Delusional infestation: a prototype of psychodermatological disease

Area of Science:

• Psychiatry
• Dermatology
• Neurology

Background:

• Delusional infestation (DI) is a somatic delusional disorder characterized by a fixed, false belief of infestation.
• DI presents complex clinical features, often requiring exclusion of other medical or psychiatric conditions.
• Cases date back to the 19th century, spanning global populations, and can be primary or secondary to other conditions.

Purpose of the Study:

• To review the clinical background and diagnostic features of delusional infestation.
• To explore current and potential treatment options for patients with DI.
• To highlight the importance of recognizing DI in nonpsychiatric settings.

Main Methods:

• Literature review of historical and contemporary case reports and clinical studies on delusional infestation.
• Analysis of diagnostic criteria and differential diagnoses for DI.
• Examination of pharmacological and non-pharmacological treatment strategies.

Main Results:

• DI is a diagnosis of exclusion, necessitating the ruling out of genuine infestations, dermatological conditions, and substance-induced psychoses.
• Patients frequently present to nonpsychiatric healthcare providers, underscoring the need for broad clinical awareness.
• Antipsychotic medications (first and second generation) are primary treatment options, alongside careful patient communication.

Conclusions:

• Effective management of DI involves a tactful approach, addressing symptoms without directly confronting the delusion.
• Further research into the pathophysiology of primary DI is warranted.
• Enhanced clinician education is crucial for timely identification and appropriate management of DI.