Abstract
Delusional infestation (DI) is a type of monosymptomatic hypochondriacal psychosis characterized by the steadfast belief that one is infested with living organisms or inanimate material in the absence of objective proof. Although DI is generally regarded as a single psychotic phenotype characterized by either the presence or absence of a delusion, our experience has been that patients with DI present with varying levels of severity represented by various phenotypes along a continuum. Distinguishing where a particular patient presents on this spectrum has allowed us to modify our approach with greater sophistication and thereby optimize management. Our aim is to describe for the first time in dermatology the concept of the DI continuum with support from the psychiatric literature, and to provide practical therapeutic recommendations for each phenotype in the spectrum.
Highlights
Delusional infestation (DI), known as delusions of parasitosis, is a type of monosymptomatic hypochondriacal psychosis characterized by the false yet steadfast belief that one is infested with living organisms or inanimate material
DI is generally regarded as a single psychotic phenotype characterized by either the presence or absence of a delusion, the variability in delusional beliefs regarding the source of infestation was recently described to represent a heterogeneous diagnostic group of patients [1]
To make the concept of a DI spectrum tangible for the practicing dermatologist, we describe four psychological constructs with corresponding recommendations for the optimal therapeutic approach (Figure 1)
Summary
The Spectrum of Ideation in Patients with Symptoms of Infestation: From Overvalued Ideas to the Terminal Delusional State. Brown1,2*, Eric Sorenson, Mona Malakouti, Argentina Leon, Jason S. Murase and John Y.M. Koo2 1College of Medicine, University of Arizona, USA 2Department of Dermatology, University of California San Francisco, USA 3University of Southern California, USA 4Chicago Medical School, North Chicago, USA 5Department of Dermatology, University of Texas Southwestern - Austin, USA 6Department of Psychiatry, University of Texas Southwestern - Austin, USA 7Department of Psychiatry, University of California San Francisco, USA 8Department of Dermatology, Palo Alto Foundation Medical Group, USA
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