![]() ![]() On receiving the above treatment for 2 weeks, she reported a decreased feeling of insects crawling on her skin with sulpiride, and the sensation was gone about 3 weeks after initiation of the psychiatric drugs. ![]() Imovane was also prescribed for improving her sleep as required. Sulpiride was started orally at a dose of 50 mg/day and was gradually increased to 100 mg/day. Her clinical picture suggested delusional parasitosis. She had no memory decline and she scored 26/30 on the Mini-Mental State Examination. She did not have any mood or anxiety symptoms. She was convinced that there were insects on her body and would repeatedly demand her husband to sweep her body for her as she was unable to do so. She could only feel them and never actually saw or heard them. The feeling persisted throughout the day. The sensation happened daily all over the body including the limbs and trunk. She described a gradual onset of the insect-crawling sensation in the last 2 years, with increased intensity and frequency in the recent few months. Her illness was complicated by spastic paraparesis, hyperesthesia, neurogenic bladder, recurrent urinary tract infections, and extensive bedsores. She had a medical history of syringomyelia, with a cervical laminatomy of C5–C7 and syringo-subarachnoid shunting performed. She was seen at our outpatient clinic, complaining of a sensation of insects crawling on her skin for 2 years. She had no history of psychiatric illnesses and no history of illicit drug use. 6 There is no previous report of having tactile hallucinations in association with Arnold-Chiari malformation or syringomyelia. To our knowledge, four cases have been reported for an anxiety disorder, 1– 4 one case was associated with dysthymia, 5 and one case was associated with a schizophrenia-like psychotic disorder. To date, several case reports have highlighted the association of Arnold-Chiari malformation with psychiatric symptoms. Additionally, it demonstrates a rare association of syringomyelia with tactile hallucinations. This case highlights the importance of taking a detailed medical history in psychiatric setting, especially in patients with an underlying neurological condition. Her symptoms improved with an antipsychotic and a hypnotic. This report describes a patient who has syringomyelia (surgery was done more than 20 years ago), presenting with an insect-crawling sensation over the whole body in the last 2 years. To the Editor: There is a limited amount of literature about psychotic disorders in association with syringomyelia. ![]()
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