Re: Happy to announce doc trip success!

Well, I don't know.
Maybe we can give him "the benefit" for a while.

However, what I'm not thrilled about is what m.d.'s are learning nowadays about patients with problems such as these on this forum. For example, check this out:



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(from
http://www.mja.com.au/public/issues/179_04_180803/le10588_fm.html )

"
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Delusional parasitosis, named in 1946,1 is a chronic psychiatric disorder in which patients have a false and fixed belief that they are infested by parasites. It is not a phobia.2 The core of the disease is the delusion of infestation and, although it is a psychiatric disorder, patients usually seek help from dermatologists.
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The prevalence of delusional parasitosis is unknown, but our literature review identified several hundred cases reported by dermatologists and entomologists.2,3,5,7,8 It can occur at any age, the average being in the fifth decade. In the older age group, women are more often affected than men.2,7 Mean duration of symptoms before attending tertiary care was 1.3 years in one study.8 Patients with no precipitating medical problems or psychiatric illness often have a personality disorder and isolate themselves, but function well in other aspects of their day-to-day living.3

Patients provide incredibly detailed descriptions of the “bugs” and explanations about why they are not visible on examination. They often bring in “specimens” in a small container, which are actually pieces of skin, lint or hair (“the matchbox sign”), or may identify “bugs” during examination by probing into skin until they are able to pick up a small piece of tissue. This may produce traumatic ulcers of varying size, typically on areas the patient can reach, in an asymmetrical distribution corresponding to the dominant hand. Secondary dermatitis may develop as a result of repeated washing and application of chemical preparations.2

Management involves first excluding a real infestation and any underlying condition, including psychiatric disorders, medical conditions with altered sensation, use of drugs (prescribed and illicit) or withdrawal from alcohol or cocaine. Mental state, including cognition, needs to be assessed. Other investigations may include examination of skin scrapings and skin biopsies.

In therapy, the most important step is to establish a trusting doctor–patient relationship. An empathic approach is required, acknowledging the reality of patients’ symptoms without challenging or confirming their views about the cause. Samples of any alleged parasites presented must be examined.

Ideally, patients should be referred to a psychiatrist, but many resist this. Consequently, medication with an antipsychotic should be initiated by the doctor who makes the diagnosis. Treatments include pimozide2,3,5,7 and the newer atypical antipsychotics, such as risperidone.9 Medication compliance can be a problem. There have been some reports that tricyclic antidepressants and anxiolytic agents alleviate the reactive component of the condition without much effect on the delusions.2,7 Doxepin has strong antihistamine and anxiolytic effects, in addition to its antidepressant effect, and, based on its effectiveness in chronic neurotic excoriation,10 may be useful in patients who frequently experience intense pruritus, anxiety and agitation as well as depressive symptoms. Corticosteroid creams and lotions may be helpful adjuncts to alleviate skin symptoms.

Lessons from practice

* Delusions of parasitosis may occur alone or in association with medical or psychiatric illness.
* Antipsychotic agents are the mainstay of medical management.
* Empathy and a good doctor–patient relationship are required to optimise outcome.

Competing interests: None identified.
"

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Talk about profiling!
Interesting to note how these guys are being taught to "tag" off-hand anyone who goes out for help with a possible specimen in their hands. That ought to teach us something when going to the doc, right?

Also interesting is how they're taught to "empathize" with the patient. Funny how the same thing is done by shrinks just before committing patients.

It all makes me SICK to my stomach.
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