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Delusional Infestation — SCE Dermatology MCQ

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HardPsychodermatologyDelusional InfestationSCE Dermatology

A patient with delusional infestation repeatedly brings fibres as specimens. Examination, microscopy and a proportionate secondary-cause screen are unrevealing. She refuses psychiatric referral but will return to dermatology and asks for help sleeping. Which approach best preserves engagement and offers evidence-based treatment?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Maintain psychodermatology engagement and discuss monitored low-dose antipsychotic treatment

Explanation lettering: E = shown as A · D = shown as B · A = shown as D · B = shown as E

D is correct. Delusional infestation is managed through a non-confrontational therapeutic alliance: acknowledge the distress and symptoms without endorsing infestation, exclude genuine and secondary causes proportionately, offer continuity and involve psychodermatology. When medication is accepted, low-dose second-generation antipsychotics such as risperidone, olanzapine or amisulpride can be used with appropriate physical, metabolic and adverse-effect monitoring. Repeated antiparasitic treatment reinforces the belief and adds harm. Abrupt confrontation or discharge loses engagement, corticosteroids lack a therapeutic target, and indiscriminate testing perpetuates specimen-seeking. Immediate risk, self-injury, safeguarding and capacity still require assessment.

Reference: BAD guideline for delusional infestation 2022: https://academic.oup.com/bjd/article/187/4/472/6966247