How do you approach treating patients with delusions of parasitosis who can not tolerate an antipsychotic?

I continue to switch them until I find one they can tolerate. My typical approach is Abilify 2 mg daily and increase by 2 mg every other week until on 10 mg daily if tolerable. If they can’t tolerate that, then I switch to Risperdal and if they can’t tolerate that then I switch to pimozide. If they truly fail all of the above, you can try treating with an SSRI as they can technically have an OCD component to their obsession with the infestation. However, I wouldn’t expect this to be completely e...