[Entomophobia and delusional parasitosis]

Entomophobia is an abnormal and persistent fear of insects. Sufferers experience anxiety even though they realize that most insects pose no threat. A similar phenomenon, known as arachnophobia is fear of spiders. Delusional parasitosis (DP) is a hypochondrial psychosis, usually monosymptomatic, where the patient is convinced of being infested with animal parasites while no objective evidence exists to support this belief. The complaints are usually about skin infestation, but involvement of the gastrointestinal tract has also been described. Numerous samples are brought for examination from their skin, clothes and environment. Practically all patients refuse psychiatric help. In primary DP, the delusion arises spontaneously as a monodelusional disorder, while in secondary DP, the delusional disorder arises secondary to another major medical, neurological or psychiatric disorder. Shared delusion -folie a deux- is a known phenomenon in delusional parasitosis. One or more members of the same family often suffer from the same psychosis, the characteristic delusional state being identical. The secondary victims are often family members, who are dominated by their spouses, show filial devotion or are trying to keep the family in harmony. Patients whose delusion of parasitosis is not severe can be helped without psychopharmacological intervention. They can be relieved of their symptoms by giving them sympathetic counseling, and gaining their confidence. Symptomatic medication may be prescribed for the relief of pruritus, pain and other symptoms. It is more important to treat patients with empathy, providing a place where they can express their distress without being stigmatized. Second-generation antipsychotics such as amisulpride, risperidone or olanzapine in age-appropriate doses are being used today for the treatment of DP.