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Brief cognitive behavioural therapy for post-stroke ‘delusional infestation’ in a 71-year-old man: a single case experimental design

Published online by Cambridge University Press:  06 July 2020

Aimee I. McKinnon Open the ORCID record for Aimee I. McKinnon [Opens in a new window]  and
Rebecca Dow
Aimee I. McKinnon*
Affiliation:
Oxford Institute for Clinical Psychology Training and Research, Oxford University, Oxford, UK
Rebecca Dow
Affiliation:
Older Adult Psychological Services, Buckinghamshire Healthcare NHS Trust, UK
*
*Corresponding author. Email: aimee.mckinnon@hmc.ox.ac.uk
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Abstract

Background:

Delusional infestation is a condition at the interface of tactile and visual hallucinations and delusions. Individuals with this condition hold the fixed and false belief that their body or their environment is infested with parasites, insects or other organisms.

Aims:

There are no guidelines or publications detailing the psychological assessment, formulation, intervention and evaluation of this presentation. This paper aims to address this gap.

Method:

Single case experimental design methodology was employed to evaluate the use of cognitive behavioural therapy (CBT) for delusional infestation in a 70-year-old male who was intolerant of anti-psychotic medication. ‘Tom’ had a large, mature infarct in the middle cerebral artery territory as well as a left posterior parietal infarct post-stroke, which may have precipitated his symptoms. After a baseline period of 3 weeks, Tom received eight sessions of CBT based on the model by Collerton and Dudley (2004).

Results:

Post-intervention, there was a reliable improvement on clinical measures as well as a large reduction in distress levels, which was maintained at 3-month follow-up. The conviction in the belief that the infestation was real did not shift.

Conclusion:

This case demonstrated the potential for the use of CBT to address distress related to delusional infestation. This work is discussed in relation to post-stroke psychosis, psychological therapies with older adults, and suggestions are made for future research.

Keywords

CBTcognitive behavioural therapydelusional infestationdelusional parasitosisolder adultorganic hallucinosispost-stroke psychosissingle case experimental designstroke
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 6 , November 2020 , pp. 717 - 724
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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