Delusions of infestation during delirium in a patient with restless legs syndrome

Area of Science:

• Neurology
• Psychiatry
• Geriatrics

Background:

• Restless Legs Syndrome (RLS) is a common neurological disorder, particularly in the elderly.
• Delirium is an acute confusional state often associated with underlying medical conditions like pneumonia.
• Delusions of infestation, characterized by the false belief of being infested with parasites, can be distressing.

Observation:

• A case study involving a patient who developed delusions of infestation during delirium secondary to pneumonia.
• The patient had a pre-existing diagnosis of restless legs syndrome (RLS).
• Tactile sensations associated with RLS were observed to precede the onset of delusional misinterpretations.

Findings:

• This case highlights the potential for sensory disturbances in RLS to manifest as delusional misinterpretations.
• Delirium, triggered by pneumonia, acted as a catalyst for the emergence of these delusions in a susceptible individual.
• The interplay between RLS-associated paresthesias and delirium-induced cognitive changes can lead to complex psychotic symptoms.

Implications:

• Clinicians should consider RLS in the differential diagnosis of delusions of infestation, especially in elderly patients presenting with delirium.
• Identifying and treating underlying causes of RLS, such as iron deficiency, may help manage associated sensory symptoms and prevent psychiatric complications.
• This case underscores the importance of a comprehensive medical and neurological assessment in patients with unexplained delusions.