The authors describe a forty-one-year-old female with possible monosymptomatic hypochondriacal psychosis (MHP): a delusional belief that she had contracted rabies. This is the first report of this type of delusion in MHP. The patient failed to respond to multiple somatic therapies and finally made a serious suicide attempt. The authors discuss the reasons for the failed treatment and suggest a sequential protocol for treatment of MHP based on the current literature.
AndrewsE.BellardJ.Walter-RyanW. G., Monosymptomatic Hypochondriacal Psychosis Manifesting as Delusions of Infestation: Case Studies of Treatment with Haloperidol, Journal of Clinical Psychiatry, 47:188–190, 1986.
2.
MunroA.ChmaraJ., Monosymptomatic Hypochondriacal Psychosis, A Diagnostic Checklist Based on 50 Cases of the Disorder, Canadian Journal of Psychiatry, 27:374–376, 1982.
3.
McKennaP. J., Disorders with Overvalued Ideas, British Journal of Psychiatry, 145:579–585, 1984.
4.
MatasM.RobinsonC., Diagnosis and Treatment of Monosymptomatic Hypochondrial Psychosis in Chronic Renal Failure, Canadian Journal of Psychiatry, 33:748–750, 1988.
5.
BrotmanA. W.JenikeM. A., Monosymptomatic Hypochondriasis Treated with Tricyclic Antidepressants, American Journal of Psychiatry, 141:1608–1609, 1984.
6.
JenikeM. A., A Case Report of Successful Treatment of Dysmorphophobia with Tranylcypromine, American Journal of Psychiatry, 141:1463–1464, 1984.
7.
PylkoT.SicignanJ., Nortriptyline in the Treatment of a Monosymptomatic Delusion (Letter), American Journal of Psychiatry, 142:1223, 1985.
8.
FermandoN., Monosymptomatic Hypochondriasis Treated with a Tricyclic Antidepressant, British Journal of Psychiatry, 152:851–852, 1988.
9.
SkottA., Delusions of Infestation, Reports from the Psychiatric Research Center, No. 13, St. Jorgen's Hospital, University of Goteborg, Sweden, 1978.
CummingsJ. L., Disorders with Overvalued Ideas, British Journal of Psychiatry, 145:16–26,1988.
12.
RossC. A.SiddiquiA. R.MatasM., DSM-III: Problems in Diagnosis of Paranoia and Obsessive-Compulsive Disorder, Canadian Journal of Psychiatry, 32:146–148, 1987.
13.
HollanderE.LiebowitzM. R.WinchelR., Treatment of Body-Dysmorphic Disorder with Serotonin Reuptake Blockers, American Journal of Psychiatry, 146:768–770, 1989.
14.
RenvoizeE. B.KentJ.KlarH. M., Delusional Infestation and Dementia: A Case Report, British Journal of Psychiatry, 150:403–504, 1987.
15.
BarskyA. J.KlermanG. T., Overview: Hypochondriasis, Bodily Complaints and Somatic Styles, American Journal of Psychiatry, 140:273–282, 1983.
16.
EgbertL. D.BattitG. E.WelchC. E., Reduction of Postoperative Pain by Encouragement and Instruction of Patients: A Study of Doctor-Patient Rapport, New England Journal of Medicine, 270:825–827, 1964.
17.
WooleyS. C.BlackwellB.WingetC., A Learning Theory Model of Chronic Illness Behavior: Theory, Treatment, and Research, Psychosomatic Medicine, 40: 379–401, 1978.
18.
CotterillJ., Dermatologic Non-Disease, British Journal of Dermatology, 104:611–619, 1981.
19.
BebbingtonP. E., Monosymptomatic Hypochondriasis, Abnormal Illness Behavior and Suicide, British Journal of Psychiatry, 128:475–478, 1976.
20.
FreinharJ. P., Delusions of Parasitosis, Psychosomatics, 25:47–54, 1984.
21.
KaplanH. I.FreedmanA. M.SadockB. J., (eds.), Comprehensive Textbook of Psychiatry (3rd Edition), Vol. 2, Williams and Wilkins, Baltimore, Maryland, 1980.
22.
MahorneyS. L.CavenarJ. O., A New and Timely Delusion: The Complaint of Having AIDS, American Journal of Psychiatry, 145:1130–1132, 1988.
