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Treatment of Delusional Parasitoses

David O. Clayton, MD; Nancy M. Clayton, MA; Winston W. Shen, MD
JAMA. 1997;278(16):1319. doi:10.1001/jama.1997.03550160039032.
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To the Editor.  —We would like to offer further comment on psychopharmacologic treatments for the dermatological conditions described by Ms Lamberg in a Medical News & Perspectives article.1Lamberg mentioned Dr Koo's suggestion to treat delusional disorder2 with dermatological theme with pimozide,3 and cautioned about the development of pimozide-induced extrapyramidal symptoms (EPS).2 Instead of using pimozide or other conventional neuroleptics such as haloperidol or chlorpromazine, we would like to recommend the use of atypical antipsychotic drugs3 that are EPS sparing.4 The latter includes clozapine, risperidone, and olanzapine. These atypical antipsychotic medications have less tendency to cause the adverse effects of EPS or tardive dyskinesia.3-5 Usually the use of anticholinergic agents (benztropin, trihexylphenidyl, and the like) or diphenhydramine hydrochloride (as recommended by Koo1) is unnecessary.5 Of note, the use of clozapine requires weekly blood monitoring for the adverse effect of agranulocytosis.5


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