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Delusional parasitosis in dementia with Lewy bodies: a report of two cases

Radosław Magierski1, Joanna Magierska1, Katarzyna Antczak-Domagała1, Iwona Kłoszewska1, Tomasz Sobów2

Affiliacja i adres do korespondencji
PSYCHIATR. PSYCHOL. KLIN. 2014, 14 (1), p. 61–64
DOI: 10.15557/PiPK.2014.0008
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Streszczenie

Dementia with Lewy bodies (DLB) is considered to be the second most frequent primary degenerative dementing illness after Alzheimer’s disease. Psychotic symptoms are typical features in DLB patients, and visual hallucinations are the most frequent neuropsychiatric symptoms and have been considered as one of the core features in the clinical diagnostic criteria of DLB. According to literature, spectrum of delusional ideation may be observed in DLB cases. There is a serious problem of misdiagnosis in cases with delusional ideation in DLB cases. The diagnosis of senile psychosis is frequently made duo to visual hallucinations and delusions. Moreover, diagnosis of delusional parasitosis (form of monodelusional disorder, known as Ekbom’s syndrome) must be taken into account during differential diagnosis. Subjects with delusions of being infested with parasites frequently consult many specialists (dermatologists, internists or allergists) and usually reject psychiatric diagnosis and treatment. Unfortunately, there is a limited evidence of the efficacy of specific pharmacologic interventions, but severe sensitivity to typical and atypical antipsychotics in approximately 50% can occur, and improvements in visual hallucinations with cholinesterase inhibitors could be expected. Herein, we report two cases of DLB suffering due to delusions of being infested by parasites (delusional parasitosis). The paper demonstrates the clinical picture and utility of cholinesterase inhibitors and low doses of second generation antipsychotics in the treatment of psychosis in the DLB cases.

Słowa kluczowe
delusions, parasitosis, dementia with Lewy bodies, cholinesterase inhibitors, antipsychotics, case report