Morgellons disease treatment with quetiapine

Carrillo de Albornoz Calahorro, Carmen Maura; López-Delgado, David; Gutiérrez-Rojas, Luis

doi:10.1016/j.medcle.2018.03.038

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This cooperation prevails fundamental in the treatment of this disease.The symptoms are similar to those of delusional parasitosis/delusional infestation and it is therefore commonly considered to be a monosymptomatic delusional disorder, somatic type.<a class="elsevierStyleCrossRef" href="#bib0035">2</a>We present a 33-year-old white male patient who entered a psychiatric unit as a result of a skin lesion. He had the firm idea that he was infected by organisms with roots that penetrated his skin and that it itches so he could not stop scratching.He has been in follow-up at the mental and community health unit in his rural area since 2006 due to continuous paranoid schizophrenia with good therapeutic adherence to date. He has had three previous admissions in a psychiatric unit due to psychotic paranoid episodes in the context of toxic consumption. There were no skin lesions on these occasions or any type of somatoform disorder. For the past two years, he has started this scraping injury in the occipital region. His family doctor has tried various topical and oral treatments at this time because of an infection of the lesions, but the patient continued to manipulate the area and the lesion did not heal properly. The psychiatrist agrees the need for an urgent involuntary admission for hospital control of the injury and supervision by the dermatology department.On arrival at the emergency room, the patient had been receiving treatment with depot risperidone 50mg every 2 weeks and 40mg clotiapine before bed during 13 months. An emergency blood test was performed without any pathological findings.Physical examination showed a deep ulcer in occipital region, with abundant fibrin and granulation tissue and other smaller ulcers in the right shoulder could be appreciated. Previous scars on the upper side of the back could be seen. Cultures for bacteria and fungus were negative and a skin biopsy was performed showing a neutrophilic non-specific infiltrate compatible with the clinical diagnosis.Treatment with mupirocin and hydrocolloid dressing every 24–48h was prescribed with improvement of the lesions.The patient remained in the psychiatric unit for 4 weeks. During his stay he proceeds in exchange for antipsychotic being the current replaced by quetiapine starting at 25mg per day and reaching 450mg a day before hospital discharge. With this new drug, scratching was reduced considerably (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Assuming that parasites are not involved, chronic pruritus and delusional infestation arise from an underlying physiological or physical cause that triggers an itch pathway. Underlying psychiatric conditions may be linked to this pathway as well.Treatment of patients suffering from delusional infestation or from chronic pruritus is largely based on the patient's interpretation of the cause and the physician's response to that interpretation.Within the medical community, Morgellons disease it is generally held to be a variation of delusional infestation, which is usually treated with antipsychotics.<a class="elsevierStyleCrossRef" href="#bib0040">3</a>The classic treatment included typical antipsychotic agents but their extrapyramidal adverse effects at therapeutic doses make such treatments less practical. More recently, several reports suggested the atypical antipsychotic agents as potential alternatives because of their more favourable adverse effect profile.<a class="elsevierStyleCrossRef" href="#bib0045">4</a>Quetiapine seems to offer several advantages in the treatment of delusional disorders. In fact, it does not seem to increase the risk of extrapyramidal or anticholinergic symptoms and cardiovascular adverse effects. The most common side effects of quetiapine are drowsiness and dizziness. These side effects can be harnessed to decrease the sensation of pruritus and avoid permanent scratching.<a class="elsevierStyleCrossRef" href="#bib0050">5</a>Dermatologists and psychiatrist should collaborate closely to make an appropriated diagnosis and treatment of these cases. Diagnosis of delusional infestation is always an exclusion diagnosis and many other cutaneous diseases should be excluded previously.Authors’ contributionThe authors of this paper were responsible for conceiving and designing the evaluation, clinical data collection, clinical data interpretation, and drafting the manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contribution" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1200 "Ancho" => 1200 "Tamanyo" => 129245 ] ] "descripcion" => array:1 [ "en" => "Occipital injury in the initial and final phases." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delusional infestation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.W. Freudenmann" 1 => "P. Lepping" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2012.10995.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "2009" "volumen" => "22" "paginaInicial" => "690" "paginaFinal" => "732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19822895" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delusional parasitosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Madoz-Gurpide" 1 => "E. García Rees" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2004" "volumen" => "123" "paginaInicial" => "66" "paginaFinal" => "69" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Information, consent and treatment of patients with Morgellons disease: an ethical perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Söderfeldt" 1 => "D. Groß" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40257-014-0071-y" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "71" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24671866" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monosymptomatic hypochondriacal psychosis manifesting as delusions of infestation: case studies of treatment with haloperidol" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Andrews" 1 => "J. Bellard" 2 => "W.G. Walter-Ryan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Psychiatry" "fecha" => "1986" "volumen" => "47" "paginaInicial" => "188" "paginaFinal" => "190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3957878" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delusional parasitosis associated to mild cognitive impairment of vascular causation. good response to low doses of quetiapine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Pías-Peleteiro" 1 => "J.M. Aldrey" 2 => "G. Fernández-Pajarín" 3 => "B. Ares Pensado" 4 => "I. Jiménez-Martín" 5 => "A. Sesar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2015" "volumen" => "61" "paginaInicial" => "334" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26411279" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015200000003/v1_201901290746/S2387020618305473/v1_201901290746/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015200000003/v1_201901290746/S2387020618305473/v1_201901290746/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618305473?idApp=UINPBA00004N"]

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Vol. 152. Issue 3.

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