Ramos Natalia, Wystrach Carter, Bolton Michael, Shaywitz Jonathan, IsHak Waguih William
Keck School of Medicine of USC, Los Angeles, CA, USA.
J Nerv Ment Dis. 2013 Jun;201(6):537-8. doi: 10.1097/NMD.0b013e31829482fd.
Delusions of foul body odors (often referred to as olfactory reference syndrome [ORS]) currently fall under the category of delusional disorder, somatic type (DDST), in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). We present the case of a 51-year-old man with no previous psychiatric history who presented with perceived foul odors that he delusionally attributed to trimethylaminuria (TMAU). TMAU is a rare metabolic disorder associated with foul body odors. The patient also experienced severe concurrent mood symptoms because of social isolation resulting from his delusion about his body odors. After considerable discussion of differential diagnoses, a diagnosis of DDST was ultimately made, given the patient's unrelenting nonbizarre delusions and lack of insight pertaining to his body odors. However, this case proved to be very useful in exploring the diagnostic challenges in this type of disorder and recent discussions of ORS and its proposed inclusion in the DSM-5.
目前，在《精神疾病诊断与统计手册》第四版（DSM-IV）中，躯体异味妄想（通常称为嗅觉参考综合征[ORS]）属于妄想障碍的躯体类型（DDST）。我们报告了一例51岁男性病例，该患者既往无精神病史，现出现自认为的难闻气味，并妄想性地将其归因于三甲胺尿症（TMAU）。TMAU是一种与躯体异味相关的罕见代谢紊乱疾病。由于对自身体味的妄想导致社交隔离，该患者还同时出现了严重的情绪症状。在对鉴别诊断进行了大量讨论后，鉴于患者存在持续的非怪异妄想且对自身体味缺乏洞察力，最终做出了DDST的诊断。然而，该病例在探索此类疾病的诊断挑战以及近期关于ORS及其拟纳入DSM-5的讨论中被证明非常有用。
