Successful treatment of delusions of parasitosis with olanzapine. Commentary

Background: Delusional parasitosis is a rare disorder in which patients have a fixed, false belief of being infested with parasites. It is often accompanied by a refusal to seek psychiatric care. Delusions of parasitosis is classically treated with typical antipsychotic agents, the traditional dermatologic choice being pimozide. However, pimozide's adverse effect profile and the need for frequent electrocardiographic monitoring make such treatment less practical. Observation: We describe 3 patients who were diagnosed as having delusional parasitosis that was successfully treated with a recently Food and Drug Administration-approved atypical antipsychotic agent, olanzapine (5 mg/d). Olanzapine has a more benign adverse effect profile than typical antipsychotic agents and eliminates the need for electrocardiographic monitoring. Olanzapine therapy has been associated with such adverse effects as sedation, hyperlipidemia, weight gain, and insulin resistance, all of which were infrequent in our patients. Conclusion: Olanzapine is an atypical antipsychotic agent that can be used as a first-line agent in delusional parasitosis as a safer therapeutic option without a specialized monitoring regimen.