Psychderm Delusions and Solutions

PsychDerm: Delusions and Solutions by John Koo MD

• Primary delusions of parasitosis may occur spontaneously, typically in older women, in the absence of other psychological conditions. This is possibly due to age-related decline in estrogen which impacts the dopamine transport system and allows for increased levels of circulating dopamines that can lead to delusions.
• Buspirone (Buspar) is a great option for patients naive to anti-anxiety medications and prescribers who are new to psych drugs as it poses minimal risk and side effects. It must be taken daily for efficacy and may take 4 weeks so see improvement.
• Pimozide is a good option for treating delusions of parasitosis. In the US, it is only indicated for Tourettes and not labeled for anxiety, depression, or other psych disorders, making patients more likely to consider taking it. Start 0.5mg and titrate up by 0.5mg every 2-4 weeks until stable, continue until clear or almost clear and another 3-4 months beyond before tapering back down by 0.5mg increments every 2-4 weeks or longer. Usually requires less than 3mg daily at peak dosing.