Treatments for Primary Delusional Infestation: Systematic Review

Area of Science:

• Psychiatry
• Dermatology
• Pharmacology

Background:

• Delusional infestation (Ekbom syndrome) is a rare psychiatric disorder characterized by a fixed delusion of infestation.
• Patients often present with dermatological symptoms, necessitating clear treatment guidelines.
• The optimal management strategy for primary delusional infestation remains unclear.

Purpose of the Study:

• To systematically review and describe the treatment and management of patients with primary delusional infestation.
• To analyze treatment efficacy, dosage, adherence, and side effects based on existing case series.

Main Methods:

• Systematic literature search conducted across major databases (MEDLINE, Embase, PsycINFO, Cochrane).
• Data extraction and analysis focused on treatment details, patient response, and adverse events.
• Inclusion of 15 case series comprising 280 patients diagnosed with delusional infestation.

Main Results:

• Aripiprazole demonstrated the highest complete remission rate (79%) in a small subset of patients.
• Selective serotonin reuptake inhibitors (SSRIs) showed high efficacy (79% complete remission) in patients with comorbid anxiety or depression.
• First-generation and second-generation antipsychotics exhibited comparable complete remission rates (approximately 54% and 48%, respectively).

Conclusions:

• First-generation antipsychotics appear to be as effective as second-generation antipsychotics for delusional infestation.
• SSRIs may be beneficial for patients with comorbid psychiatric conditions.
• Larger studies and randomized controlled trials are essential to confirm the efficacy of pharmacological treatments.