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Case Reports
. 2022 Jul 28;13(1):201-210.
doi: 10.1515/tnsci-2022-0230. eCollection 2022 Jan 1.

Long-acting paliperidone in Ekbom's syndrome in Lewy body dementia: A case report

Laura Orsolini  1 , Diana Corona  1 , Virginio Salvi  1 , Umberto Volpe  1
Affiliations
Case Reports

Long-acting paliperidone in Ekbom's syndrome in Lewy body dementia: A case report

Laura Orsolini et al. Transl Neurosci. .

Abstract

Introduction: Ekbom Syndrome (ES) is characterised by fixed, delusional beliefs that one's body is infested by parasites or other vermin in absence of supporting clinical evidence. Antipsychotic (AP) treatment, including long-acting injectable (LAI) AP in subjects with poor compliance, is prescribed to manage behavioural and psychotic symptomatology.

Objectives: We describe a 70-year-old woman who was hospitalised after experiencing new-onset delusions of infestation with visual and tactile hallucinations that led to bizarre behaviours and progressive social withdrawal.

Methods: She was diagnosed with ES and was initially treated with risperidone 3 mg; however, due to poor compliance and a lack of insight, she was switched to LAI palmitate paliperidone (LAI-PP). She was followed up for 8 months, administering Positive and Negative Syndrome Scale, Montreal Cognitive Assessment, Global Assessment of Functioning, Brief Psychiatric Rating Scale, neurocognitive assessment, and neuroimaging.

Results: After a progressive cognitive deterioration, she was diagnosed with an ES secondary to Lewy body dementia (DLB).

Conclusion: The LAI-PP treatment determined a complete clinical remission of psychotic symptoms despite the emergence of an iatrogenic akinetic-rigid syndrome. The delay of confirmatory neurological diagnosis, the associated risky behaviours of the patient, and poor treatment adherence led clinicians to prescribe LAI-PP following a good clinical response to oral paliperidone. However, in the case of a suspected DLB diagnosis, the prescription of an LAI-PP as a first-line strategy should be carefully evaluated.

Keywords: Ekbom syndrome; LAI; delusional parasitosis; long-acting injectable antipsychotic; paliperidone; paliperidone palmitate.

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Conflict of interest statement

Conflict of interest: The authors state no conflict of interest.

Figures

Figure 1
Figure 1
Brain MRI of the patient. The imaging was obtained at T 6 and shows global alterations suggesting a primary neurodegenerative condition. Relative preservation of medial temporal lobe volume can be observed.
Figure 2
Figure 2
DaT Scan of the patient. The imaging was obtained between T 7 and T 8.
See this image and copyright information in PMC

References

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