Efficacy of antipsychotics in delusional infestation.
Journal
Journal of the European Academy of Dermatology and Venereology : JEADV
ISSN: 1468-3083
Titre abrégé: J Eur Acad Dermatol Venereol
Pays: England
ID NLM: 9216037
Informations de publication
Date de publication:
10 May 2024
10 May 2024
Historique:
received:
10
01
2024
accepted:
26
03
2024
medline:
10
5
2024
pubmed:
10
5
2024
entrez:
10
5
2024
Statut:
aheadofprint
Résumé
Data remain scarce for the first-line antipsychotic choice in treating delusional infestation (DI). We evaluated the treatment responses associated with different antipsychotics in DI patients. We undertook a multicentre, retrospective observational study using anonymised electronic patient records from two hospitals in the United Kingdom from 1 January 2011 to 1 January 2023. Eligible participants were adults (≥18 years) diagnosed with DI treated with an antipsychotic, and had both an assigned baseline and follow-up Clinical Global Impression Scale (CGI-S) score. The CGI-S is a validated psychiatric research tool. Participants were excluded if they had known limited or non-adherence to an antipsychotic, or if no CGI-S scores were present at follow-up. First clinic visits before the initiation of an antipsychotic were assigned as the baseline CGI-S score. The last available CGI-S score before the patient either changed antipsychotic or left the clinic for any reason was used to assign follow-up CGI-S scores. The primary outcome was the response to each individual antipsychotic treatment, measured by the difference in the baseline and last available follow-up CGI-S scores. Differences in CGI-S changes between antipsychotic episodes were tested by analysis of variance (ANOVA). In total, 414 patient records were analysed, and data were extracted. The mean age was 61.8 years (SD 14.1). One hundred seventy (41%) of 414 patients were men and 244 (59%) were women. In total, 156 (38%) of 414 patients were eligible, yielding a total of 315 antipsychotic prescribing episodes. The ANOVA, ranking in order of treatment response, showed that the highest mean score (expressing highest treatment response) was observed in amisulpride (31 [67%] of 46) and risperidone (95 [57%] of 167), followed by some distance by quetiapine (9 [36%] of 25), aripiprazole (13 [28%] of 46) and olanzapine (7 [25%] of 28). Amisulpride and risperidone were associated with a higher treatment response than quetiapine, aripiprazole and olanzapine. Amisulpride and risperidone should therefore be considered the first-line treatment options in DI patients.
Sections du résumé
BACKGROUND
BACKGROUND
Data remain scarce for the first-line antipsychotic choice in treating delusional infestation (DI).
OBJECTIVES
OBJECTIVE
We evaluated the treatment responses associated with different antipsychotics in DI patients.
METHODS
METHODS
We undertook a multicentre, retrospective observational study using anonymised electronic patient records from two hospitals in the United Kingdom from 1 January 2011 to 1 January 2023. Eligible participants were adults (≥18 years) diagnosed with DI treated with an antipsychotic, and had both an assigned baseline and follow-up Clinical Global Impression Scale (CGI-S) score. The CGI-S is a validated psychiatric research tool. Participants were excluded if they had known limited or non-adherence to an antipsychotic, or if no CGI-S scores were present at follow-up. First clinic visits before the initiation of an antipsychotic were assigned as the baseline CGI-S score. The last available CGI-S score before the patient either changed antipsychotic or left the clinic for any reason was used to assign follow-up CGI-S scores. The primary outcome was the response to each individual antipsychotic treatment, measured by the difference in the baseline and last available follow-up CGI-S scores. Differences in CGI-S changes between antipsychotic episodes were tested by analysis of variance (ANOVA).
RESULTS
RESULTS
In total, 414 patient records were analysed, and data were extracted. The mean age was 61.8 years (SD 14.1). One hundred seventy (41%) of 414 patients were men and 244 (59%) were women. In total, 156 (38%) of 414 patients were eligible, yielding a total of 315 antipsychotic prescribing episodes. The ANOVA, ranking in order of treatment response, showed that the highest mean score (expressing highest treatment response) was observed in amisulpride (31 [67%] of 46) and risperidone (95 [57%] of 167), followed by some distance by quetiapine (9 [36%] of 25), aripiprazole (13 [28%] of 46) and olanzapine (7 [25%] of 28).
CONCLUSIONS
CONCLUSIONS
Amisulpride and risperidone were associated with a higher treatment response than quetiapine, aripiprazole and olanzapine. Amisulpride and risperidone should therefore be considered the first-line treatment options in DI patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : British Association of Dermatologists
Informations de copyright
© 2024 European Academy of Dermatology and Venereology.
Références
Bewley A, Lepping P, Taylor R, editors. Psychodermatology in clinical practice. 1st ed. Springer Nature Switzerland A&G; 2021.
Freudenmann RW, Lepping P. Delusional infestation. Clin Microbiol Rev. 2009;22(4):690–732.
Kohorst JJ, Bailey CH, Andersen LK, Pittelkow MR, Davis MDP. Prevalence of delusional infestation—a population‐based study. JAMA Dermatol. 2018;154(5):615–617.
Huber M, Wolf RC, Lepping P, Kirchler E, Karner M, Sambataro F, et al. Regional gray matter volume and structural network strength in somatic vs. non‐somatic delusional disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2018;82:115–122.
Lepping P. Cogito, ergo praedico, commentary on delusional infestation. BJPsych Adv. 2021;27:349–351.
Huber MK, Schwitzer J, Kirchler E, Lepping P. Delusion and dopamine: neuronal insights in psychotropic drug therapy. In: NeuroPsychopharmacotherapy. Riederer P, Laux G, Nagatsu T, Le W, Riederer C, editors. Cham: Springer; 2020.
Lepping P, Huber M, Freudenmann RW. How to approach delusional infestation. BMJ. 2015;350:h1328.
Lepping P, Aboalkaz S, Squire SB, Romanov DV, Bewley A, Huber M, et al. Later age of onset and longer duration of untreated psychosis are associated with poorer outcome in delusional infestation. Acta Derm Venerol. 2020;100(16):5874.
McPhie ML, Kirchhof MG. A systematic review of antipsychotic agents for primary delusional infestation. J Dermatolog Treat. 2022;33(2):709–721.
Lepping P, Baker C, Freudenmann RW. Delusional infestation in dermatology in the UK: prevalence, treatment strategies, and feasibility of a randomised controlled trial. Clin Exp Dermatol. 2010;35(8):841–844.
Waykar V, Wourms K, Tang M, Joseph V. Delusional infestation: an interface with psychiatry. BJPsych Adv. 2021;27(5):343–348.
Lepping P, Russell I, Freudenmann RW. Antipsychotic treatment of delusional parasitosis—a systematic review. Br J Psychiatry. 2007;191:198–205.
Ahmed A, Affleck AG, Angus J, Assalman I, Baron SE, Bewley A, et al. British Association of Dermatologists guidelines for the management of adults with delusional infestation 2022. Br J Dermatol. 2022;187(4):472–480.
Lu JD, Gotesman RD, Varghese S, Fleming P, Lynde CW. Treatments for primary delusional infestation: systematic review. JMIR Dermatol. 2022;5(1):e34323.
Busner J, Targum SD. The clinical global impressions scale. Psychiatry. 2007;4(7):28–37.
Fisher RA. On the interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc. 1922;85(1):87–94.
Fisher RA. The conditions under which χ2 measures the discrepancy between observation and hypothesis. J R Stat Soc. 1924;87(3):442–450.
Scheffé H. The analysis of variance. New York: Wiley; 1959.
Wilkinson L. Statistical methods in psychology journals; guidelines and explanations. Am Psychol Assoc. 1999;54(8):594–604.
Gelman A. Analysis of variance? Why it is more important than ever. Ann Stat. 2005;33(1):1–31.
Wilcoxon F. Individual comparisons by ranking methods. Biometrics. 1945;1(6):80–83.
Bridge PD, Sawilowsky SS. Increasing physicians' awareness of the impact of statistics on research outcomes: comparative power of the t‐test and Wilcoxon rank‐sum test in small samples applied research. J Clin Epidemiol. 1999;52(3):229–235.
Faul F. G power version 3.1.9.6 ©. Kiel, Germany: Universität Kiel; 2020.
Kemperman P, Wennekers M, Lepping P, Bewley A, Aboalkaz S, Kazmi A, et al. Risk factors for nonattendance in delusional infestation: a multicenter observational study. Dermatology. 2023;239(1):116–121.
Ahmed A, Bewley A. Delusional infestation and patient adherence to treatment: an observational study. Br J Dermatol. 2013;169(3):607–610.
Todd S, Squire SB, Bartlett R, Lepping P. Delusional infestation managed in a combined tropical medicine and psychiatry clinic. Trans R Soc Trop Med Hyg. 2019;113(1):18–23.
Ungvari G, Vladar K. Pimozide treatment for delusion of infestation. Act Nerv Super. 1986;28(2):103–107. (in German).
Freudenmann RW, Lepping P. Second‐generation antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy. J Clin Psychopharmacol. 2008;28(5):500–508.
Cosar B, Taskinoglu K, Lepping P, Burhanoglu S, Yapici Eser H, Taner M, et al. Treatment options of delusional parasitosis: case series of 14 patients. Alpha Psychiatry. 2012;13(3):239–242.
Wong YL, Affleck A, Stewart AM. Delusional infestation: perspectives from Scottish dermatologists and a 10‐year case series from a single centre. Acta Derm Venereol. 2018;98(4):441–445.
Assalman I, Ahmed A, Alhajjar R, Bewley AP, Taylor R. Treatments for primary delusional infestation. Cochrane Database Syst Rev. 2019;2019(12):CD011326.