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Observational Study
. 2025 Apr;39(4):815-822.
doi: 10.1111/jdv.20081. Epub 2024 May 10.

Efficacy of antipsychotics in delusional infestation

Paul K Tang  1 , Peter Lepping  2   3   4 , Sophie G Lepping  5 , Eric O Noorthoorn  6   7 , Stephen B Squire  8   9 , Padma Mohandas  10 , Anthony Bewley  10   11
Affiliations
Observational Study

Efficacy of antipsychotics in delusional infestation

Paul K Tang et al. J Eur Acad Dermatol Venereol. 2025 Apr.

Abstract

Background: Data remain scarce for the first-line antipsychotic choice in treating delusional infestation (DI).

Objectives: We evaluated the treatment responses associated with different antipsychotics in DI patients.

Methods: We undertook a multicentre, retrospective observational study using anonymised electronic patient records from two hospitals in the United Kingdom from 1 January 2011 to 1 January 2023. Eligible participants were adults (≥18 years) diagnosed with DI treated with an antipsychotic, and had both an assigned baseline and follow-up Clinical Global Impression Scale (CGI-S) score. The CGI-S is a validated psychiatric research tool. Participants were excluded if they had known limited or non-adherence to an antipsychotic, or if no CGI-S scores were present at follow-up. First clinic visits before the initiation of an antipsychotic were assigned as the baseline CGI-S score. The last available CGI-S score before the patient either changed antipsychotic or left the clinic for any reason was used to assign follow-up CGI-S scores. The primary outcome was the response to each individual antipsychotic treatment, measured by the difference in the baseline and last available follow-up CGI-S scores. Differences in CGI-S changes between antipsychotic episodes were tested by analysis of variance (ANOVA).

Results: In total, 414 patient records were analysed, and data were extracted. The mean age was 61.8 years (SD 14.1). One hundred seventy (41%) of 414 patients were men and 244 (59%) were women. In total, 156 (38%) of 414 patients were eligible, yielding a total of 315 antipsychotic prescribing episodes. The ANOVA, ranking in order of treatment response, showed that the highest mean score (expressing highest treatment response) was observed in amisulpride (31 [67%] of 46) and risperidone (95 [57%] of 167), followed by some distance by quetiapine (9 [36%] of 25), aripiprazole (13 [28%] of 46) and olanzapine (7 [25%] of 28).

Conclusions: Amisulpride and risperidone were associated with a higher treatment response than quetiapine, aripiprazole and olanzapine. Amisulpride and risperidone should therefore be considered the first-line treatment options in DI patients.

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References

REFERENCES

    1. Bewley A, Lepping P, Taylor R, editors. Psychodermatology in clinical practice. 1st ed. Springer Nature Switzerland A&G; 2021.
    1. Freudenmann RW, Lepping P. Delusional infestation. Clin Microbiol Rev. 2009;22(4):690–732.
    1. Kohorst JJ, Bailey CH, Andersen LK, Pittelkow MR, Davis MDP. Prevalence of delusional infestation—a population‐based study. JAMA Dermatol. 2018;154(5):615–617.
    1. Huber M, Wolf RC, Lepping P, Kirchler E, Karner M, Sambataro F, et al. Regional gray matter volume and structural network strength in somatic vs. non‐somatic delusional disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2018;82:115–122.
    1. Lepping P. Cogito, ergo praedico, commentary on delusional infestation. BJPsych Adv. 2021;27:349–351.

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