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Area of Science:

  • Psychiatry
  • Dermatology
  • Neurology

Background:

  • Delusional infestation (DI), also termed delusional parasitosis, is characterized by a patient's fixed false belief of being infested by organisms or substances.
  • Patients often report infestation by insects, worms, or scabies, despite a lack of objective medical or entomological evidence.
  • DI predominantly affects women and older individuals, presenting a variable clinical course and prognosis.

Purpose of the Study:

  • To provide a comprehensive overview of delusional infestation, encompassing its definition, presentation, and diagnostic considerations.
  • To outline the management strategies and prognostic factors associated with delusional infestation.
  • To emphasize the importance of a therapeutic physician-patient relationship in managing DI.

Main Methods:

  • Review of literature on delusional infestation, including its classification, diagnostic approaches, and treatment modalities.
  • Diagnostic evaluation involves a detailed history, physical examination, and appropriate laboratory investigations to exclude organic causes.
  • Categorization of DI into four types: overvalued concern, somatoform preoccupation, delusional state, and terminal delusional state, guiding management.

Main Results:

  • DI can manifest as a primary psychiatric disorder or secondary to other medical or psychiatric conditions.
  • Treatment for primary DI typically involves antipsychotic medications (first and second-generation).
  • Management of secondary DI is contingent upon addressing the underlying etiology.

Conclusions:

  • Accurate diagnosis of DI requires ruling out organic pathologies and considering the spectrum of presentation.
  • Treatment efficacy and patient prognosis are influenced by factors such as insight, comorbidities, and treatment adherence.
  • Maintaining a strong therapeutic alliance is crucial for effective management of patients with delusional infestation.