DELUSIONAL INFESTATION REVEALED THROUGH A MEDICO-LEGAL CONTEXT. CASE PRESENTATION
Abstract:
The article presents the case of a male patient, aged 74 years diagnosed with delusional
parasitosis, who is brought to the emergency room of the psychiatric hospital by the police and ambulance
after he torched the households of some neighbours to stop the spread of parasites in the neighbourhood,
being convinced that himself and his household are infested with lice. Psychiatric examination, physical
examinations and laboratory explorations have ruled out other psychiatric or somatic conditions that could
cause or explain the complaints. Secondary depressive and anxiety symptoms were insufficient to diagnose
any distinct or remitting affective or anxiety disorder, decreasing the acute psychotic symptoms. The
delirious symptoms developed gradually in the course of about two years, unnoticed by those around, in an
unmarried patient, living alone in rural area where infestations with parasites in animal breeders are
relatively common, with long-term preserved social and occupational functioning and a premorbid
personality with paranoid and anancast traits. Treated with Risperidone 2mg/day, delirious nucleus
dissolved gradually during maintenance treatment, as confirmed by patient’s assessment 4 weeks after
discharge. The case confirms the obsessive-compulsive role and paranoid personality traits (distinct sense of
cleanliness, responsibility, also interpersonal sensitivity, interpretation and overreaction in the context of
frustration) in the pathogenesis of the disorder. The case requires careful medical dispensary for assessing
compliance and continuous social monitoring because of the forensic potential, questioning the role of the
community and local authorities in identifying psychopathological decompensations with self and heteroaggression.
The presence of auditory and visceroceptive hallucinations consistent with the delusional theme
in the context in which the psychotic clinical picture is dominated by tactile hallucinations and delusional
ideation of non-bizarre infestation raises the issue of nosological classification, according to DSM-5, all the
other criteria of persisted delusional disorder being met.
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