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Background Objectives Methods Results Conclusions 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. [ABSTRACT FROM AUTHOR]

Key content: Studies reveal a high prevalence of mental health issues around the menopause transition.Menopausal symptoms are influenced by personal and environmental factors.Beneficial effects of estrogen for menopausal depression have been reported.An integrated care model for the management of mental health symptoms is recommended.Evidence‐based management options include considering the impact of lifestyle changes, hormone replacement therapy (HRT) and cognitive behavioural therapy. Learning objectives: To understand the assessment and management of mental health issues in menopauseTo understand the role of lifestyle modifications, HRT and alternatives to HRT in the management of menopause‐related mental health issues [ABSTRACT FROM AUTHOR]

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of delusional infestation (DI) in adults. B R18 (GPP) b Offer treatment for at least 1 year after symptoms have resolved to adults with DI and restart treatment if symptoms recur following cessation of treatment. Management B R9 (GPP) b Allow at least a 45-minute appointment for new patients and 30 minutes for subsequent follow-up appointments for adults with DI. B R10 ( b ^^ B ) b Offer* early referral to a specialist psychodermatology clinic, where available, to adults with DI. B R11 ( b ^^ B ) b Offer* psychiatric and psychological support in addition to dermatological treatment to adults with DI if acceptable to the patient. The guideline is presented as a detailed review with highlighted recommendations for practical use in dermatology clinics (see Summary of recommendations), in addition to a patient information leaflet (available on the BAD website: https://www.skinhealthinfo.org.uk/a-z-conditions-treatments) and a PowerPoint presentation on 'Communication skills when seeing a patient with delusional infestation' (File S1; see Supporting information). [Extracted from the article]

The article discusses the management of patients with delusional infestation (DI) across Europe, a rare somatic delusional disorder where patients believe they are infested despite lack of evidence. A survey of dermatologists and psychiatrists revealed varying diagnostic and treatment practices, with a strong preference for antipsychotic treatment. Challenges include patient acceptance of psychiatric explanations and premature discontinuation of antipsychotics. The study emphasizes the need for standardized guidelines and interdisciplinary collaboration to improve patient outcomes in managing DI. [Extracted from the article]

Background: Nonattendance is common among patients suffering from delusional infestation (DI) with a risk factor for poorer patient outcomes., Objective: The aim of this study was to determine the incidence rate and predictors of nonattendance among patients presenting to a psychodermatology department with DI and the subsequent effect on the success of prescribing new antipsychotics., Methods: Data of 265 patients were reviewed of the Amsterdam UMC, the Erasmus University Medical Center, the Royal London Hospital, and the Liverpool School of Tropical Medicine between January 2008 and October 2019., Results: We observed that among the patients who attended the first consultation, 57% (n = 144) did not attend their second visit. Recreational drug use was significantly higher in the nonattendance group compared to the attendance group (25% against 18%). Patients who had a history of previously prescribed antipsychotics at the time of the first consultation were less likely to get prescribed antipsychotics from the psychodermatology departments for DI; however, prescribing antipsychotic drugs by the psychodermatology department did not influence nonattendance significantly., Conclusions: People suffering from DI are at high risk of nonattendance, even in specialist settings. Patients with current illicit drug use and younger patients are particularly at risk of this., (© 2022 The Author(s). Published by S. Karger AG, Basel.)