Of the patients who present with cutaneous dysesthesia, those who believe that their discomfort is caused by invasion by some foreign agent are the most difficult to treat. Parasitic infestation may still be the most common delusion, but we now learn of a variety of other foreign elements subsumed under the rubric Morgellons disease and reported in detail on the Morgellons Web site (http://www.morgellons.org). For the patient, the false belief serves as a defense against the need to acknowledge psychological issues, so he or she may not readily accept psychotropic medication.1 Meehan et al2 describe sensitive and thoughtful interactions that enabled each of 3 patients to accept treatment with olanzapine, which resulted in a speedy resolution of their symptoms.
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