A FOURTH CASE OF ANOSMIA,
WITH CACOSMIA AND AGEUSIA, TREATED WITH ANTISTRESS AND ANTIDEPRESSANT DRUG
THERAPY.
Renato Cocchi, neurologist and medical
psychologis,
(Other five articles on this topic)
Summary
It reports the case
of a 53-years-old woman, already depressed, with high blood tension, headache
and easiness to vagotonic cardiac answers, which after a flu episode suffered
subsequently from anosmia, ageusia (trouble of the taste), and cacosmia
(sensation of bad odours).
The first two months
of antistress and antidepressant drug therapy allowed the disappearance of the
cacosmia, the reduction of the ageusia, the decreasing of vagotonic answers,
and a modest improvement of the sleep.
Key words: Anosmia, cacosmia, ageusia,
depression, vagotony, stress, drug therapy.
Drug modulation of stress reactions
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I shall give here the report of a new case
of anosmia, with cacosmia (sensation of bad odours) and ageusia (loss of the
taste), with quite singular features. What follows it is even the result of
first two-months therapy, primarily as an antistress one, which it will
progressively be updated.
The case history.
F. fifty-three years old, a mother of two
sons, who came to my outpatients' for anosmia, cacosmia and ageusia, following
a flu episode.
March 2004, first consultation. She is
anosmic since about a year, and she was aware of it exactly in March 2003, to
which the dysgeusia followed in April 2003. In last summer appeared ageusia,
and in August 2003 the cacosmia came out.
Now, she doesn't feel more the odours, for
example of the coffee, of the chocolate, of biscuits. The talcum powder gives
her nausea even if she does not see it, but her son has used it. Many other
odours result distorted and very unpleasant. During her pregnancies, over
twenty-five years ago, she had either hypersensitivity to some odours (hyperosmia)
or repulsion (cacosmia).
The anosmia had investigation by
examinations to the nose apparatus, with negative results, and a brain NMR
resulted also negative. A treatment with prednisone for one week did not get
any improvement.
Troubles of half-brain dominance: She
inclines to do bad dreams, and has a fluctuating intrusive thinking that lasts
even at night,
Depressive and stress symptoms: She
currently has high blood tension, already under therapy; She inclines to
vagotonic answers, with pulse baiting reduced to forty-two per minute, but she
has neither frequent need to urinate neither colic ache, with or without
diarrhea. Her sleeping is seriously disturbed with difficulty to fall asleep,
frequent awakenings and an early-morning wake up. To fall asleep she uses
auditory overstimulation (the television on). Drooling during the sleep, no
nighttime bruxism, were reported, but she suffers from frequent nighttime
cramps. If she succeeds to sleep some hours towards the 7-8 in the mornings,
she does not get up tired. She is hungry just up. Now, she doesn't use to eat
sweet things, in particular the chocolate.
She likes meat broth or cube bouillon, which
not disgust her. No intolerance to light, noise and confusion reported. Not
dental shut during the day. She did not observe any difference between morning
and afternoon, does not have any disbandment feelings, neither of faint.
Sometimes she had brief tachycardia episodes. She suffers from mediastinal
oppression, but no lump in the throat. Hands or axillae oversweating, lacks.
Sudden asthenias occur. Sometimes she is affected by dyslalia.
Her hairs are normal. Lately she digests
badly. Sudden frontal headaches with middle skull diffusion occur, with
photophobia and nausea. Symptoms of an internal tremor, nor an express tremor
was reported. She usually stays indoors, and feels without any willingness, for
which does housework with difficulty.
The somatic and depressive symptoms had drug
therapies with levosulpiride, retinol+tocopherol, venlafaxine, fluoxetine and
s-adenosil-l-methionine, without appreciable improvements. Currently she takes
lorazepam 0.5mg in the evening.
In past she had dizziness, asthenia of the
right hand, for which she doesn't succeed to hold back the objects, which fell
him. She thinks to be a sensitive person, more for what she sees that for what
she hears.
Starting therapy (daily doses, by the oral
via): Glutamine 125mg; pyridoxine 75mg; carbamazepine 200mg; lorazepam 1mg;
mianserine 24mg.
May 2004, the first checkup after two months
of drug therapy. She is doing better. The cacosmia disappeared, but she is
still anosmic. As for the flavours, she doesn't distinguish them in an exact
way outside "pleasant or disagreeable". However, she has recovered to
eat sweet things and to drink coffee, while two months ago she was unable to do
it. The talcum powder continues to give her the bother.
The intrusive thought did not vary. Bad
dreams did not stop.
Her higher blood tension decreased, and the
heart frequency came back to the 70 pulsations per minute. She has problems
with her husband, for which to the already present depression, she added a
notable share of reactive depression. Crying is usual. The falling asleep is
now better, and definitely wakes up on about 5.00 am. When she did not sleep
enough, she inclines to take back some sleep on about 8.00 am. In the evening,
habitually the television is on to help her to fall asleep. Nighttime cramps
stopped. Now she has a light tremor to her hands, of emotional type.
Tachycardia episodes decreased but the mediastinal oppression increased. She
has a better digestion. Headaches stopped, as well as sudden asthenias.
Dyslalias and memory difficulties in the choice of the words increased. She is
still without any willingness.
Therapeutic variation (daily doses, by the
oral via): Mianserine 30mg; Chlomipramine 10mg.
Discussion.
This is a difficult case for its prominent
and long lasting depressive aspects, recently worsened by couple problems.
After two months from the beginning of the drug
therapy, the anosmia did not vary, but the cacosmia run out. Even the trouble
of the taste seems modifying. She reduced her vagotonic, primarily cardiac,
answers. Sleeping is still disturbed, but it has improved its maintenance. The
initial insomnia, of depressive type, persists. She missed headaches.
Still a time we have here the confirmation
that beyond a common symptom, the anosmia, every body reacts to stress
according to its ways, for which it will be always difficult to set up a
standardized drug therapy applicable to all.
It may finally be interesting to observe
what happened as for the cacosmia, the last symptom to appear and first to give
up. Is the cacosmia a distorted perception (an illusion) or is it the
equivalent of a true hallucination? In the first case it should precede the
anosmia, which fact did not happen. In the second case, we have to ask
ourselves why the body would have the need to build hallucinations (some kind
of fragrant dreams?). Is this perhaps a compensation mechanism aiming to supply
with stimuli brain areas that otherwise could become atrophic, because not
used? From which memory these fragrant memories would be picked up to be sent
to these areas?
Since we are dealing with bad odours (the
cacosmia), we have to think that the involved memory is either that of the
unpleasant fragrant perceptions, or what has recorded the opposite of the
pleasant fragrant perceptions. If it is a compensation mechanism, its current
reduced or null need to be used does presuppose that some stimuli come from
another part, from the external world then.
For which even the anosmia could have
started to give up, even if in a way that not have reached till now the
awareness of the subject.
It dealt with so tangled problems, here only
mentioned, and that will need attention and discernment to be understood.
Certainly there is this. These events that happen are not by chance, and they
not have anything to do with supposed paradoxes, as we term a typical
rationalization of our ignorance.
(Other four articles on this topic)
References
Cocchi R. An anosmia-hyperosmia case with hypogeusia, from probable stress, Improved following an antistress drug therapy. June 2002. <www-stress-cocchi.org/Other1.htm>
Cocchi R. A second case with hyperosmia-anosmia with ageusia (a taste trouble), improved following an antistress drug therapy. December 2003 (Updated March 2004). <www-stress-cocchi.org/Other8.htm>
Cocchi R . A third case of anosmia-hyperosmia with ageusia,
following stress and possible viral infection, improved with an antistress drug
therapy. (Updated March 2004). <www-stress-cocchi.org/Other7.htm>
Posted on Internet on May 2004. Copyright by Renato Cocchi, 2004.
Author's address: dr
Renato Cocchi, via Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
Drug modulation of stress reactions
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