Delusion of Parasitosis
Today a patient came to me with the typical history of Delusion of Parasitosis. He thinks that his middle ear cavity is infested with insects. He has already consulted many Dermatologists and ENT surgeons. Many of them have suggested psychiatric evaluation which the patient has vehemently declined. Textbooks say that the doctor should take a neutral stand neither accepting his delusion thereby reinforcing it nor out rightly rejecting the delusion which will antagonize the patient. I wrote the diagnosis down on a piece of paper and told him to go to the internet and study about the condition. If he returns to me, I will refer him to a psychiatrist. Drugs like pimozide are controlled in this country. It is difficult for a dermatologist to start such medications.
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I had a gentleman who used to insert anything he could lay his hands on into his ear canal to remove the so called block.Altho it looked clean to me he deftly inserted a pin and with circular motion extracted a lump os soft scales!This man was referred to me by the ENT specialist.
Interesting!
This patient just thinks that he is infested. He could never remove anything from the ears. Even his level of conviction was low and he seemed to be open to suggestions.