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Ekbom’s syndrome (delusional infestation) and body dysmorphic disorder
Published in David Enoch, Basant K. Puri, Hadrian Ball, Uncommon Psychiatric Syndromes, 2020
David Enoch, Basant K. Puri, Hadrian Ball
The treatment approach to Ekbom’s syndrome is based on the following principles:If the disorder occurs as a symptom of another condition, then the treatment must be directed at the latter. For example, if a strong affective element is present, ECT or other antidepressant treatment may be reasonably successful in bringing about a degree of relief (Gupta et al., 1986; Dowson, 1987).In those cases where the disorder exists in isolation, antipsychotic medication is the treatment of choice. Pimozide may be worth a trial, but despite its advocates (Munro, 1978; Avnstorp et al., 1980; Lindskov and Baadsgaard, 1985; Mitchell, 1989), any claim for superiority over other neuroleptics is uncertain and issues of drug safety must be borne in mind (Freudenmann and Lepping, 2009). Other antipsychotics which have been advocated include aripiprazole (Carpiniello et al., 2011; Yeh et al., 2014), blonanserin (Bhatia et al., 2013), clozapine (in combination with citalopram) (Cupina and Boulton, 2012), olanzapine (Kansal et al., 2012), paliperidone (Albayrak et al., 2011; Altinoz et al., 2014) and ziprasidone (Contreras-Ferrer et al., 2012; De Berardis et al., 2013). In a study of 17 consecutive delusional infestation patients attending an Italian psychiatric outpatient clinic, Huber et al. (2011) reported that the vast majority (88%) benefitted from antipsychotic treatment, with an average duration of treatment of 3.8 years. However, in a cross-sectional study of 69 patients with delusional infestation receiving treatment at a London psychodermatology clinic, Ahmed and Bewley (2013) found that the compliance with psychotropic medication, which included second-generation antipsychotic drugs and antidepressant drugs, was around only 59%.A psychotherapeutic approach, especially when combined with appropriate medication, may be helpful. A symptom-free remission in an “infested” patient who was the dominant partner in a folie imposée following weeks of supportive psychotherapy alone has been described (Macaskill, 1987).
Comparison of long-term efficacy and safety of blonanserin treatment in individuals with first-episode and relapsed schizophrenia: a 3-year retrospective study
Published in Psychiatry and Clinical Psychopharmacology, 2019
In conclusion, blonanserin is effective in improving symptoms and preventing relapse of schizophrenia. Moreover, during the 3-year study period, there were no statistically significant differences in prolactin, LDL, HDL, and glucose levels, and there was a minimal increase in weight. Additionally, based on the length of this study period, the results suggest that blonanserin is highly effective in boosting medication adherence in long-term treatment.