Delusional Parasitosis case report

Male, 54 y.o., a successful chef, started at the age of 47 to display symptoms of a psychotic state. The patient reported the presence of lice under the scalp, felt their bites and movements, and believed that these are very special lice that can only be infected by pigeons. The patient was repeatedly examined by a dermatologist, before turning to a psychiatrist. The patient often douses his head with gasoline, and multiple wounds have emerged on his scalp due to his itching. There was no sign of self-judgment or insight at the start of therapy. Numerous attempts at pharmacotherapy were made - typical and atypical neuroleptics, mood stabilizers, augmentation – with no improvement. After several years of treatment, suicidal thoughts emerged, and he was referred to a psychiatric home-hospitalization program. Following protocol, ECT treatment started via ambulatory care and without hospitalization in the hospital. Under ECT, pharmacological treatment, and home hospitalization care with trained staff, the patient's symptoms almost disappeared within the first 15 sessions. But, symptoms of a stroke suddenly appeared (slurred speech and severe tremors and weakness in the hands were displayed). Examined by a neurologist, CT of the head, and MRI- no pathological findings were shown. These neurological symptoms made it impossible to complete ECT treatment, the patient returned to pharmacotherapy, with an atypical neuroleptic drug and a mood stabilizer. At the time of writing this, the patient is fully functioning, while his symptoms of psychosis are minimal and do not lessen his quality of life.