INS NYC 2024 Program

Poster	Poster Session 05 Program Schedule 02/15/2024 02:30 pm - 03:45 pm Room: Shubert Complex (Posters 1-60) Poster Session 05: Neuropsychiatry \| Addiction/Dependence \| Stress/Coping \| Emotional/Social Processes Final Abstract #32 Delusional Parasitosis: A Case Report Lena Etzel, Emory University School of Medicine, Atlanta, United States Suzanne Penna, Emory University School of Medicine, Atlanta, United States Category: Psychiatric Disorders Keyword 1: psychosis Keyword 2: neuropsychiatry Keyword 3: Parkinson's disease Objective: Delusional parasitosis (DP) is a disorder characterized by the belief that one has a parasitic infestation under their skin. Although rare, DP most commonly occurs in older adult women and can cause significant distress. Patients often visit numerous medical specialties with the hope of identifying and treating the cause of their condition. However, especially in individuals without prior psychotic symptoms, symptoms are often puzzling to providers. Individuals may be referred for a neuropsychological evaluation, particularly as late-onset psychotic symptoms are not uncommon in neurodegenerative diagnoses. This study will describe a case of DP that was mistaken for Dementia with Lewy bodies (DLB). Participants and Methods: A 75-year-old female patient presented with a 10-year history of attempts to seek diagnostic clarification in the context of recurring delusions and tactile hallucinations pertaining to her skin (e.g., being infested by different worms or mold). She denied cognitive concerns though family members reported difficulties with organization and planning. Imaging revealed mild chronic microvascular ischemic changes and incidental right MCA/ACOM aneurysms. She has a remote history of alcohol use disorder (sustained remission) and uses tobacco chronically. Neuropsychological performance in 2014 was largely intact apart from a few areas of mild impairment and taken together with her tactile hallucinations, she was initially diagnosed with DLB. Subsequent providers considered a mood/anxiety disorder, psychotic disorder, and body dysmorphic disorder as differential diagnoses. The patient was repeatedly treated with atypical antipsychotics which had variable benefit, and at higher doses, caused her to develop symptoms of tardive dyskinesia. For unclear reason, she was repeatedly prescribed amphetamines, and symptoms became more severe during these times, frequently resulting in psychiatric hospitalization. Results: The patient was functionally independent. Consistent with prior records, the patient did not present with parkinsonism, orthostatic hypotension, or REM sleep behavior disorder. Neuropsychological test findings revealed largely intact cognitive functioning with mildly impaired psychomotor processing speed and variable visuospatial functioning suggestive of a relative weakness. Compared to her test results in 2014, cognitive functioning remained relatively stable, although her performance on visual memory tasks improved during this evaluation relative to initial testing. Based on stable and intact cognitive functioning over 10 years and lack of other supporting symptoms, a neurodegenerative condition, notably DLB, was ruled out. Conclusions: The striatal dopamine transporter (DAT) system is thought to be critical in the regulation of dopamine reuptake. Post-menopausal women can experience an age-related DAT density decline that may result in an abundance of available dopamine, which may trigger symptoms of DP. Further, substances such as amphetamines result in increased levels of dopamine which can exacerbated symptoms, as may have been the case with our patient. With a thorough history and available neuropsychological data, a diagnosis of DP could be made, and the patient could be referred to Psychodermatology for management and treatment of her condition. The medical trajectory of this case highlights the importance of critical consideration of symptom profiles, early diagnosis, and initiation of timely treatment to improve quality of life.

Poster

02/15/2024
02:30 pm - 03:45 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 05: Neuropsychiatry | Addiction/Dependence | Stress/Coping | Emotional/Social Processes

Final Abstract #32

Delusional Parasitosis: A Case Report

Lena Etzel, Emory University School of Medicine, Atlanta, United States
Suzanne Penna, Emory University School of Medicine, Atlanta, United States

Category: Psychiatric Disorders

Keyword 1: psychosis
Keyword 2: neuropsychiatry
Keyword 3: Parkinson's disease

Objective:

Delusional parasitosis (DP) is a disorder characterized by the belief that one has a parasitic infestation under their skin. Although rare, DP most commonly occurs in older adult women and can cause significant distress. Patients often visit numerous medical specialties with the hope of identifying and treating the cause of their condition. However, especially in individuals without prior psychotic symptoms, symptoms are often puzzling to providers. Individuals may be referred for a neuropsychological evaluation, particularly as late-onset psychotic symptoms are not uncommon in neurodegenerative diagnoses. This study will describe a case of DP that was mistaken for Dementia with Lewy bodies (DLB).

Participants and Methods:

A 75-year-old female patient presented with a 10-year history of attempts to seek diagnostic clarification in the context of recurring delusions and tactile hallucinations pertaining to her skin (e.g., being infested by different worms or mold). She denied cognitive concerns though family members reported difficulties with organization and planning. Imaging revealed mild chronic microvascular ischemic changes and incidental right MCA/ACOM aneurysms. She has a remote history of alcohol use disorder (sustained remission) and uses tobacco chronically. Neuropsychological performance in 2014 was largely intact apart from a few areas of mild impairment and taken together with her tactile hallucinations, she was initially diagnosed with DLB. Subsequent providers considered a mood/anxiety disorder, psychotic disorder, and body dysmorphic disorder as differential diagnoses. The patient was repeatedly treated with atypical antipsychotics which had variable benefit, and at higher doses, caused her to develop symptoms of tardive dyskinesia. For unclear reason, she was repeatedly prescribed amphetamines, and symptoms became more severe during these times, frequently resulting in psychiatric hospitalization.

Results:

The patient was functionally independent. Consistent with prior records, the patient did not present with parkinsonism, orthostatic hypotension, or REM sleep behavior disorder. Neuropsychological test findings revealed largely intact cognitive functioning with mildly impaired psychomotor processing speed and variable visuospatial functioning suggestive of a relative weakness. Compared to her test results in 2014, cognitive functioning remained relatively stable, although her performance on visual memory tasks improved during this evaluation relative to initial testing. Based on stable and intact cognitive functioning over 10 years and lack of other supporting symptoms, a neurodegenerative condition, notably DLB, was ruled out.

Conclusions:

The striatal dopamine transporter (DAT) system is thought to be critical in the regulation of dopamine reuptake. Post-menopausal women can experience an age-related DAT density decline that may result in an abundance of available dopamine, which may trigger symptoms of DP. Further, substances such as amphetamines result in increased levels of dopamine which can exacerbated symptoms, as may have been the case with our patient. With a thorough history and available neuropsychological data, a diagnosis of DP could be made, and the patient could be referred to Psychodermatology for management and treatment of her condition. The medical trajectory of this case highlights the importance of critical consideration of symptom profiles, early diagnosis, and initiation of timely treatment to improve quality of life.