Future research should focus on pathophysiology and the neural basis of DI, as well as on conclusive clinical trials, which are widely lacking. Pimozide is no longer the treatment of choice for reasons of drug safety. In primary DI, antipsychotics are the treatment of choice, according to limited but sufficient evidence. The most intricate problem is to engage patients in psychiatric therapy. Specialized outpatient clinics in dermatology with a liaison psychiatrist are theoretically best placed to provide care. For clinicians, clinical pathways for efficient diagnostics and etiology-specific treatment are provided. Patients with self-diagnosed “Morgellons disease” can be seen as a variation of this delusional theme.
Epidemiology and history suggest that the imaginary pathogens change constantly, while the delusional theme “infestation” is stable and ubiquitous.
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They avoid psychiatrists and consult dermatologists, microbiologists, or general practitioners but often lose faith in professional medicine. Patients with DI pose a truly interdisciplinary problem to the medical system. A set of minimal diagnostic criteria and a classification are provided. DI is no single disorder but can occur as a delusional disorder of the somatic type (primary DI) or secondary to numerous other conditions. It is characterized by the fixed belief of being infested with pathogens against all medical evidence. Summary: This papers aims at familiarizing psychiatric and nonpsychiatric readers with delusional infestation (DI), also known as delusional parasitosis.
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