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Delusional infestation in the treatment of ADHD with atomoxetine
  1. Catriona F Howes1,
  2. Clifford Sharp2
  1. 1 Department of Psychiatry, NHS Borders, Melrose, UK
  2. 2 Psychiatry, Huntlyburn, NHS Borders, Melrose, UK
  1. Correspondence to Howes Catriona F; catriona.howes{at}

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In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.


The case describes an adult diagnosed with attention deficit hyperactivity disorder and treated with atomoxetine who quickly developed a florid case of delusional infestation. The patient described very distressing experiences that were significantly impacting her daily life. The symptoms improved with the withdrawal of atomoxetine and resolved completely with antipsychotic medications. Atomoxetine is proposed as the putative causative agent in this case.


Delusional infestation (DI), also known as Ekbom’s syndrome, is a disorder whereby an individual incorrectly believes that they are infested by living or inanimate pathogens despite the absence of any supporting medical evidence.1 2 DI can occur as a primary or secondary condition. In the latter, it can be as a result of a number of medical or psychiatric illnesses or due to substance use or prescribed medications. We are unaware of any other reports in which a case of DI is thought to be secondary to atomoxetine treatment. It is therefore of importance and interest to all who may prescribe this medication or treat those with attention deficit hyperactivity disorder (ADHD).

Case presentation

The patient is a 38-year-old, unemployed mother of two. She had been referred to the community mental health team by the child and adolescent psychiatrist treating her daughter for ADHD as it was felt likely that she suffered from this condition also.

A detailed assessment was undertaken over two 60 min appointments, including the use of the diagnostic interview for ADHD in adults (DIVA) and a collateral history obtained from her own …

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  • Republishing from Howes CF, Sharp C. Delusional infestation in the treatment of ADHD with atomoxetine. BMJ Case Rep 2018. doi:10.1136/bcr-2019-226020

  • Contributors CFH: assessed and treated the patient and performed literature review. CS: supervised CFH and provided oversight of written case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.