I’ve decided to describe a largely unacknowledged process of disease pathogenesis that I will call folie a news. To explain though, I’ll have to first discuss a disease called delusional parasitosis.
Delusional parasitosis (DP – sometimes called Ekbom’s disease) is a lot like what it sounds like. Normal or abnormal sensations of itching are interpreted by the patient as being bug bites, or bugs traveling under the skin despite the absence of histological evidence of a parasitic infection. This is what is known as a “fixed delusion” and it becomes an obsession for the patient. The disease has a few known organic causes such as amphetamine or cocaine-use and many common co-morbities including diabetes, schizophrenia, fibromyalgia, chronic fatigue syndrome, lyme disease and depression.(1) Patients usually present to a dermatologists office complaining of sensations of itching and biting from insects, and frequently carry in samples of skin or lesions they’ve scratched off – this is referred to as “matchbook sign” in that the patients would often present with their skin scrapings in a small box like a matchbook. These days it’s probably more likely to be “zip lock sign”.
12% of DP patients present with what is known as folie a deux(literally madness of two) in which the patient is not the primary sufferer of the delusion, but has adopted the delusion of another patient – usually a spouse or other family member.(2) It’s also important to remember that these people may be perfectly rational in every other way, but have just this single fixated delusion. Also, the feelings they’re having are real – one must not tell them it’s just “in their head” – it’s just what they’re ascribing them to is off . Further treatment with atypical anti-psychotics – which is effective a majority of the time – should be broached carefully as people feel stigmatized by diagnoses of mental illness.
Now keep these things in mind while watching the following video that grrlscientist blogged this weekend about people who think bugs are crawling out of their skin.
(video and more below the fold)
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