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LETTER TO THE EDITOR
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Olfactory reference syndrome: A case report


 Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission10-Jul-2021
Date of Decision11-Jul-2021
Date of Acceptance12-Jul-2021

Correspondence Address:
Suprakash Chaudhury,
Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_550_21



How to cite this URL:
Jadav A, Chag J, Chaudhury S, Saldanha D. Olfactory reference syndrome: A case report. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 1]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=339183



Dear Sir,

Olfactory reference syndrome (ORS) was first named by Pryse-Phillips in 1971, although the initial description of the symptoms was in 1891. Since then, some case reports and small case series have been published.[1] Despite published literature on the subject spanning more than a century, areas of controversies persist in terms of the nosology and treatment of the disease. The patient with ORS (bromosis, hallucinations of smell, chronic olfactory paranoid syndrome, olfactory delusional syndrome, monosymptomatic hypochondriacal psychosis, olfactory delusional state, olfactory hallucinatory state, and autodysomophobia) presents with preoccupation with the belief that he emits an offensive odor, that is not perceived by others.[2],[3] It is associated with substantial distress. Odors are often believed to originate from the mouth, genitals, rectum, or skin. Common concerns include halitosis, genital odor, flatulence or anal odor, or sweat. Many patients perform repetitive behaviors, such as smelling themselves, showering excessively, and attempting to mask the odor.[2],[3] We report a patient with typical symptoms of ORS who responded well to therapy.

A 20-year-old male, a known case of moderate intellectual disability, was referred to psychiatry OPD from a dental clinic for persistent belief that foul smell is emitted from his mouth, though dental examination had revealed no abnormalities. He has had these complaints for the last 8 months. The patient believed that due to an oral infection his mouth was emitting a foul smell, even though it was not perceived by others. He was greatly distressed because of the smell which he believed was because his saliva was contaminated. To get rid of the smell, he would spit frequently and brush his teeth several times. The patient was diagnosed with ORS classified under delusional disorder and was treated with antipsychotic medication in the form of tablet olanzapine 5 mg which was gradually uptitrated to a dose of 20 mg. After a month of pharmacotherapy along with cognitive behavioral therapy, the delusion resolved and the patient was convinced that there was no foul smell emitted from his mouth.

ORS is not a separate diagnosis in ICD-10[4] but is classified as persistent delusional disorder. It has similar symptomatology to “taijin kyofusho” which is a culture-bound syndrome in Japan.[5] The diagnostic checklist prepared for the ORS states that it is neither monosymptomatic nor monodelusional, and may be accompanied by hallucinations, depression, and delusions with paranoid content.[6] Single-photon emission computed tomography has linked ORS to decreased cerebral blood flow in the frontal lobes, as is seen in depression, suggesting the utility of antidepressants in ORS.[6] Treatment options include antidepressants or antipsychotics alone or a combination of both.[7] There have been case reports where amisulpride,[8] blonanserin,[9] quetiapine,[10] and aripiprazole[11] have been found useful as augmentation therapy. Majority of patients of ORS present to physicians, dentists, and dermatologists, and might be overlooked by them. Early detection of such cases, timely psychiatric referral, and treatment can lead to more favorable outcomes and better prognosis overall of the illness, as was seen in our case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Thomas E, Voges J, Chiliza B, Stein DJ, Lochner C. Sniffing out olfactory reference syndrome. S Afr J Psychiatr 2017;23:1016.  Back to cited text no. 1
    
2.
Jegede O, Virk I, Cherukupally K, Germain W, Fouron P, Olupona T, et al. Olfactory reference syndrome with suicidal attempt treated with pimozide and fluvoxamine. Case Rep Psychiatry 2018;2018:7876497.  Back to cited text no. 2
    
3.
Bhagat H, Bendre A, Dikshit R, De Sousa A, Shah N, Karia S. Olfactory reference syndrome treated with electroconvulsivetherapy. Ann Indian Psychiatry 2017;1:129-31.  Back to cited text no. 3
  [Full text]  
4.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organization; 1993.  Back to cited text no. 4
    
5.
Suzuki K, Takei N, Iwata Y, Sekine Y, Toyoda T, Nakamura K, et al. Do olfactory reference syndrome and jiko-shu-kyofu (a subtype of taijin-kyofu) share a common entity? Acta Psychiatr Scand 2004;109:150-5.  Back to cited text no. 5
    
6.
Konuk N, Atik L, Atasoy N, Ugur MB. Frontotemporal hypoperfusion detected by 99mTc HMPAO SPECT in a patient with olfactory reference syndrome. Gen Hosp Psychiatry 2006;28:174-7.  Back to cited text no. 6
    
7.
Phillips KA, Menard W. Olfactory reference syndrome: Demographic and clinical features of imagined body odor. Gen Hosp Psychiatry 2011;33:398-406.  Back to cited text no. 7
    
8.
Yeh YW, Chen CK, Huang SY, Kuo SC, Chen CY, Chen CL. Successful treatment with amisulpride for the progression of olfactory reference syndrome to schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009;33:579-80.  Back to cited text no. 8
    
9.
Takekita Y, Kato M, Sakai S, Suwa A, Nishida K, Tajika A, et al. Olfactory reference syndrome treated by blonanserin augmentation. Psychiatry Clin Neurosci 2011;65:203-4.  Back to cited text no. 9
    
10.
Murad A, Sevda K, Mustafa NN, Hasan K, Murat K. Olfactory reference syndrome treated with quetiapine: A case report. Bull Clin Psychopharmacol 2011;21:246-8.  Back to cited text no. 10
    
11.
Muffatti R, Scarone S, Gambini O. An olfactory reference syndrome successfully treated by aripiprazole augmentation of antidepressant therapy. Cogn Behav Neurol 2008;21:258-60.  Back to cited text no. 11
    




 

 
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