Hindawi Publishing Corporation Case Reports in Psychiatry Volume 2012, Article ID 624235, 3 pages doi:10.1155/2012/624235 Case Report Delusional Parasitosis in a Female Treated with Mixed Amphetamine Salts: A Case Report and Literature Review Martha Buscarino,1 Jaime Saal,2 and Joel L. Young2 1 University of Michigan, Ann Arbor, MI 48109, USA 2 Rochester Center for Behavioral Medicine, 441 South Livernois Road, Suite 205, Rochester Hills, MI 48307, USA Correspondence should be addressed to Joel L. Young, jyoung@rcbm.net Received 12 June 2012; Accepted 16 August 2012 Academic Editors: T. Frodl, D. Matsuzawa, and N. Muller Copyright © 2012 Martha Buscarino et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. To explore factors underlying the onset of delusional parasitosis; a condition in which an individual has a ﬁxed, false belief that he/she is infested with insects. Case Description. MJ is a 57-year-old female who presents with symptoms of fatigue and AD/HD. Upon treatment with extended release mixed amphetamine salts, the patient displayed symptoms of delusional parasitosis. After eventual discontinuation of this medication, her delusions resolved. Comments. In order to maintain conﬁdentiality, all identifying information was removed. To this end, please note that MJ is a ﬁctitious name. 1. Introduction Delusional parasitosis is an uncommon psychiatric con- dition. It is characterized by a patient’s ﬁxed, false belief that he/she is infested with insects. This delusion persists despite an absence of medical evidence for infestation. The development of delusional parasitosis may be idiopathic or associated with exposure to various medications. The onset of the condition is multifactorial including the presence of psychiatric or neurological illness. Recent literature empha- sizes the use of atypical antipsychotic agents. This study reports the development of transient symptoms of delusional parasitosis after exposure to high levels of extended release mixed amphetamine salts. The symptoms quickly resolved after discontinuation of the oﬀending agent with no addi- tional treatment required. 2. Case Presentation MJ is a 57-year-old married Caucasian female who initially presented with chronic fatigue. In addition, she reported complaints of irritability, anxiety, and disturbed sleep. Upon further evaluation, the patient endorsed symptoms of generalized pain, impaired concentration, and motivation. She emphasized chronic disorganization, forgetfulness, low energy, and a subjective inability to initiate and complete daily tasks. Although her complaints of fatigue were longstanding, MJ’s treatment began ﬁve years earlier. Having worked with various primary care doctors and psychiatrists, she was frustrated that trials of antidepressant medications, including escitalopram and ﬂuoxetine, had not been helpful. Augmentation with bupropion and risperidone had also proven ineﬀective. At the time of evaluation she was taking duloxetine 60 mg per day. Various eﬀorts at physical therapy and chiropractic care did not yield lasting beneﬁt. MJ had previously pursued speciﬁc evaluation for chronic fatigue. Several years ago she was diagnosed with Epstein Barr virus. She was treated with intravenous antiviral agents but derived no more than a transient response. At her current presentation, MJ was being treated with levothyroxine, although her TSH was never detected to be abnormal. She suﬀers from mild gastroesophageal reﬂux disease for which she is prescribed omeprazole. After an extensive psychiatric interview, various diag- nostic screeners were administered. These included the Hamilton Depression Inventory [1], the Conners Adult ADHD Rating Scale (CAARS) [2], Millon Clinical Multiaxial