MORE
Reframing delusional infestation: perspectives on unresolved puzzles https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171510/
"The first step needs to determine whether delusion exists or not. A delusion is defined as a firmly, but false belief held with strong conviction and contrary to the superior evidence. It is distinct from beliefs based on an unusual perception, such as formication. The beliefs that patients hold could be delusion, true observations, or overvalued ideas. This must be determined on a case-by-case basis. The presentation of a specimen is not a delusional behavior. Patients with DI/MD with animate or inanimate objects can exist, but the belief of cutaneous fibers may or may not be delusional. A physician is required to perform fiber analysis to identify the nature of fibers. If fibers are present and biofilaments of human origin, then they are a true observation. It is also possible that patients might observe fibers and mistake them for worms in which case the idea of infestation could be an overvalued idea. Real infestation with arthropods such as mites can also occur. Additionally, some patients could have lesions with adhering textile fibers that are accidental contaminants and could mistakenly believe that they have MD, in which case they do not have a delusional belief, but a mistaken belief. In summary, if a physician cannot differentiate between true observations, delusions, and overvalued ideas, they should not immediately make a diagnosis of delusional mental illness.
The next procedure would be screening the causes of the symptoms. If a delusional belief is present, then various medical conditions need to be ruled out, including psychiatric disorders (eg, schizophrenia and depression), neurological illnesses (eg, dementia), metabolic illnesses (eg, diabetes), vitamin deficiencies, substance intoxication, tumor, dermatological illnesses (eg, pruritus senilis), and infection. History taking, physical examination, laboratory tests, and e..
