The most common monosymptomatic hypochondriacal psychosis encountered by a dermatologist
is delusions of parasitosis. In this condition, patients have an “encapsulated”
fixed, false belief that they are infested with parasites or have foreign objects extruding from
their skin. The patient will often experience feelings of biting, crawling and stinging related
to the delusion. Most patients do not have other major psychiatric problems outside of their
encapsulated delusion. The patient usually presents with a long history of symptoms and
multiple visits to physicians in more than one specialty. Without an informed approach to
these patients that focuses on the development of therapeutic alliance, clinical interactions
can become very unpleasant. However, when treated with pimozide, risperidone, or other
antipsychotic medications, patients have a very high response rate. Therefore, it is important
for dermatologists to be able to handle these cases and know that the development of
the therapeutic alliance is the key step to successful management.
Semin Cutan Med Surg 32:73-77 © 2013 Frontline Medical Communications
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