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What Is The Treatment For Delusions Of Parasitosis?

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Posted on Mon, 3 Aug 2015
Question: EMAIL: under this letter.

THESE NOTES I HAVE FILED UNDER SCHOZOPHRENIA.
My son XXXXXXX aged 51 and a diagnosis of Psychosis

GP (known to me for forty five years of my social life) yesterday mentioned the word schizophrenia to me and said (I have not told XXXXXXX this) XXXXXXX has for two years had a condition complaining of creatures in his head and insect flying out. Lice and all other treatments have been tried. No one has seen this happen. Although he says people at work say they have seen them. He did not go to work this week (2 days work only) repetitive answering phones to potential eclectic company users.
Last night he told me he was spraying them with Mortein and ointment from Dermatologist was not working any more.
I am a former XXXXXXX University Lecturer in Health Sciences a Midwife and Nurse of 50 years paid experience. I live with my sons' stepfather my husband XXXXXXX in South Gippsland. My son is in Croydon Melbourne 3 hours drive for us and him, but he maintains contact with me by email phone and visits. (I have been losing my temper with him for lack of practicality recently)

In 1964. I was given heroin in error twenty minutes before my first birth at XXXXXXX Mac and obstetrician XXXXXXX Adey, arrived in panic at his birth and XXXXXXX was virtually lifeless for a period of time. He married built a home in Perth and had two children then divorced without financial settlement. Looked after his alcoholic father in XXXXXXX (and Peter)’s current inherited home from his grandparents. He lived with and looked after his father and was there when he died of white leg amputation and eventual heart attack.

I have given credit to the heroin event for some of his inadequacies. He is by nature a comedian and caring and thoughtful with insight into others personalities but not his own. He played cricket and baseball with distinction at local level, and managed school but was recommended to do repetitive work by the school counselor and left school early.
Has Always been vague but his younger clever sensible brother filled in for him and has taken care of him. His first apprenticeship for Wilkies printers his arm went through a print roller but still intact he was sacked 4 years later after he printed a whole book run back to front and upside down. He is colour blind (inherited).

Son is 51 has two children 20 19 divorced and was shafted by his ex wife financially. He has had regular contact - but is they now at an age of going their own way so he has not seen the even when he drives down to Inverloch 30 minutes from our home.
I answer yes to current social isolation and withdrawal.
Lives alone in an inherited home.
Brother a bachelor aged 50 will not live with him too untidy and disorganized.
Currently in dispute over selling house and splitting or taking out mortgages etc.
He keeps repairing and driving a 30 year old ca


I have suspected his condition for some time.
It is a relief to know in the meantime the doctor will manage him.
A specialist dermatologist has stated that the insect in his scalp are psychosomatic - I agree I have never seen any evidence but I try to go along with his belief.

QUESTION
Should I pursue specialty treatment and should I mention this diagnosis to him?. The dermatologist told him it was psychosomatic and he does not believe that. Should he be admitted for assessment and confirmation of diagnosis?

The GP said I have not mentioned schizophrenia to him. I asked about a psychiatrist and the GP said no for now I will manage him. I trust this doctor implicitly as a caring and clever man. The GP has given him medication which will according XXXXXXX "I will wake up and 'they' (insects or larvae will be gone)' and laughs scathingly. (he thinks they are in a capsule from which the insect breaks out).
doctor
Answered by Dr. Chintan Solanki (4 hours later)
Brief Answer:
please take opinion of psychiatrist, no need to inform diagnosis to him

Detailed Answer:
Hello,

Thanks for writing to us. I have read your query twice and understood your concern for your son.

He is probably suffering from Delusional parasitosis, or delusory parasitosis, also known as Ekbom's syndrome. It is a form of psychosis whose victims acquire a strong delusional belief that they are infested with parasites, whereas in reality no such parasites are present. It may be a symptom of schizophrenia but no always. Schizophrenia is diagnosed by a psychiatrist with detail history from patient and relative and with help of detail mental status examination.


This delusional parasitosis is difficult to treat. We psychiatrist get reference of such patients from our dermatologist colleagues. In this problem anti-psychotic medicines specifically first generation atypical anti-psychotic like haloperidol or pimozide is more useful. Sometime SSRI like fluoxetine is also added.

At present there is no need of telling him diagnosis. He first should be evaluated by psychiatrist for diagnosis. It is better that psychiatrist should explain him about his problem. So from my clinical experience I would suggest to take opinion of psychiatrist first not go with treatment by GP without it.
Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (8 hours later)
Hello Dr Shintan Solanki midnight in Asutralia. Thank you very much you have given me the answers which display a lot of thought and that you have read and absorbed my first letter. Sorry for the length of the following notes I am known for the length of my conversations. So you are spared that.

The name of of Delusional paristosis is the name which the GP gave me. XXXXXXX has been seen by a dermatologist who must have indicated to him that he thought the condition deacribed by XXXXXXX was psychosomatic or imagined. The GP and Dermatologist have been consulting. The GP is aware of my background and wide ranging in depth knowlege both practical clinical and academic in the health field.

I began nursing in the 1950s when ECT shock therapy was in vogue and various treatments like Insulin and glucose combined were used. I experienced first hand treatment in the family setting of various kinds of psychological treatments of both my family. I was involved in team care by psychiatrists physicians, counsellors nurses physiotherapists and occupational health workers at a Government Maroohdah Social Health Centre in the 1970s for 5 years and was appointed a youth (unemployed) worker for one year until I had my now thiety seven year old daughter..

My last ten years at University XXXXXXX Lecturer level form 1989-to 2000 after which I ran a private business called B.E,V. where I lectured at vairous universities about Midwifery Bioethics. I was involved in being qualified in psychology to the point of teaching undergraduates up unitl 2000. I achieved a Masters Degree in Bioethics with XXXXXXX Singer in 1995 and gave a paper at Georgetown University XXXXXXX DC UNC and Duke Universities in 1995. I co-orindated two courses one in post graduate Midwifery and one in undergradaute midwifery as well as designingthe first Certificat Course in Lactation consultancy.

I am aware that all of the above can be irrelevant when caring for your own family or children - where emotional pain and distress gets in the way of common sense. I am on good terns with my son. It has taken three years to get him to the Dermatologsit which I have begged cajoled and stayed silent to achieve. Because he trusts the GP as does his brother I am inclined to not interfere except to discuss your advice shortly with his brother XXXXXXX aged 50) and the GP.

The GP suggested I encourage XXXXXXX to take the tablet ( name not yet given to me by my son but sounds similar to the treatment you suggest above. ) XXXXXXX is not inclined to be regular with doctors. While he trusts and contineus to see this GP I just hold my breath that he will continue tod go to him.

I will suggest to the GP that he have a full assessment after a the two week trial of tablet) which the Specialist Dermatologist recommended that is for the condition. A wait and see process. I have told his brother who gernerally cares about him but does not live with him. The diagnosis of Shiczophrenia actually confirms much of what I anticipated over many years of close watching of his behaviour and which has deteriorated recently when his children stopped contacting him.

HIs sister our daughter, says he is capable of looking after himself and safe with things like fixing his car. He is not violent or aggressive and respects my second husband. XXXXXXX has been working on his physcial health swimming walking playing golf (except fo a fore right arm) and ceased drinking beer and is on a better diet. So he has not abandoned his well being.

He has had several relationships with nice women but they do not last - he confides in me and I had good relationships with his wife and two other women. - but has decided to give women away he is inclined not to trust and on a regular basis suspiciously questions theirs and his work colleagues behaviours towards him. .

I agree that XXXXXXX should be assessed by specialist psychiatristor a team. I have contacts in the medical field but reluctant to share this news with them. But will make discrete inquiries about the best solution for assessment. We have a reasonably good system in this country in the field of psychiatry The GP indicated that he had not told XXXXXXX and that is because my son may not accept any treatment if he is upset if condition is announced. The GP knows his personality well.

REagrds and gratitude for your considered reply.

I do not have any questions at this time you have relaxed my concerns a great deal.
Ih ave no questions right now but await any comments you may wish to make aboutmy long mixxive above. Thank you
doctor
Answered by Dr. Chintan Solanki (3 hours later)
Brief Answer:
interesting description, wish you good health to you and your son

Detailed Answer:
Hello XXXX,

I read your description and really enjoyed it. I felt that you are talking in front of me.
I congratulate you for your bright career.

It is good that your GP has very good rapport with your son. We psychiatrist really face difficulties to convince such patients about their problem. Few of psychiatrists with inherent skills of patience and empathy can deal with such patients well.
Most of the patients do not accept that his/her belief is delusion and it can be treated with medicine.
Your GP of course can discuss case with psychiatrist and treat him.

And rarely patient of schizophrenia is violent. But his relationship problem suggests possibility of schizophrenia. If at all it is schizophrenia treatment should be started as soon as possible.

I request you to avoid stigma and discuss freely this issue with your known psychiatrist. Anyone can suffer from psychiatric illness even I also!

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page.

All the best and take care.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
Answered by
Dr.
Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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What Is The Treatment For Delusions Of Parasitosis?

Brief Answer: please take opinion of psychiatrist, no need to inform diagnosis to him Detailed Answer: Hello, Thanks for writing to us. I have read your query twice and understood your concern for your son. He is probably suffering from Delusional parasitosis, or delusory parasitosis, also known as Ekbom's syndrome. It is a form of psychosis whose victims acquire a strong delusional belief that they are infested with parasites, whereas in reality no such parasites are present. It may be a symptom of schizophrenia but no always. Schizophrenia is diagnosed by a psychiatrist with detail history from patient and relative and with help of detail mental status examination. This delusional parasitosis is difficult to treat. We psychiatrist get reference of such patients from our dermatologist colleagues. In this problem anti-psychotic medicines specifically first generation atypical anti-psychotic like haloperidol or pimozide is more useful. Sometime SSRI like fluoxetine is also added. At present there is no need of telling him diagnosis. He first should be evaluated by psychiatrist for diagnosis. It is better that psychiatrist should explain him about his problem. So from my clinical experience I would suggest to take opinion of psychiatrist first not go with treatment by GP without it. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.