1/3. superinfection: another look.superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved. We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections. Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, whould reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. An approach to the treatment of psychogenic parasitosis.BACKGROUND: patients with psychogenic parasitosis typically seek help from nonpsychiatric physicians and can be difficult and time-consuming to treat. pimozide has been promoted as the treatment of choice but is not indicated for every patient presenting with this symptom. Our purpose was to develop a realistic treatment protocol for the nonpsychiatric physician faced with these patients. methods: Using what is known about this problem through review of the literature and our own experience with 20 patients, a practical treatment strategy is suggested. RESULTS: It is proposed that dermatologists and primary care professionals seeing these patients determine (1) whether or not the patient's belief in infestation is shakable and (2) whether or not the patient is depressed, in order to chose a therapeutic plan. CONCLUSIONS: Dermatologists and psychiatrists can work together to develop treatment protocols that minimize risk and maximize therapy for patients with psychogenic parasitosis.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/3. delusional parasitosis in the elderly: a review and report of six cases from northern finland.A patient with delusional parasitosis has a strong conviction of being infested with parasites: for example, lice or worms. Such a patient is not satisfied with assurances or test results that no parasites are present, but is so convinced that he or she will go as far as to bring the parasites in "matchboxes" to a physician. Subjectively worried, the patient may try to pick the parasites out of the skin, causing cutaneous lesions and even ulcerations. The condition is classified as a delusional/paranoid disorder, somatic type according to DSM-III-R. Not much is known epidemiologically of this rare disorder, which usually affects older women who often are isolated socially. Therapy is regarded as difficult, and a wide variety of treatment methods have been attempted. In this article six female cases are presented, showing that a typical patient is an elderly woman who has suffered losses or is socially isolated. These patients lack deeper psychiatric insight into their problem, so they are mostly in the care of nonpsychiatric physicians. Treatment with a low dose of high-potency neuroleptics combined sometimes with antidepressants appears to be effective. Reducing social isolation is also important.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |