Friday, May 15, 2009

Delusional parasitosis

The ones that crawl in are lean and thin
The ones that crawl out are fat and stout
Your eyes fall in and your teeth fall out
Your brains come tumbling down your snout

No lighthearted matter, these creeping mites, for two of my patients. The first middle-aged lady came in last summer toting a small aquarium full of water. Floating within were numerous diaphanous strands that trembled and tumbled as she heaved the case onto the table.

"Bugs," she declared, "the things that are crawling into my nose and making me crazy."

She was not kidding; she was in tears. She didn't say I think I'm going crazy because I imagine bugs, she said these are bugs.

The second lady came with her brother and sister in tow. He was carrying a crystal wine glass filled with alcohol and covered with saran wrap. Within floated three 'mites' captured as they scurried up someone's arm; I can't remember which one of the sibs caught the little buggers. I carefully poured off the alcohol and managed to snag the tiny particles onto a slide.

"Two clumps of fiber and pile of skin cells," I declared on returning to the exam room. "C'mon back and have a look."

Did they say "Oh my goodness, how foolish we feel now?" Nope, they just shrugged and said "we must've missed them which is amazing as they swarm by the thousands up our arms and legs." Lady #1 didn't go so far as to pin down the species of her infestation, Lady #2 was quite clear the pests were bird mites.

This is not only a psychotic syndrome, but the ability to pass the delusion along to others is a known phenomenon dubbed Shared Psychotic Disorder (SPD) which occurs in as many as 15% of cases of Delusional Parasitosis (DP). Must be a huge delusional exaggeration of the way one starts to itch when someone near by starts to scratch.

Per Wolfgang Trabert(1), when SPD patients are separated from the 'inducer,' a significant number of them undergo a spontaneous remission. Indeed, the brother and sister of this patient pulled back from their personal mitey troubles and had Lady #2 involuntarily admitted for psychiatric evaluation. She emerged slightly less upset due to the use of anti-psychotic meds, but still convinced that her house (that she's abandoned), her car (which she still drives but coats herself before doing so in olive oil as mites don't care for the taste), and her new apartment all continue infested.

Helping Lady #2 try to regain some semblance of a normal life is the hardest thing I've ever attempted in 28 years of practice. Her major source of information is birdmites.org. Check it out; is this fact or a web-site run by a bunch of SPD patients?
_____
1. Trabert, W.
Shared Psychotic Disorder in Delusional Parasitosis. Psychopathology 1999;32:30-34.

11 comments:

Cilicious said...

Yikes
Well, living as I do in the land of gnats and no-see-ums, I can see how someone can go buggy. Sometimes, all you have to do is *think* about the critters, and your skin begins to crawl. But in Colorado? Not so much.

Ruth said...

oh my! I collect feathers and have handled many nests and haven't encountered any problems myself. Very interesting post.(No comment on the other site...if I dismiss it, I may get infested! ;-))

Anonymous said...

Dr Paley, you could learn the free basic method at www.emofree.com and apply it to her and her delusion, and maybe learn something new about healing.... It works right away and
it only takes a few minutes... be amazed....it works right away on all kinds of problems, even physical, try it out , maybe on Adeles pain? or something
otherwise i recommend acupuncture and an experienced doctor in this

Anonymous said...

Here is my brainstorming board about all this:
If i were the one presenting with these symptoms i would want to know that my doctors had properly tested my hormones (thyroid, along with ft3, sex,adrenal, cortisol)as per these experts at www.feelingfff.com and consulted with the docs there, also... they have a lot of experience with these mental health issues and hormones.... and they test differently, and read them differently than 'normal medical protocol'...(and if i were you specifically, i would use this consult as an opportunity to find out what they know about treating/preventing alzheimers, also)
I would want my docs to know if i had one autoimmune disorder, there was probably another one lurking undiagnosed, also.
This one thing would save millions of people from a lot of pain and suffering from age 12 on thur life, the more I know about hormones and the problems they can cause and go untreated properly, the more i am convinced of this.... and i am not an expert in it... just me with some experience.
I would request an MRI of my brain and neck, abdomen.
I would want a glucose evaluation done.
I would want you to try and balance all these as much as possible, getting back down to using naturals, (the adaptogens like panax ginseng for adrenals,and I personally do suspect adrenal involvement here because it effects the yin and the eyes and there are herbs to rebuild that, rhodiola for autoimmune, lungs,etc, eleuthero for anti aging, perisalsis, ...padma basic for autoimmune,etc) as appropriate after testing...and as soon as possible after the meds...
In asian medicine they use the heavy sedatives,and brain tonics like schizandra, (BU NAO WAN, ardisia, albizzia, hemitite,etc)and acupuncture, claiming at least improvement in most...cases of psychosis.(which is similar to their treatment for drug withdrawal)
I would want you to send me to an allergist and test everything, (environment, food, chemicals, medication sensativites) then to a naturopathic doc to let them retest everything in their way, and the one who realized that individual ideal levels (eg .3 to 2 ideal for TSH, and the bioavailabilities of the rest) would get my vote.....
I would want to know how antibodies could trigger any of this and to test and bring them down.
I would then brainstorm any other known cause medically speaking.Brain scans, disorders, etc...
Then I would cover the spiritual and psychological aspect.... LAST!
EFT experts have worked well with psychosis...
and removing the underlying psyc problems...
Finally, I would ask that someone pray to remove the TAOISTS who turn mothers into bugs,(kind of a joke here, kind of, because they are known to attatch to everyone spiritually) and remember that bugs in shamanism are often associated with mean thoughts, people, etc intruding on an individual... sometimes in response to others mean spiritedness, etc...
Edgar Cayce said when he left his body in meditation to heal someone, he often found their spirit distorted, and he had to heal the astral spirit first, and the rest followed without any further intervention... first the mind healed, then the body...
So , for what it is worth......
here is my opinion. Have a great day.
Arent you glad you are not my doctor? If these things had been done , it would have saved me 2o or thiry years of pain, some very difficult to reverse, now, which is why I am sharing .
I just saw Dr. Daniel G. Amen a neuro psychiatrist talk, he has written a book on natural brain healing you may be interested in.
I personally think psychiatry will be proven wrong someday about many things... but like the newer brain scans being done.

Anonymous said...

I would also like to know what you do, and what you find that works... some follow up here, would be nice... since you share, ask and we share, also...please?
Did MRS. B make it? for example...

Anonymous said...

Dont know whos site that is, usually if it is a doctor they dont hesitate to say so. There is usually reference to the author somewhere in content....

Anonymous said...

Wow. Counting myself lucky for just being plain old middle class neurotic.

Mauigirl said...

We saw a play called "Bug" that was probably about a case of this psychosis.

http://www.amazon.com/Bug-Play-Tracy-Letts/dp/0810123487

Check it out. I think they made it into a movie too.

Very interesting, amazing how people can be convinced of something like this.

femail doc said...

Anon: Thanks for your thoughts on this case. This lady does not have very good insurance; she is already in debt over her involuntary hospitalization and completely alienated from psychiatrists. The one she saw during that stay put her on an outrageously expensive medication that she can't afford and told her to follow up with me. I will be gratified if she continues to show up for her appts. at my office. I gave her another month's worth of the pricey med which is slightly decreasing her agitation, and hope to switch her to one in the same class that has recently gone generic. I am currently taking the stance that I won't judge bugs or no bugs, but will make our goal decreasing her sky-high anxiety and returning her as much as possible to her former life.

Mauigirl: I read about that play; how bizarre! Did you enjoy it?

femail doc said...

p.s. Mrs. B (who had ESBL e coli UTI and was hospitalized for IV antibiotics has had two recurrences, both caught early and treated with outpatient IV antibiotics, and recently had another UTI that was a completely ho hum run-of-the-mill klebsiella infection sensitive to everything. She is freaking out and scared to death of this deadly bug. And rightly so!

Anonymous said...

My husband has this. Has destroyed our family and left him unable to function. How does this happen? How does it resolve? How does one look at fuzz and see parasites? His whole existence revolves around the hunt for bugs. He sees me as his enemy for telling him he is delusional. Terrible tragic. Children lost their father and I have lost a husband