ODOR ------------------------------------------------------ From: MerrillC@aol.com This posting is exteremly timely since I have just seen a patient who feel that she has acquired a new body odor since moving into a "new" house about 1 yr ago. She has a history of breast ca (very early) and was put on Tamoxifen for a while but D/C'd it because of side effects (headaches or something), and because she thought it might be the cause of the body odor. She had also been on Paxil (for depression attributed to the Tamoxifen) and D/c'd that too. Neither of these has made any difference. She says that she can smell a chemical type odor, kind of like the ozone smell from a xerox copier. She notes it is stronger in a closed environment, with little air circulation, and not noticeable when she is outdoors. Being in her house, makes no difference. She notes that her husband and her son don't smell anything. She says she can smell it in laundry and in the shower water when it is very hot. I couldn't smeel anything, but then, I am on antihistamines for allergies, so I don't smell much anyway. The "new" house she lives in now is a farmhouse in the country, about 30 years old, and the water is drawn from a well--the same situation as her "old house" about 50 miles away. Is this some aberrant form of dygeusia, or is it possible she is smelling some sort of pesticide/herbicide residue in the water? I told her to get her water checked, since that's where she thinks she can smell it, and let me know. Any other ideas? She really isn't the hysterical type. Heidi Cole MD ------------- Have you considered a seizure disorder in the woman who believes she smells but no one else can smell anything? Fred Parker MD, CCFP -------------------- Consider sinus infection or tumor. Also, odd smells such as burnt rubber can indicate brain tumor or mets. Temporal lobe seizure? Jerry Eisner MD --------------- I have a young female patient (30) who complains of a ten year history of body odor without hyperhidrosis. She is healthy except for "fatigue" and has no discernable odor to me or my assistant raising the probability of a psychiatric component. Any one had this type of case? Jay Barnett, MD --------------- Sounds like a monosymptomatic delusion. I had a patient with delusion of body odor do well on Orap a few years ago [same as delusions of parasitosis], but my current favorite is Risperdal {Janssen, risperidone} 1-2 mg hs - works as well as Orap but less sedating and less likely to cause dystonic reactions. KC Smith MD FRCPC Niagara Falls ON ---------------- I think we all see these types of cases and it's a question of dysmorphophobia, which is more of a description of the behavior than a psychiatric diagnosis. I tend to treat them like I do my patients with mild delusions of parasitosis , which is to say I humor them to a point and give them something that is either supportive treatment or placebo as the situation dictates. I generally don't give them pimozide (which would be unwarranted in a dysmorphophobic patient). If they seem to have emotional problems they need to talk about I would consider sending them for counselling or psychiatric referral, but probably most of these folks won't take you up on that unless they really want to anyway. Mark Naylor, M.D. Fleishaker Assistant Professor for Dermatology Research Center for Molecular Medicine University of Oklahoma Health Sciences Center --------------------------------------------- I called George Preti,an expert organic chemist who studies odors, and he reminded me that your patient could have trimethylaminuria or an elevated androstenone level. These substances can cause body odor.Only 50% of the population can detect the latter compound, so you may not be able to smell what she is smelling. George Cotsarelis MD -------------------- Why would you say pimozide would be "unwarranted" in dysmorphophobia? In my view dysmorphophobia is a type of monosymptomatic delusion. This can be very disabling, and can lead patients to do or avoid doing things which can result in considerable financial, social and even physical harm. Pimozide works, and it is quite safe and effective, in particular at the low doses these folks tend to need [eg. 1-3 mg hs]. Risperdal can be used if pimozide is poorly tolerated. KC Smith MD FRCPC Niagara Falls ON ---------------- ------- 4.17.96