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Senile depression with olfactory reference syndrome: a psychopathological review

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Olfactory reference syndrome (ORS) is a psychiatric condition characterized by a persistent preoccupation with body odor and is regarded as a common clinical entity known as jiko-shu-kyofu or jiko-shu-sho in published Japanese medical reports. However, the condition has not been assigned appropriate significance in recent operational diagnostic criteria. While adolescent patients with ORS seem to nosologically range from patients with obsessive–compulsive disorder to patients with schizophrenia, ORS is likely to be observed in depressive patients during presenile and senile periods. In this paper, two elderly patients with depression and ORS are presented and the relationship between depression and ORS is discussed from the viewpoint of psychopathology. The first case involved a 60-year-old woman with depression who complained that she was emitting a decaying body odor. Six years prior to this episode, she had been plagued by typical depression with inhibition; in the next phase of her illness, she manifested little inhibition, but developed ORS, which was effectively treated with clomipramine. The second case was an 88-year-old woman with depression and mild senile dementia who was placed in a nursing home for the elderly. After a delirium-like episode, she became depressed and complained that she was emitting a bad body odor. Clomipramine was efficacious in providing relief from her symptoms. These case studies show two aspects of the relation between depression and ORS. First, ORS appears to arise from the ambiguity surrounding the onset of depressive delusion, in line with S. Kato's discussion of the ‘semantic horizon of evil’. Second, ORS appears to be equivalent to the mixed state defined by T. Miyamoto as ‘the matrix of both mania and depression’.
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Keywords: clomipramine; depression; depressive delusions; mixed states; olfactory reference syndrome

Document Type: Research Article

Affiliations: Department of Psychiatry, Jichi Medical School, Tochigi, Japan

Publication date: June 1, 2005

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