Ekbom syndrome treated with olanzapine: A case report

Objectives: Ekbom syndrome is a rare psychiatric disorder also known as delusional parasitosis or delusional infestation or dermatozoic delusion. There is no consensus on the most appropriate treatment. Traditionally, typical antipsychotic pimozide has been considered as first choice. Due to the side effects of typical antipsychotics, atypical antipsychotics (AA) can be taken into consideration as a valid alternative. Method: We report a case of Ekbom syndrome treated with olanzapine. We examined the case of a 69-year-old woman. About three years ago, the patient began feeling as if infested by worms and eggs after a butterfly landed on her hair. She referred that the worms were spread throughout her body and amassed under her skin, and in her eyes, mouth, nose and genitals. The patient perceived materials such as lint or skin debris as worms and eggs, and collected them in pieces of paper as "proof" of infestation. The patient believed to have infected her husband and was worried about infecting other family members. The patient had a history of recurrent depressive episodes with many admissions to psychiatric wards. Results: The patient agreed to be hospitalized and to be treated with antipsychotics. Olanzapine was administered. The initial dose was 5 mg/day, then increased stepwise to 20 mg/day. After about 4 weeks, the patient showed improvement regarding her delusion: she improved her critical ability about the infestation; appetite and sleep also improved. Conclusions: This case report shows the efficacy of olanzapine in this type of disturbance, and that can be used as a first-line agent in delusional parasitosis. In addition to drug therapy, establishing a therapeutic alliance was crucial. In fact, while at the beginning the patient was reluctant to accept psychiatric help, at the end a good therapeutic alliance was established and she was fully adherent to pharmacotherapy.