanger AP, Crouzet J, Boussard M, et al. Ectoparasites or Ekbom Syndrome? Can Fam Physician. 2009;55:1089–90.PubMed
26.
Bewley AP, Lepping P, Freudenmann RW, Taylor R. Delusional parasitosis: time to call it delusional infestation. Br J Dermatol. 2010;163:1–2.PubMedCrossRef
27.
Waldron WG. The role of the entomologist in delusory parasitosis. Bull Entomol Soc Amer. 1962;8:81–3.
28.
Szepietowski JC, Salomon J, Hrehorow E, et al. Delusional parasitosis in dermatological practice. J Eur Acad Dermatol Venereol. 2007;21:462–5.PubMed
29.
Traver JR. Unusual scalp dermatitis in humans caused by the mite, Dermatophagoides (Acarine, Epidermoptidae). Proc Entomol Soc Wash. 1951;53:1–25.
30.
31.
Kim C, Kim J, Lee M, Kang M. Delusional parasitosis as ‘Folie à deux.’ J Korean Med Sci. 2003;18:462–5.PubMedCrossRef
32.
Poli R, Agrimi E. Ekbom’s syndrome: two case reports treated with olanzapine. Clin Neuropsychiatry. 2009;6:124–7.
33.
Bhandary SK, Peter R, Bhat S. Delusional parasitosis in ENT. Indian J Otolaryngol Head Neck Surg. 2008;60:387–9.CrossRef
34.
35.
Hillert A, Gieler U, Niemeier V, Brosig B. Delusional parasitosis. Dermatol Psychosom. 2004;5:33–5.CrossRef
36.
Ahmad K, Ramsay B. Delusional parasitosis: lessons learnt. Acta Derm Venereol. 2009;89:165–8.PubMed
37.
Räsänen P, Erkonen K, Isaksson U, et al. Delusional parasitosis in the elderly: a review and report of six cases from Northern Finland. Int Psychogeriatr. 1997;9:459–64.PubMedCrossRef
38.
Duggal H, Singh I. Delusional parasitosis as a presenting feature of dementia. J Neuropsychiatry Clin Neurosci. 2010;22:1.
39.
Daniel E, Srinivasan TN. Folie à Famille: delusional parasitosis affecting all the members of a family. Indian J Dermatol Venereol Leprol. 2004;70:296–7.PubMed
40.
Friedmann AC, Ekeowa-Anderson A, Taylor R, Bewley A. Delusional parasitosis presenting as folie à trois: successful treatment with risperidone. Brit J Dermatol. 2006;155:841–65.CrossRef
41.
Niemeier V, Kupfer J, Gieler U. Observations during an itch-inducing lecture. Dermatol Psychosom. 2000;1 Suppl 1:15–8.CrossRef
42.
Koblenzer CS. The current management of delusional parasitosis and dermatitis artefacta. Skin Ther Lett. 2010;15:1–3.
43.
Amato Neto V, Amato JGP, Amato VS, Ferreira CS. Ekbom Syndrome (delusory parasitosis): ponderations on two cases. Rev Inst Med Trop S Paulo. 2007;49:395–6.PubMed
44.
Edlich RF, Cross CL, Wack CA, Long WB. Delusions of parasitosis. Amer J Emerg Med. 2009;27:997–9.CrossRef
45.
Nicolato R, Correa H, Romano-Silva MA, Teixeira Jr AL. Delusional parasitosis or Ekbom syndrome: a case series. Gen Hosp Psychiatry. 2006;28:85–7.PubMedCrossRef
46.
Koo J, Lee CS. Delusions of parasitosis: a dermatologist’s guide to diagnosis and treatment. Amer J Clin Dermatol. 2001;2:285–90.CrossRef
47.
• Freudenmann RW, Lepping PL. Second-generation antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy. J Clin Psychopharmacol. 2008;28:500–8. This paper analyzes 63 ES cases treated with second-generation antipsychotics and points to their preference over pimozide. PubMedCrossRef
48.
• Lee CS, Accordino R, Howard J, Koo J. Psychopharmacology in dermatology. Dermatol Ther. 2008;21:69–82. These recommendations assist dermatologists in treating psychopathological disorders. PubMedCrossRef
49.
• Bak R, Tumu P, Hui C, et al. A review of delusions of parasitosis, part 2: treatment options. Cutis. 2008;82:257–64. This review summarizes and compares treatment recommendations, including potential drug side effects. PubMed
Metadata
Title
Ekbom Syndrome: A Delusional Condition of “Bugs in the Skin”
Author
Nancy C. Hinkle
Publication date
01-06-2011
Publisher
Current Science Inc.
Published in
Current Psychiatry Reports / Issue 3/2011
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-011-0188-0

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