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Delusional Infestation Successfully Controlled With Neuroleptic Depot Injection: A Case Report

Jamaluddin Ruzita, Najwa Baharuddin, Nurul Hazwani Hatta


Objective: Delusional infestation is a psychiatric condition in which a patient belief that they are infested with living organisms in the absence of any objective evidence. The objective of this case report is to highlight a rare case of delusional infestations in a patient with schizophrenia who misusing polysubstance abuse.

Methods: We report a case of 36-year-old Malay gentlemen, unemployed, married with three children, known case of schizophrenia since 2013, with history of polysubstance abuse presented to the emergency department with symptoms of itching followed by a sensation of insects crawling, biting and burrowing under the skin on his head causing an ulcerated wound.

Results: He was diagnosed to be suffering from schizophrenia and was successfully treated with monthly antipsychotic depot injection in view of his poor adherence to medication On examination, ulcerated scalp wound measuring 4 x 4 cm was noted at the parieto-occipital region of the scalp. Skull X-ray and computerized tomography (CT) scan of the brain were normal. Electroconvulsive therapy (ECT) was introduced in view of slow treatment response and self-inflicted injury. The symptoms were successfully controlled after eight months, and no extrapyramidal side effect was observed.

Conclusion: Patients with delusional infestation often poorly adhered to his treatment medication and the usage of depot injection of antipsychotic may benefited some patients to control the psychotic symptoms.

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Delusions; Infestations; Neuroleptic treatment; Case Report

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