Aripiprazole as a treatment option for delusional parasitosis: case series of 8 patients

OBJECTIVE: Delusional parasitosis (DP), also known as Ekbom’s Syndrome, is a rare, generally monosymptomatic disorder that characterizes with the fixed belief of being infected by parasites without any evidence of medical or microbiological proof. These patients are examined in dermatology and infection clinics with symptoms and signs of pruritus, skin and subcutaneous scars secondary to itching. Primary DP is diagnosed when no etiological factor is detected while secondary DP arises from underlying physical or mental disorder. Formerly, pimozide was the commonly preferred choice of treatment with cases of DP. However, there is growing evidence that second-generation antipsychotics and antidepressants can be used in the treatment of DP. In this study, the usage of aripiprazole in the treatment of DP cases is presented.

METHODS: 8 patients with the diagnosis of primary DP were evaluated in terms of demographic data, clinical variables and responses to treatment. A psychiatric diagnosis was made based on a clinical interview performed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) SCID-I. The patients were followed for six months. Three patients were female, five patients were male. The average age of the patients was 57.5. Four patients had essential hypertension as comorbidity. The duration of the symptoms ranged from 6 to 48 months with an average of 24.75 months. All of our 8 cases were consulted by the dermatology department. The patients were performed Hamilton Depression Scale (HDS) and Mini-Mental Status Examination (MMSE). Eight patients were treated with aripiprazole 10 or 15 mg/day, and no dose alteration was made.

RESULTS: From the patients who were treated with aripiprazole, seven (87.5%) patients had complete remission after three months, eight (100%) patients achieved complete remission after six months.

DISCUSSION: The earliest drug choice for patients with DP was pimozide, but because of the extrapyramidal side effects and cardiac side effects like QTc prolongation, second-generation antipsychotics are being investigated for treatment. Various researches are available related to the usage of second-generation antipsychotics like risperidone, olanzapine, paliperidone, ziprasidone, quetiapine, and aripiprazole in the cases with DP. This study shows that aripiprazole can be a successful treatment choice for DP, but further studies are needed for this topic.