- Letters to the Editor
- Psychiatric News June 1, 2007
- Volume 42, Number 11, page 24
- © 2007 American Psychiatric Association
- I am pleased to see that in the December 15, 2006, issue,
Psychiatric News drew attention to Morgellons disease and that the excellent
article gave sound advice on communicating with delusional parasitosis
patients. However, I would like to add comments about the distinction between
Morgellons disease and delusional parasitosis.
- I've evaluated and treated Morgellons patients, spoken
with researchers and other clinicians who work with these patients, read
the limited literature on the subject, and reviewed a database of 3,000
Morgellons patients. The Morgellons patients I have seen had surprisingly
similar symptoms, with an abrupt onset, often following a toxic exposure.
Before the onset of their illness, these patients' mental status appeared
to be quite representative of the general population, and some (including
physicians) were high-functioning professionals. The condition appears
more common in nurses, teachers, and in family members in the same household,
which suggests a contagious component.
- After the onset of the illness, these patients report
surprisingly similar symptoms. They have a combination of bizarre dermatological
sy mptoms, cognit ive impairments, mood disturbances, and sometimes paranoia
and suicide attempts in later stages of the illness.
- Their symptoms are not compatible with schizophrenia,
bipolar illness, substance abuse, or other recognized causes of delusions.
When patients complain of fibers protruding from their skin, examination
with a low-power digital microscope can visualize and photograph the presence
or absence of these fibers. In addition, many Morgellons patients test
positive for Lyme disease. The mental symptoms seen in Morgellons are similar
to those of other chronic general medical illnesses with psychiatric manifestations,
since the mental symptoms fluctuate in a pattern similar to that of the
general medical symptoms; and this suggests that the mental symptoms are
probably associated with immune and/or toxic effects upon the brain.
- When these patients are treated with modest courses of
antibiotics, their dermatological and psychiatric symptoms often show significant
improvement. Without a thorough assessment, Morgellons patients are commonly
given a diagnosis of delusional parasitosis, resulting in a delay in proper
treatment. Whatever Morgellons is, it is something very different and unique
and should be considered as a condition needing further study and possibly
listed in the next edition of the DSM.
- In summary, Morgellons disease and delusional parasitosis
are two distinct clinical entities. Morgellons does not appear to be an
imaginary or delusional illness and merits the research effort that we
see with any other emerging and serious illness.