Two Cases of Oral Somatic Delusions Ameliorated With Brain Perfusion Asymmetry: A Case Report

Umezaki, Yojiro; Uezato, Akihito; Toriihara, Akira; Nishikawa, Toru; Toyofuku, Akira

doi:10.1097/wnf.0000000000000207

Cited by 13 publications

(19 citation statements)

References 14 publications

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“…Under the clinical entity of DDST, some case reports and reviews suggested that antidepressants, antipsychotic drugs, and electroconvulsive therapy (ECT) are effective. When only the oral symptoms are present, paroxetine, 12 fluvoxamine, 13 amitriptyline, 13 , 14 sulpiride, 14 risperidone, 13 , 15 olanzapine, 13 perospirone, 11 aripiprazole, 16 and ECT 11 , 26 were reported to be effective. In this study, aripiprazole was the most effective medicine, especially in low doses.…”

Section: Discussionmentioning

confidence: 99%

“…Psychotherapy and pharmacotherapy are the mainstream treatments for oral cenesthopathy. Antidepressants and antipsychotic drugs were prescribed in our clinic depending on the patients’ symptoms, medical complications, former reports, 11 – 16 personality features, and background such as lifestyle, habits, income, opportunity, and family relationships. If dental treatment was needed during our treatment, their family dentists or attending dentists in our clinic (YU, AM, YS, LM, SS, KK, TT, TW, TS, MW, MT, and TY) treated them while confirming their symptoms.…”

Section: Methodsmentioning

confidence: 99%

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Clinical characteristics and course of oral somatic delusions: a retrospective chart review of 606 cases in 5 years

Umezaki¹,

Miura²,

Shinohara³

et al. 2018

NDT

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ObjectiveOral cenesthopathy is characterized by foreign body sensations without medical and dental evidence for them. It is thought to be a rare disease in psychiatry, but many patients are visiting dental clinics seeking treatment to remove a foreign body. Even though the features of oral cenesthopathy might be different between a psychiatric clinic and a dental clinic, there has been no clinic-statistical study from dentists. In this study, we report a clinico-statistical study of patients with oral cenesthopathy in dentistry.MethodsThis is a retrospective chart review of 606 outpatients with oral cenesthopathy in Tokyo Medical and Dental University from April 2010 through to March 2015.ResultsA total of 159 male and 447 female patients were included in this study. The mean age was 62.08 years, and female patients were older than male patients. The trigger of the dental treatment and the acute phase of depression at the onset were significantly related (p=0.037). Only 128 patients (36%) had clinically significant improvement after 6 months of pharmacotherapy. No history of psychiatric disorders (odds ratio [OR] 0.479 [95% confidence interval {CI}: 0.262–0.875], p=0.017) and longer duration of illness (>18 months) (OR 2.626 [95% CI: 1.437–4.799], p=0.002) were significant factors for clinical outcomes.ConclusionPatients with oral cenesthopathy in our clinic were predominantly elderly female patients. Dental treatment in the acute phase of depression might be a risk factor for oral cenesthopathy. Therefore, comprehending the situation of psychiatric disorder and obtaining adequate informed consent might be required to prevent the trouble concerning oral cenesthopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinical characteristics and course of oral somatic delusions: a retrospective chart review of 606 cases in 5 years

Umezaki¹,

Miura²,

Shinohara³

et al. 2018

NDT

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“…These delusions cause enormous anguish, and sometimes lead to suicide [ 2 ]. Psychotropics such as antipsychotics [ 2 – 4 ] and antidepressants [ 5 , 6 ] are efficacious for some patients. For pharmacotherapy-resistant cases in DDST [ 7 ], bipolar disorder [ 8 ], and schizophrenia [ 9 ], electroconvulsive therapy (ECT) has been reported to be effective.…”

Section: Introductionmentioning

confidence: 99%

Improvement of Somatic Delusions with Altered Regional Cerebral Blood Flow Following Electroconvulsive Therapy in a Patient with Schizoaffective Disorder

et al. 2021

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Patient: Male, 52-year-old Final Diagnosis: Schizoaffective disorder Symptoms: Somatic delusions Medication:— Clinical Procedure: — Specialty: Psychiatry Objective: Unusual or unexpected effect of treatment Background: Somatic delusions are false and fixed beliefs about health and organ function, which are observed in various psychiatric disorders. Psychotropic drugs such as antipsychotics and antidepressants are effective for some patients, while the efficacy of electroconvulsive therapy (ECT) for pharmacotherapy-resistant cases has been reported. Previous reports suggest that somatic delusions in delusional disorder somatic type are associated with reduced regional cerebral blood flow (rCBF), but it remains unclear whether this association is also observed in other psychiatric disorders. We report the case of a patient with schizoaffective disorder whose drug-resistant somatic delusions showed remarkable improvement accompanied by altered rCBF after successful ECT. Case Report: The patient was a Japanese man aged 52 years with a diagnosis of schizoaffective disorder. He was suffering from severe and persistent somatic delusions such as “There is a thick stick or bowl in my head” and “Something like a film stretches over my head and face”, which were resistant to several antipsychotics and antidepressants. In our hospital, he received bitemporal ECT 8 times. His somatic delusions started to improve from the third administration, and they disappeared by the eighth administration. In parallel with this clinical improvement, reduction of rCBF in the bilateral parietal and occipital lobes observed before ECT disappeared. Conclusions: The present study suggests that ECT is a useful choice for drug-resistant somatic delusions. Reduction of rCBF in the bilateral parietal and occipital lobes may be associated with manifestation of somatic delusions in schizoaffective disorder.

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“…The CNS involvement were suggested in previously. In a case report with OC, the asymmetric CBF pattern ameliorated after the treatment with aripiprazole [22]. The case report of the modi ed electroconvulsive therapy to the OC patients showed improved CBF asymmetry in the temporal region and reduced the symptoms of OC [23].…”

Section: Discussionmentioning

confidence: 94%

The difference in clinical characteristics in the patients with unilateral oral cenesthopathy with and without the neurovascular compression of trigeminal nerve: A clinical chart review

Watanabe¹,

Watanabe²,

Suga³

et al. 2020

Preprint

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Background Oral cenesthopathy (OC) is characterized by unusual sensation in the oral cavity without corresponding medical and dental evidence. Their complaints are vary and some patients show sever symptoms which decline their quality of life. The neurovascular compression (NVC) of trigeminal nerves is known as one of the factors to indicate abnormal sensation in facial area including oral cavity. The aim of the present study was to investigate the pathophysiology of OC by comparing the clinical characteristics of unilateral OC patients with and without trigeminal nerve NVC. Methods This is a retrospective study reviewing medical records of patients diagnosed with unilateral OC seen between April 2016 and February 2019. Magnetic resonance images (MRI) were performed to assess the presence of NVC. Results Among 321 patients who were diagnosed with OC, 87 patients showed unilateral OC. finally, 52 patients who were performed MRI were involved in the present investigation. In 48.1% subjects (25/52), NVC of trigeminal nerves was observed. In the patients without NVC, 85.2% (23/27) were female with significant difference (p = 0.010) compared to the patients with NVC (48.0%, 12/25). There was no significant difference in age, the presence of psychiatric history and psychosomatic dental comorbidity, and the scores of psychological questionnaires. However, in the patients without NVC, significantly higher scores were observed in the symptom severity and the functional impairment as follow; movement (p = 0.042), pain (p = 0.040), work (p = 0.013) and social activities (p = 0.015), compared to the group with NVC. Conclusion These results suggest that unilateral OC has two subtypes based on predominant involvement of peripheral or central nervous system (CNS). The unilateral OC with NVC may involve predominantly peripheral nervous system. Furthermore, the unilateral OC without trigeminal nerve NVC which showed severe functional impairment may be reflected predominant CNS involvement.

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Two Cases of Oral Somatic Delusions Ameliorated With Brain Perfusion Asymmetry: A Case Report

Cited by 13 publications

References 14 publications

Clinical characteristics and course of oral somatic delusions: a retrospective chart review of 606 cases in 5 years

Clinical characteristics and course of oral somatic delusions: a retrospective chart review of 606 cases in 5 years

Improvement of Somatic Delusions with Altered Regional Cerebral Blood Flow Following Electroconvulsive Therapy in a Patient with Schizoaffective Disorder

The difference in clinical characteristics in the patients with unilateral oral cenesthopathy with and without the neurovascular compression of trigeminal nerve: A clinical chart review

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