新人999疑病如何治疗配图，仅供参考
Treatment OptionsSince this disorder can have various potential origins,it is imperative to consider all possible causes of this disorder and to then select an appropriate therapy for the specific form of delusional parasitosis that the patient is suffering from. Persistent symptoms such as delusions are always an indication for the administration of antipsychotic medications . Studies evaluating the disparity in efficacy between first- and second-generation antipsychotics in the treatment of delusional parasitosis are lacking. Currently,second-generation antipsychotics such as risperidone or olanzapine are considered first-line therapies,mostly due to their safer profiles and better tolerabilities.
When selecting the medicine,both the efficacy and possible side effects should be analyzed in detail. All atypical antipsychotics could cause metabolic dysfunction,so constant monitoring of laboratory values during therapy is necessary. There is no known consensus on the dosage of antipsychotics to use in cases of delusional parasitosis. In elderly patients,the dose should be adjusted for age as well as for kidney and liver function and the presence of other chronic diseases. Dosages range between 1 and 8 mg/day for risperidone and from 5 to 10 mg/day for olanzapine . In the critical literature review conducted by Freudenmann et al.,risperidone and olanzapine were found to be the most commonly used atypical antipsychotics. Risperidone and olanzapine had a positive impact on 69% and 72% of the patients under examination,respectively. The maximum effect was achieved after at least 6 months of therapy . Many physicians do not recommend olanzapine as the first-line pharmacotherapy because of its metabolic side effects. A good alternative could be aripiprazole,which has the smallest side effect profile and does not cause weight gain. However,only seven case reports have described its efficacy in delusional parasitosis . In most cases,the therapy should be conducted long term in lower doses because discontinuation of the treatment may cause a recurrence of symptoms.
Over the years,administration of pimozide as a first-line treatment option has lost its importance due to concerns about its safety profile,its prolongation of the QTc interval,and a high risk of extrapyramidal symptoms . A double-blind,placebo-controlled crossover trial comprising 11 patients with delusional parasitosis was performed in which the effects of pimozide were evaluated. Pimozide turned out to be better than placebo at relieving the sensation of pruritus and delusions. However,“feelings of vermin” and excoriations remained unchanged . In a case series of 33 patients with delusional parasitosis,18 of them received pimozide at dosages from 1 to 5 mg/day while the other 15 patients did not take the drug. Among patients receiving pimozide,61% achieved improvement or complete remission,while the other 39% remained unchanged . Although pimozide has shown relatively good efficacy in the majority of patients,its use is significantly limited by its side effects. Regarding other first-generation antipsychotics,haloperidol,perphenazine,and sulpiride seem to be safer choices . Depot antipsychotics might be considered when there is a concern about the correct use of oral medications .
Depressive symptoms could be secondary to delusional parasitosis. Before starting pharmacological treatment,patients with mild symptoms should try cognitive behavioral therapy (CBT). CBT should focus on building patient trust. CBT can help to create connections between the patient’s thoughts,emotions,and behaviors . The goal of CBT is to convince the patient to start questioning their own fixed beliefs,which can lead to significant improvements in the patient’s social life. Antidepressants might be necessary to relieve distress in patients with moderate depressive symptoms. Selective serotonin reuptake inhibitors should be first-line drugs. Escitalopram or sertraline seem to be good alternatives; combining them with antipsychotics leads to the fewest side effects. In patients with delusional parasitosis secondary to medication-resistant depression,electroconvulsive therapy might be considered.","department":"
