Episode 978: Delusional Parasitosis

Episode 978: Delusional Parasitosis

Contributor: Taylor Lynch, MD

Educational Pearls:

  • Delusional parasitosis is a subtype of the psychiatric condition delusional disorder
    • Defined as a fixed, false belief of infestation by parasites or other organisms
    • A somatic type of delusional disorder
  • Primary delusional parasitosis
    • Occurs in the absence of other psychiatric or medical conditions
  • Secondary delusional parasitosis
    • Causes include methamphetamine use disorder, schizophrenia, neurologic diseases, or medical conditions such as thyroid disease
  • Pathophysiology
    • Poorly understood
    • Upregulation of striatal dopamine system is implicated
  • Management
    • Form a strong therapeutic alliance and do not discredit the patient immediately
    • Perform a full physical exam
      • This helps reassure the patient and strengthen the therapeutic alliance
      • Some day there may be a patient in whom this is not a delusion
  • Treatment & Management
    • Discontinuation of substances if substance-induced
    • Antipsychotic medications like risperidone or olanzapine

References

  1. Lepping P, Russell I, Freudenmann RW. Antipsychotic treatment of primary delusional parasitosis: systematic review. Br J Psychiatry. 2007;191:198-205. doi:10.1192/bjp.bp.106.029660
  2. Moriarty N, Alam M, Kalus A, O'Connor K. Current Understanding and Approach to Delusional Infestation. Am J Med. 2019;132(12):1401-1409. doi:10.1016/j.amjmed.2019.06.017
  3. Skelton M, Khokhar WA, Thacker SP. Treatments for delusional disorder. Cochrane Database Syst Rev. 2015;2015(5):CD009785. Published 2015 May 22. doi:10.1002/14651858.CD009785.pub2

Summarized and Edited by Jorge Chalit, OMS4

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