Delusional Infestation, Psychiatric Comorbidity, and Dementia: A Review of 146 Swedish Patients
DOI:
https://doi.org/10.2340/actadv.v105.43823Keywords:
delusional infestation, Delusional Parasitosis, dementia, ComorbiditiesAbstract
Delusional infestation is a rare but severe dermatopsychiatric disorder. The diagnosis is associated with great suffering for the patients and their relatives, as well as substantial use of healthcare resources. It has been observed that patients with delusional infestation often have psychiatric comorbid conditions. Neurodegenerative diseases like dementia have been reported to be associated, but only in a few case reports. An observational, retrospective search was conducted in the institutional database and all medical records of patients with a diagnostic ICD code in the range F40.0–F40.9 (i.e., phobic anxiety disorders) were collected. A total of 146 patients met the criteria of delusional infestation; 42% were observed to have a former or current psychiatric comorbidity. Half the group, 50%, had more than 1 concomitant psychiatric diagnosis; depressive and/or anxiety disorder was the most common (62%). Furthermore, 9.6% developed dementia during the investigation period. Psychiatric comorbid conditions are common in this patient group. Such conditions should be diagnosed and treated. Further, delusional infestation could be an early sign of dementia and if signs of cognitive impairment are noted, further investigations and follow-up regarding dementia are recommended.
Downloads
References
Hylwa S, Foster A, Bury J, Davis M, Pittelkow M, Bostwick M. Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic. Psychosomatics 2012; 53: 258–265. DOI: https://doi.org/10.1016/j.psym.2011.11.003
Norman F, López-Vélez R. Delusional parasitosis: an unrecognized and underdiagnosed entity? Enferm Infecc Microbiol Clin (Engl ed). 2021; 39: 221–222. DOI: https://doi.org/10.1016/j.eimce.2021.03.001
Lepping P, Huber M, Freudenmann R. How to approach delusional infestation. BMJ 2015; 350: h1328. DOI: https://doi.org/10.1136/bmj.h1328
Balogh E, Beuerlein K, Feldman S. Choosing the appropriate pharmacotherapy for Morgellons disease: an expert perspective. Expert Opin Pharmacother 2022; 23: 527–530. DOI: https://doi.org/10.1080/14656566.2022.2029407
Lepping P. Delusional infestation. In: Bewley A, Lepping P, Taylor R, editors. Psychodermatology in Clinical Practice. Cham: Springer Nature Switzerland AG, 2021. p. 131–150. DOI: https://doi.org/10.1007/978-3-030-54307-5_12
Armin S, LaPointe G, Jacob R. Importance of early recognition and management of delusional parasitosis. Baylor Univ Med Cent Proc 2022; 35: 256–258. DOI: https://doi.org/10.1080/08998280.2021.2001126
Freudenmann R, Lepping P. Delusional infestation. Clin Microbiol Rev 2009; 22: 690–732. DOI: https://doi.org/10.1128/CMR.00018-09
Lai J, Xu Z, Xu Y, Hu S. Reframing delusional infestation: perspectives on unresolved puzzles. Psychol Res Behav Manag 2018; 11: 425–432. DOI: https://doi.org/10.2147/PRBM.S166720
Johnson K, Nasol E, Wood S, Chien J. Probable Alzheimer’s dementia presenting as delusional infestation. Psychogeriatrics 2017; 17: 493–494. DOI: https://doi.org/10.1111/psyg.12250
Kohorst J, Bailey C, Andersen L, Pittelkow M, Davis M. Prevalence of delusional infestation: a population-based study. JAMA Dermatol 2018; 154: 615–617. DOI: https://doi.org/10.1001/jamadermatol.2018.0004
Creavin S, Wisniewski S, Noel-Storr A, Trevelyan C, Hampton T, Rayment D, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev [serial online] 2016 Jan [cited 2022 Nov 23]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011145.pub2/full?highlightAbstract=mmse
Diniz B, Butters M, Albert S, Dew M, Reynolds C 3rd. Late-life depression and risk of vascular dementia and Alzheimer’s disease: systematic review and meta-analysis of community-based cohort studies. Br J Psychiatry 2013; 202: 329–335. DOI: https://doi.org/10.1192/bjp.bp.112.118307
Almeida O, Hankey G, Yeap B, Golledge J, Flicker L. Depression as a modifiable factor to decrease the risk of dementia. Transl Psychiatry 2017; 7: e1117. DOI: https://doi.org/10.1038/tp.2017.90
Yu JT, Xu W, Tan C, Andrieu S, Suckling J, Evangelou E, et al. Evidence-based prevention of Alzheimer’s disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials. J Neurol Neurosurg Psychiatry 2020; 91: 1201–1209. DOI: https://doi.org/10.1136/jnnp-2019-321913
Folstein M, Folstein S, McHugh P. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198. DOI: https://doi.org/10.1016/0022-3956(75)90026-6
Arevalo-Rodriguez I, Smailagic N, Roqué-Figuls M, Ciapponi A, Sanchez-Perez E, Giannakou A, et al. Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2021; 7: CD010783. DOI: https://doi.org/10.1002/14651858.CD010783.pub3
Trabert W. 100 years of delusional parasitosis: meta-analysis of 1223 case reports. Psychopathology 1995; 28: 238–246. DOI: https://doi.org/10.1159/000284934
Freudenmann R, Lepping P. Second-generation antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy. J Clin Psychopharmacol 2008; 28: 500–508. DOI: https://doi.org/10.1097/JCP.0b013e318185e774
Bourgeois M, Rager P, Peyré F, Nguyen-Lan A, Etchepare J. Fréquence et aspects du syndrome d’Ekbom. Enquête auprès des dermatologues français (a propos de 150 cas). Ann Med Psychol (Paris) 1986; 144: 659–668.
Published
How to Cite
License
Copyright (c) 2025 Jessica Norberg, Sol-Britt Lonne-Rahm, Louise Lönndahl

This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.