Self mutilating behaviour in monosymptomatic hypochondriacal psychosis

Abstract

INTRODUCTION Delusional parasitosis is an infrequent psychotic illness characterized by an unshaken belief of having been infested by a parasite when one is not.[1] It is also called Ekbom syndrome after the Swedish neurologist Karl Axel Ekbom who did seminal work on this entity.[2]Primary delusional parasitosis consists primarily of a single delusional belief of having been infested by parasite and comes under monosymptomatic hypochondriacal psychosis.[3] Discrete bruises, nodular pruritis, ulcers, and scars are frequently produced by patient trying to extract the parasite.[4] Patient injure themselves to get rid of parasites or present to health professionals for help. They may even bring dust, fibers, scab, or debris excoriated from the skin as evidence for inspection in, for example, a matchbox, often called as “match-box sign.”[5] Morgellons, which refers to cutaneous symptoms like biting, crawling, or stinging sensation, finding fibers on or under skin, and persistent skin lesions, are often seen in delusional parasitosis.[6] Morgellons disease (MD) is a disfiguring and completely baffling skin condition associated withspirochetal infection and tick-borne illness. The distinguishing diagnostic feature of MD is appearing ulcerative skin lesions that contain unusual filaments lying under, embedded in, or projecting from the skin. The characteristic filaments are microscopic, visually resembling textile fibers, and are white, black, or more vibrant color. In addition to fiber production, some patients may experience formication, described as stinging, biting, creeping and crawling sensation. CASE REPORT The patient came to psychiatry opd in santosh medical college with c/o infestation of skin by threads coming out of skin over face, abdomen and limbs start from eye since 4 years. Patient started feeling threads coming out of skin after operation in right eye for entropion after which she started developing these symptoms. Patient brought to hospital by neighbour when she noticed multiple unhealed skin lesion which was developed when patient try to cut skin by blade or scissor for taking out thread and insect this was present on right side of body. She tells if the thread not removed from area lateral to eye, it will fill up in the eye socket and causes unbearable pain, thus she tries to pull out the thread continuously and it also reaches the skin of chest and abdomen. Sometimes she makes a wound over skin by sharp object like blade to pull out the threads. This delusional behavior is present persistently from four year period for which she took multiple consultations. DISCUSSION The local exam and investigation were normal. These patient commonly seek attention of dermatologist or physicians and may continue seeking different therapies in search of a cure. Most of the reports are from the dermatologic literature and the exact prevalence is not known.[7] Patient sought treatment primarily from physicians and could come to psychiatric attention only when he presented with depressive feature secondary to his delusional belief Treatment primarily involves use of antipsychotics.[8] It also involves management of primary psychological and medical condition in case of secondary or organic delusional parasitosis respectively.[4]

Imprint

Sakshi Sharma, Ram Mehar, Shubhkarman Singh Saini, Nitish Verma, Vivek Pathak, Brijesh Saran, A. K. Seth. Self mutilating behaviour in monosymptomatic hypochondriacal psychosis. Cardiometry; Issue 25; December 2022; p.1431-1432; DOI: 10.18137/cardiometry.2022.25.14311432; Available from: https://www.cardiometry.net/issues/no25-december-2022/self-mutilating-behaviour