reborbit.com has april 15th 2007 news article

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Morgellons: Disease or Delusions?
By Paquette, Mary

Is Morgellons a disease or a state of mind? Patients say it is an infection and they need medical treatment for the disturbing symptoms. Some dermatologists contend it is a case of delusional parasitosis, and the antipsychotic Orap relieves symptoms (Healy, 2006). Other physicians believe that the patients' wounds are self- inflicted. Either way, Morgellons disease has recently become a media headliner for TV, newspapers, and the Internet. The cause of Morgellons disease is currently a medical mystery. After several requests to the Centers for Disease Control and Prevention (CDC) by patients and politicians, the CDC initiated an investigation for potential causes in January 2006. Public health officials hope to rule out some unseen environmental toxin or new strain of infection. The epidemiologic investigation includes examining patients and collecting and analyzing tissue samples and strange fibers that seem to emerge from the flesh.

Symptoms

The symptoms of Morgellons read like horrifying science fiction that is not real or possible. Ask 46-year-old Donna Grace about her symptoms and she will tell you that they began in 2002 after receiving a flu shot and the injection site developed an infection.

Itching and crawling sensations under her skin began and would not abate no matter what she did. In July 2006, Grace says she felt a mass rumbling beneath her scalp and a few weeks later she felt a hatching of hundreds of thousands of tiny bugs that crawled around her head and down her back. "I felt like I was going crazy, and I knew I wasn't" (Healy, 2006, p. F. Individuals with this disease report disturbing sensations of bugs or worms crawling, stinging, and biting as well as nonhealing skin lesions, rashes, and wounds. "I am not crazy," patients proclaim when describing symptoms of fiber-like filaments that emerge from the flesh and the presence of black speck-like material and crystal-like granules under the skin. Nearly all people with this illness also report extreme difficulty with mental concentration and short-term memory. Patients often suffer chronic fatigue and what appear to be symptoms of depression, obsessive-compulsive disorder (OCD), and attention deficit disorder (ADD) (Morgellons Research Foundation, 2006).

Is It Delusional Parasitosis?

As in the DSM-IV-TR (APA, 2000) Delusional Disorder criteria, Morgellons patients are functioning in society, have no obvious signs of mental illness, and appear to have a nonbizarre somatic delusion. Many dermatologists say patients have been complaining of these symptoms for years and it is a dreadful, painfully real delusion. What are new are the name Morgellons and the online community that has developed and reinforces the reality of this psychotic condition (Healy, 2006). The prevailing conviction among most dermatologists that this is a delusion rather than a real disease results in patients not being taken seriously and further investigation being neglected. The physician fears reinforcing and making the patient's delusion worse. Adding to the confusion is that over half of all individuals with Morgellons disease also suffer from mood disorders such as depression and bipolar disorder. It is estimated that 65% of children with Morgellons have some form of psychiatric illness such as attention deficit/hyperactivity disorder, oppositional defiant disorder, mood disorders, or autism (Morgellons Research Foundation, 2006).

Dermatologist Mark Horowitz has treated patients with these symptoms for over 30 years and believes they have a "psychological disorder thaf s very limited in its spectrum" (Healy, 2006, p. F8A). Horowitz says that the recent upsurge in the disease and all the media attention can be directly traced to the Internet and information circulating widely online. Web sites have become a meeting place for patients who cannot find adequate medical help and turn to others with the same symptoms in hopes of finding relief from the nightmarish disease. Sociologist Robert Bartholomew, with the Australian government, says that the World Wide Web has become the incubator for mass delusion and it seems to be a socially transmitted disease over the Internet (Healy).

Is It a Disease?

The more than 5,000 sufferers of this malady believe that there is a new type of infection caused by a parasite, a worm, or a virus, and its source is still unknown. Morgellons disease is also referred to as the fiber disease and is, as yet, unrecognized by the medical community. Fibers are reported in and on skin lesions and are usually white, but clinicians also report seeing blue, green, red, and black fibers that fluoresce when viewed under ultraviolet light. As many as 94% who have Morgellons also test positive for Lyme disease (Morgellons Research Foundation, 2006). Preliminary evidence suggests that Morgellons disease is not delusions of parasites, according to Randy Wymore (2006), assistant professor of pharmacology and physiology, who has taken on the research challenge of Morgellons in his academic research. Wymore empathizes with the patients and believes that he and his team will find the etiology that will hopefully lead to successful treatment options. Dr. William Harvey of Houston (Fowler, 2004) says one parasite filament is confirmed as the infectious yeast Candida tropicalus. Others seem to be algae or mold, all common in moist areas.

Treatment

Very few medical practitioners recognize this disease or understand what the patients are going through. Today Ginger Savely, a nurse practitioner in San Francisco who specializes in this disorder and Lyme disease, is treating Donna Grace, who lives in southern California. After treating about 100 patients with Morgellons disease, Savely has developed several cocktails of antibiotics, antifungal, antiparasitic medications, and herbal supplements. She has even tried light therapy (Savely & Leitao, 2005). Savely says, "Whatever is causing this is extremely resistant or very adaptable" (Healy, 2006, p. F. Her protocols mostly provide symptomatic relief for all patients afflicted with the condition rather than a permanent cure. Aggressive, long-term antibiotic therapy has provided significant symptom relief in chronic Lyme patients, and is also being used with Morgellons patients. This seems to help some patients; however, if they are stopped the symptoms come back (Wymore, 2006).

Role of Psychiatric APRNs

It is important to note that a family nurse practitioner plays a significant role in treating Morgellons disease and providing real empathy toward a group of patients who have few places to turn to except the Internet for understanding. As psychiatric nurses we need to be aware of this disease so we are not too quick to side with the skeptics just because the symptoms are bizarre, like so many delusional symptoms we see in the mentally ill. Even though there is no evidence yet of what causes these strange and unrelenting symptoms, the CDC and other reputable scientists have taken on the challenge to uncover the mystery and provide answers for both patients and providers of care. Attention needs to be drawn to Morgellons so physicians and nurses are informed and able to make accurate diagnosis the first time the patient shows up for help. When we simply dismiss patients' painful symptoms as delusional when there is no physical evidence of fibers, granules, rashes, and unhealed wounds, we need to question our ability to shift our paradigms when reality challenges our educated beliefs. We need to be willing to believe in the unbelievable when it presents itself to us in the form of a suffering human being who has come to us for help with strange symptoms.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

Fowler, J. (2004). Segment 2: Mysterious parasite striking bay area residents. KTVU-FOX. San Francisco, CA April 30, 2004. Retrieved January 2, 2007, from http://www.ilads.org/ mysterious_parasite.htm

Healy, M. (2006, November 13). Disease: Real or state of mind? Los Angeles Times, Health Section, pp. FA, 8A.

Morgellons Research Foundation. (2006). Case definition. Retrieved December 21, 2006, from http://www.morgellons.org/

Savely, G. R., & Leitao. M. (2005). Skin lesions and crawling sensations: Disease or delusion? ADVANCE for Nurse Practitioners, May, 16-17.

Wymore, R (2006). Morgellons research. Retrieved December 21, 2006, from http://www.healthsciences.okstate.edu/morgellons/ research.cfm

Mary Paquette, PhD, APRN-BC

mary@artwindows.com

Copyright Nursecom, Inc. Apr 2007

(c) 2007 Perspectives in Psychiatric Care. Provided by ProQuest Information and Learning. All rights Reserved.



Source: Perspectives in Psychiatric Care


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