Delusions of Parasitosis Follow-up

Updated: Jul 18, 2018
  • Author: Bettina E Bernstein, DO; Chief Editor: Glen L Xiong, MD  more...
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Follow-up

Further Outpatient Care

After medication has cleared the delusions of parasitosis, the agent should be continued for several months and then discontinued. Often, patients come to think that the medication has killed the bugs, and many (but not all) have a remission of their delusions.

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Complications

If delusions of parasitosis are not treated, scarring can result. The patient's entire life and family may be disrupted by their distress and attempts at treatment.

Therapy for delusions of parasitosis can cause adverse effects. Pimozide can result in tardive dyskinesia and akathisia. Extrapyramidal reactions have been reported to occur in approximately 10-15% of patients taking pimozide. Pimozide can have cardiotoxic effects at high doses. It may cause ECG changes such as prolongation of the QT interval, T-wave changes, and the appearance of U waves.

Lim et al [54] noted an incidence of camphor-related, self-inflicted keratoconjunctivitis secondary to delusions of parasitosis.

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Prognosis

Many patients with delusions of parasitosis refuse treatment and are lost to follow-up. For those patients who can be convinced to undertake treatment, the prognosis for a remission of the delusions is good.

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Patient Education

Patients must be reassured that they are not alone and that the physician will listen to them and sincerely desires to help them to get better. While one should not say anything to confirm the delusion, it is usually not helpful to forcefully confront patients with delusions of parasitosis.

Statements such as the following might be helpful: "I know you feel strongly that there are parasites here, and I'm sure that you itch severely, but I cannot prove that parasites are or have been the cause of your problem."

For patient education resources, see the Mental Health and Behavior Center.

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