South African Psychiatry - February 2019

CULINARY CORNER
atrium of a large ten storey building where they chose
the floor that they wished to tackle first. Tasks were
graded from easier to more difficult and an attempt
was made for each challenge to be engaging and
entertaining. For example, one of them was: playing
a xylophone near the edge of a floor.
As expected, the researchers found the virtual reality
treatment to be associated with significant changes
in scores on the HIQ (mean change score: -24.5; SD:
13.1) as against the scores of those in the control
group (mean change score: -1.2; SD: 7.3). Treatment
uptake was high and levels of discomfort after a VR
session were very low.
The authors point out that the strength of VR treatment
is that patients are willing to go into situations that
trouble them and to try different ways of responding
because it is a simulation. The learning achieved in
this way has been found to transfer to the real world.
Use of VR can also offer one of the most powerful
aspects of a direct therapeutic intervention - namely
direct coaching in everyday situations that trouble
people.
MAIN MEAL
TREATING PARASITOSIS
The feeling of insects crawling on one’s skin is not in
itself unpleasant. However, it is irritating and most of
us will look quickly to see where the creature is and
swiftly flick or blow it away. How awful it must be if
the cause of the tickling sensation on one’s body
remains hidden - like a ghostly bug. This is a case of
a patient with parasitosis, reported on by Rathi and
Bhatia (2018) in the Indian Journal of Psychiatry.
THE INDIVIDUAL CONCERNED WAS A
THIRTY-FOUR-YEAR-OLD HINDU MALE
WHO WORKED IN AN ELECTRONICS
SHOP. HE WAS INITIALLY REFERRED TO A
DERMATOLOGIST ON ACCOUNT OF A
YEAR-LONG HISTORY OF FEELING THAT
AN INSECT WAS CRAWLING OVER HIS
LEGS AT NIGHT. PREOCCUPIED WITH
WORRY REGARDING THIS NOCTURNAL
PEST, HE SUSPECTED THAT HIS BEDDING
MIGHT BE INFESTED, DESPITE HAVING
WASHED IT OUT SEVERAL TIMES.
As might be expected, he was then directed to the
psychiatrists. The authors reported that they started
him on 4mg of blonanserin per day. After two weeks
they increased the dosage to 8mg per day. He was
also given 2mg of lorazepam at night to help him
with sleep (on an SOS basis). There was complete
remission of his symptoms at six weeks and on followup,
at three months, he continued to be well.
MIRROR THERAPY
From ghostly insects to ghostly limbs - it’s bad enough
when the existing parts of a person’s body produce
discomfort and suffering, but how disconcerting to
have one’s amputated body parts evoking pain too.
Phantom limb pain (PLP) happens when there is a
visual-proprioception dissociation in the brain. Mirror
therapy has been used to relieve PLP by resolving
this dissociation. However previous studies into this
treatment modality have been based on small
sample sizes.
Ramadugu et al (2017) carried out a randomized
single crossover study of mirror therapy in the
treatment of PLP in a sample of 64 amputees. The
participants (between the ages of 15 and 75 years)
were randomly distributed into test and control
groups. The test group were made to carry out a
standardized set of exercises for 15 minutes a day in
front of a mirror for 4 weeks. The control group carried
out these tests in front of a covered mirror.
A significant reduction in PLP was revealed in the test
group by means of the visual analog scale and the
short-form Mc Gill Pain Questionnaire (P