EKBOM'S SYNDROME
Description
● Definition:
➣ A person with Ekbom's Syndrome, a rare mental illness, has a persistent, unfounded conviction that parasites (such as insects, worms, or mites) are infesting their skin, body, or environment, even in the face of overwhelming medical proof to the contrary.
➣ According to psychiatric diagnostic standards, it is categorised as a somatic type delusional disease.
● History:
➣ Swedish neurologist Karl-Axel Ekbom first reported it in 1938. The characteristic is the lack of objective proof, which is sometimes mistaken for actual parasite infections.
● Clinical Features:
➣ Core Symptom: Constant perception of infestation (burrowing, biting, and crawling parasites).
➣ Sensory Experiences: Patients frequently talk about formication, which is the feeling of insects scuttling on or beneath their skin.
➣ Behavioural indicators:
• excessive skin picking, itching, or chemical usage to "disinfect" oneself.
• Presenting physicians with "evidence" (such as lint, skin flakes, scabs, and fibres), sometimes referred to as the "matchbox sign."
• Skin Lesions: As a result of plucking, scratching, or applying caustics.
• Psychiatric State: Aside from this entrenched belief, patients may otherwise seem reasonable.
● Types:
➣ Primary Ekbom's Syndrome:
• Just delusions without any other mental health conditions.
➣Secondary Ekbom's Syndrome (Functional):
• Linked to mental illnesses such as dementia, depression, or schizophrenia.
➣Secondary Ekbom's Syndrome (Organic) :
→ connected to neurological and medical disorders like:
• Parkinson's disease;
• peripheral neuropathy;
• vitamin B12 insufficiency;
• diabetes mellitus;
• substance misuse, particularly cocaine, amphetamines, and alcohol withdrawal.
●Differential diagnosis:
➣Actual parasite infection (lice, scabies);
➣ Dermatological disorders that cause itching (psoriasis, dermatitis, eczema).
➣Paraesthesia due to neurological conditions (multiple sclerosis, neuropathy).
➣ Hallucinations caused by substances (methamphetamine, cocaine).
●Complications include:
➣Risk of subsequent bacterial skin infections;
➣ Social isolation and reduced quality of life;
➣ Severe skin damage from scratching or the use of dangerous drugs.
➣The doctor-patient relationship was strained as a result of the emphasis on infestation.
● Diagnosis:
• Lab testing (skin scrapings, blood work, microscopy) to rule out parasites;
• Thorough history and physical examination to rule out actual infestation.
• A psychiatric assessment to validate delusions.
Protocol
● Management:
➣ Establishing rapport:
• Refrain from openly questioning the misconception since this might undermine trust.
• Compassionate hearing and comfort.
➣ Pharmacological Intervention:
• The cornerstone is antipsychotics
• Older: Pimozide (used historically, but use is limited due to cardiac adverse effects).
• More recent atypical antipsychotics include aripiprazole, olanzapine, and risperidone.
• Comorbid depression treated with antidepressants.
➣ Non-pharmaceutical Methods:
• CBT, or cognitive-behavioral treatment.
• Support groups and psychoeducation.
● Issues Nurses Face in Ekbom's Syndrome:
➣ Communication Issues:
• Patients may refuse psychiatric referrals or assurances because they firmly feel infected.
• If nurses deny infestation outright, there is a high chance of mistrust and confrontation.
➣ Non-Adherence to Treatment:
•Patients frequently refuse antipsychotics, which are mental meds, claiming they want antiparasitic or dermatological treatments instead.
➣Self-harming injuries:
• Constant picking at the skin, itching or using dangerous substances (pesticides, bleach, kerosene).
• Causes scarring, infections, and wounds.
➣ Psychological Anxiety:
• Severe social disengagement, anxiety, sadness, and sleep issues; in extreme situations, suicidal thoughts may occur.
➣Overuse of Medical Services:
• Repetitive testing, many consultations, and frequent medical visits might cause nurses to get frustrated and burned out when dealing with these expectations.
➣ Stigma and Isolation: Patients frequently experience rejection, which exacerbates their mistrust of medical personnel.
● Ekbom's Syndrome Nursing Management:
Safety, therapeutic communication, symptom management, and adherence support are the main goals of nursing care.
➣Building a Therapeutic Relationship:
• Develop trust by attentively listening without challenging the misconception.
• Speak neutrally: state "we could try treatments that may reduce the sensations you are experiencing" rather than "there are no parasites."
• To prevent distrust, give constant attention.
➣ Encouraging safety:
• Keep an eye out for infections, self-inflicted wounds, and harmful substance usage.
• Gently teach the patient about proper hygiene and skincare.
• When required, tend to wounds.
➣ Medication Management:
• Promote compliance with antipsychotic and/or antidepressant prescriptions.
• To guarantee integrated treatment, work with dermatologists and psychiatrists to monitor for drug adverse effects.
➣ Psychological Support:
• Use soothing methods (deep breathing, relaxation, and regimented routines) to lessen anxiety.
• Promote verbal communication of anxieties rather than damaging scratching.
• If the patient is receptive, refer them to counselling or CBT.
➣ Support from Family and Society:
• Teach family members to refrain from feeding delusions (e.g., not looking for parasites).
• Instruct them on constructive communication techniques.
• Involve family members in wound care monitoring and treatment compliance.
➣ interdisciplinary collaboration.
• Collaborate with dermatologists to rule out actual infestations
• Work with psychiatrists to manage antipsychotics.
• Involve social workers to help with isolation reduction and home support.
➣ Health Education:
• Discuss how medical conditions that might exacerbate skin feelings, such as stress, exhaustion, or diseases, can be taught.
• Promote proper sleep, hydration, and diet.
• Discourage the use of chemicals for dangerous self-treatment.
Ekbom's Syndrome Nursing Care Plan (NCP)
Diagnosis in Nursing:
← Disturbed Cognitive Functions
➣ Objectives/Results:
• The patient will become less fixated on the infestation;
• The patient will gain trust and take part in treatment.
➣ Interventions:
• Develop a therapeutic alliance and engage in active listening.
• Make neutral remarks rather than actively contesting hallucination.
• Promote diversions and activities that are grounded in reality.
→ The possibility of self-mutilation
➣ Objectives and Results:
• Skin integrity will be preserved by the patient.
• Within a week, lesions will begin to heal.
➣Interventions:
• Keep an eye out for infections and wounds.
• Offer advice on safe skincare practices and wound care.
• Discourage the use of dangerous chemicals, such as insecticides and bleach.
• Offer substitute coping mechanisms, such as relaxation techniques or stress balls.
→ Anxiety
➣ Objectives/Results:
• The patient will express feeling less anxious.
• The patient will employ a minimum of one coping mechanism.
➣ Interventions:
• Preserve a composed, orderly atmosphere.
• Provide relaxing techniques, such as guided visualisation and deep breathing.
Encourage the sufferer to express their anxieties in words.
• As directed, provide prescription antipsychotics and anxiolytics.
→ Failure to Follow Treatment
➣ Objectives and Results:
• The patient will take their medications as directed;
• The patient and their family will comprehend the need for therapy.
➣ Interventions:
• Educate patients about medications (focus on sensory alleviation, not "delusion").
• Encourage adherence by including the family.
• Track and record adherence to medicines.
→ Social Isolation
➣ Objectives and Results:
• The patient will interact with others on a daily basis;
• The patient will experience a decrease in feelings of loneliness and an increase in support.
Interventions:
• Promote involvement in ward activities or group therapy.
• Communicate in a nonjudgmental and encouraging manner.
• Connect patients with support groups or local services.
Notes
1.Gay P, Bayssade-Dufour C, Grenouillet F, Bourezane Y, Dubois JP. Etude expérimentale de dermatites cercariennes provoquées par Trichobilharzia en France [Experimental study of cercarial dermatitis induced by Trichobilharzia in France] Med Mal Infect. 1999;29(10):629–37. [Google Scholar]
2.Wilson N. Acarina: Mesostigamata: Halarachnidae, Rhynonyssidae of South Georgia, Heard and Kerguelen. Pac Insect Monog. 1970;23:71–7. [Google Scholar]