STILL ANOSMIA, HYPEROSMIA, CACOSMIA,
AGEUSIA AND DYSGEUSIA IN TWO WOMEN, TREATED BY ANTIDEPRESSANT AND ANTISTRESS
DRUGS WITH SOME DIFFICULTIES.
Renato COCCHI, a
neurologist and a medical psychologist.
Summary.
This article reports the clinical
histories of two patients aged 67 and 50 years at their first consultations,
with troubles of the sense of smell and of the taste. One of them had these
troubles after the therapy for obstructive chronic bronchitis, and in the
second one two years after a cranial trauma with two and half months of a coma.
They showed even depressive symptoms and stress symptoms.
The prescribed therapy, primarily with
antidepressant and antistress drugs, initially did get modest results mainly in
the post-traumatic person, even for the objective difficulty of returning for
checkups, so allowing the changes of the prescription.
About one year later, in both cases the
recovery of the sense of smell and of the taste is ongoing, even if slower in
the post-traumatic patient.
Key words: Anosmia, ageusia, hyperosmia,
cacosmia, dysgeusia, women, stress, OCB, cranial trauma, depression,
antibiotics, corticosteroids, antidepressant, antistress, drugs, therapy, results.
Drug modulation of stress answers.
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The two clinical cases of trouble of the
sense of smell and of the taste, following reported, match from the
characteristic of a modest or scarce initial answer to prescribed therapies
after the first consultation. Both referable to women, in both them there was
an objective difficulty to come back for checkups with increased frequency than
I could have. For that the adapted therapeutic variations had longer times. It
is even possible that either of them, had a particular neuropathological
structure, and surely this was true for the post-traumatic patient, as the
first case faced by me with this previous history. Probably even a chronic
therapy with corticosteroids, in the other case, could have had his weigh as
causal factor.
The case history #1.
It refers to a woman of 67 years at the
moment of the first consultation.
The third decade of June 2005. She reports
to have become totally deprived of the sense of smell and of the taste
following an antibiotic and cortisone-based therapy for obstructive chronic
bronchitis (OCB), appeared about two years before. Even currently she is often
forced to use a nasal atomizer with cortisone. Before the OCB she was
hyperosmic for perfumes. First she had low sense of the coffee's odour and as
altered that of the cigarette smoke. Some time later she restarted to sense the
odour of the exhausting gas.
Meanwhile she recovered, as always
unpleasantly altered, the odours of the cleansers and of the bath foam. The
basil, the rosemary and the mint have unbearable smell (cacosmia). The coffee
has not any real odour, as well as the ammonia, while the bleach smells
normally.
She perceived nearly all the foods as
disgusting. The taste of the meat is altered but not disgusting, while if the
meat is cooked like into a barbecue, it disgusts and smells unpleasantly. For
the chicken on the spit, it depends from the aromatic herbs that seasoned it.
The eaten kid's meat during the last Easter
was good, and she starts to appreciate again the raw ham. Of the cooked ham she
feels a chemical taste (the glutamate?) Among the cheeses, she bears more the
"Gorgonzola", while the other ones have an unbearable taste of
casein. When she eats the Sicilian pizza(with tomatoes, anchovy paste, olives,
capers, oregano) she doesn't feel the flavours. The stockfish Sanremese style
has not much taste, while she finds savoury the meat to the carpaccio style.
The milk has normal flavour. She finds unbearable fruit juices, sour orange
drink, tamarind, citrus fruits (oranges, lemons and mandarins).
Never she has noticed hyperosmia, neither in
the premenstrual phase, when she had still her menses.
The NMR of the brain has a negative
referral.
Stress symptoms: Habitually she suffers from the cold. Now, she
appreciates more the sweet things, which however taste of fat. She sleeps well.
Sometimes she has drooling during her sleep, and she suffers from nighttime
muscular cramps. Bad dreams do not happen, and she doesn't talk during her
sleep. Nighttime bruxism occurs, but not daily dental shut. Rarely, she had
colic pain and diarrhea. She doesn't have sudden asthenias for any reason, no
disbandment feelings, neither faint feelings. She bears badly the noise. Now
she does not find any difference of comfort between morning and afternoon.
Something like the Restless Legs Syndrome is reported. No frequently need to go
to urinate and the nocturia varies from 0 to 2 episodes.
Problems of half-brain dominance: To the test "Which is the opposite of the
colour Red " she answers: White. Always she was The Contrary Mary. In the
mornings she shows some negativism. She doesn't know if she thinks too much.
There is not rising of bad feelings against beloved persons. Sometimes she used
counting objects, for no reason.
Delivery risk factors and behaviour in
the first year of life: As she heard,
in the first year of life she refused the mother's milk, she had frequent
gastroenteritis, besides nausea, vomit and acetone, she was much pale, At night
she has never lost her sleep. She did not cry without evident reason.
Depression: Sometimes she feels sadness, but she doesn't cry.
Greediness for milk is normal, while she has always been dripping-pan cheese.
No headache occurs, and she does not feel as stunned. She doesn't suffer from
tachycardia, nor from mediastinal oppression, neither of the lump in the
throat. Till the sexual puberty she was timid, reserved and taciturn.
Other: At school, she went better in Italian. She has hot flashes, from her
menopause. Sometimes hands' oversweating occurs, but rare amnesias, no
dyslalias. In past, and still now, she has always been an overactive person,
with a particular need for the precision.
Test therapy (daily doses, by the oral via):
Glutamine 125mg; pyridoxine 75mg; carbamazepine 100mg; amitriptyline 12mg;
bromazepam 0.5mg.
Third ten days of July 2005: The first
checkup. She says that it is doing better because she has less dysgeusia and
cacosmia. Now, she feels the taste of the raw tomato and of the ice cream and
has restarted to eat even the grilled meat, but cheese as usual. She tastes
more the jam and sometimes, she can even the vinegar.
They persist of the different odour of the
coffee, of the basil, of the rosemary, of the mint. She smells more slightly
fried onions. Both the odours of the urine (even that of the cats) and of the
faeces did not reappear, while that of the pizza is sometime more
fragrant.Moreover, she feels under stress.
The nighttime cramps reduced. The counting
of objects did not change. Hot flashes happen as first, and she is no more
deflated. Now, only one episode of nocturia occurs. She used to smoke when she
feels her stomach as full. Now, she is worried for real reasons.
Therapeutic variation (daily doses, by the
oral via): Bromazepam 0.7mg.
First ten days of June 2006: The second
checkup. She tells to do enough well. As for the taste, she thinks to feel at
least 30% of normal tastes. Now, she can distinguish the taste of the
Neapolitan pizza, of the raw ham, but those of the oregano and of the basil are
always disgusting. The taste of the coffee is good. Now, she succeeds to eat in
enough varied way. Asparagus and the artichokes do not have any taste. In the
"risotto Milanese style" she doesn't feel the saffron. She recovered
to eat the ice cream. As for the meat, she perceives 30-40% of the taste. When
she is going to the market, she feels the fruit's odour, but as an aspecific
one of vegetation. She recovered to eat oranges, but not mandarins. The lemon
has even an unpleasant taste.
The cacosmia reduced. Now, she senses again odours
that transform themselves in flavours: Onions, garlic, soothe, carrots, so too,
the perfume of the broth when she does the bouillon. If she prepared the pizza,
she feels the perfume of the leavened pasta, but not that of the cooked pizza.
The talc perfumes better, even if a little
more altered. She feels well the odour of the bath-foam and of her English bars
of soap, also that of the cleansers. The new modern fragrances still bother
her, while she bears well the J.M.Farina's eau de Cologne. The odours of the
urine and of the faeces, are still missed but she perceives the axillary odour
when not covered by the deodorant.
She sleeps wellų and has only one episode of
nocturia. Nighttime cramps even reduced.
From time to time she has sudden diarrheas.
Even the Restless Legs Syndrome disappeared. She does not feel as deflated. The
physicians diagnosed to her a hernia of the hiatus. In this time, she had
difficulties following a building restructuring. Her interpersonal
relationships improved.
Therapeutic variation (daily doses, by the
oral via): Carbamazepine 200mg.
The case history #2..
A woman aged 50 years at the first
consultation.
First ten days of April 2005, the first
visit. Since two years she is suffering from anosmia, dysgeusia and cacosmia as
appeared two years after she has had a cranial trauma, with two and half months
and of a coma. She inclines to connect the two events with a cause and effect
relationship [???]. In past, she was never hyperosmic neither she noticed
hypersensitivity to odours even in the premenstrual period.
Stress symptoms: She has Some intolerance to light, noise and
confusion. In some days dyslalic phenomena appear. She has disbandment feelings
but not feelings of fainting, and she thinks much. In past she suffered from colic,
while now her bowel function is normal. Some muscular hypertonus occurs in the
morning and bony pain.
Sometimes, she counts objects, for no
reason. Often she has hands' emotional oversweating. She doesn't have tinnitus,
nor dizziness.
Problems of half-brain dominance: To
the Test "Which is the opposite of the colour Red?" she answers:
White, which then she modifies her answers as Black. The Contrary Mary was
never her behaviour. She denies having the onset of bad thoughts against
beloved persons.
Depression: Probably masked depression occurs. There is not
mediastinal oppression, nor the lump in the throat, nor air hunger, nor
stomachache nor need to often go to urinate. The job gives her satisfaction.
Test therapy (daily doses, by the oral via):
Glutamine 125mg; pyridoxine 75mg; amitripttline 10mg + perphenazine 2mg;
carbamazepine 100mg; bromazepam 0.6mg.
Second ten days of May 2005, the first
control. Initially she improved, during three weeks, but after a family
emotional trouble, she affirms to have totally regressed. First the taste
improved, then even of the sense of smell did it. She did get with cacosmia as
first. In evening, the falling asleep is becoming further, and she sleeps
better. The bony pain of the morning is not changed, but she becomes less tired
and is less asthenic. She is also less abulic. Now, she bears better light,
noise and confusion. The feeling of disbandment missed. It happens less to
count objects for no reason. Less hands' oversweating occurs. Muscular
hypertonus in the morning disappeared.
Therapeutic variation (daily doses, by the
oral via): Glutamine 250mg; carbamazepine 200mg; bromazepam 0.9mg.
First ten days of May 2006, the second
checkup. Something is improved. Now, she does not suffer more from dysgeusia
but from ageusica for all foods. Cacosmia reduced. During some time she had
some smell troubles by the garbage, while now it has a normal odour. For some
instants she feels the odour of the cigarette.
She smells the perfumes but not
distinguishes them, as it happens too for the soap and for the toothpaste. She
doesn't feel the odours of the coffee, of the urine and of the faeces, of the
exhausting gas of the cars, of the roasted meat.
Last winter, she had bad moments; she cried,
because she did not yet accepted the death of her husband. Unreal feelings
occurred. At home, she has restart to do her housework. Her job is going well.
She says that now she has less intrusive thinking.
Now, she is less distracted and more active.
Sleeping increased. On her initiative, she has hung the benzodiazepine, because
"she was sleeping well" [???]. There is not any bony pain in the
morning.
To count objects for no reason greatly
reduced. The palmar oversweating is nearly disappearing. Her falling asleep is
normal. Two nocturia episodes happen every night. Her facies changed, and the
mimicry is more mobile. Now, she says that she inclines to forget easily. She
has recovered the sequence of preparing and cooking the meat sauce. Her
speaking is less difficult, even if not always she finds at once the right
word.
Therapeutic variation (daily doses, by the
oral via): Oxazepam 15mg; Carbamazepine 300mg; 5-hydroxytryptophan 50mg;
Glutamine 125mg; S-adenosil-l-methionine 100mg; Pyridoxine 75mg; Amitriptyline
10mg + Perphenazine 2mg.
First ten days of October 2006, the third control.
She says to be a little improved. Now, she
smells again the urine and faeces, and she feels the odour of the dirty
laundry. Tastes would have not varied. The tuna doesn't have its smell and its
taste.
During her job in the hospital, she doesn't
know if she can perceive the odour of the methylated spirit. The coffee does
not have any smell and flavour. In the road, she doesn't feel the odour of
exhausted gases produced by cars.
Cacosmia did not reappear. She feels the
odour of toilet perfumes, but she cannot distinguish them. For some instants
she perceives the odour of the cigarette smoke. The roasted meat does not have
any smell for her. The odours of the soap and of the toothpaste, are felt but
confused. She has lost again the taste of the meat sauce.
Now, she feels less depressed, and she
succeeds to do some housework. She is in tension for a recently detected
non-active thyroid adenoma. Her head is less full of thoughts. In her work, she
is more attentive and active. In the morning she is less tired, and bony pain
did not return.
The need of counting objects with no reason
still reduced. The hands' sweating diminished. Even the nocturia is now much infrequent.
Her facies is more relaxed. The persons who know her, find her relieved and say
she appears younger. She says that now she forgets less. The ability of her
oral expression improved. She has recovered to drive the car, with the help of
her daughter, but now she drives alone, and can pay attention to the road
signs.
She became emotionally hypersensitive. Her
hair is stronger and more healthy. Now, she has a better care of her own
physical aspect, and she says to be a little returned to live.
Therapeutic variation (daily doses, by the
oral via): Hanging oxazepam, I prescribed bromazepam 0.75mg.
Discussion.
In both cases, differently from the
preceding case (Cocchi, 2006) there was a delay in the results of the therapy.
It could happen so, either for specific characteristics, either for the
difficulty to come back for checkups or for both causes, being more probable in
the post-traumatic subject.
Before the loss of the smell, only one of
them was a particularly sensitive woman to the odours (to perfumes). Neither of
them had this sensitiveness in the premenstrual period, a fact already reported
in many other treated subjects. (Cocchi, 2002; Cocchi, 2004b; Cocchi, 2004c;
Cocchi, 2004d; Cocchi, 2004e; Cocchi, 2005b; Cocchi, 2006).
The loss of the sense of smell and
subsequently of the taste appeared during a therapy with antibiotics and
corticosteroids, in the first case. The same came out after two years from a
cranial trauma, in the second case.
A possible cause and effect relationship, in
the second case, is not to consider entirely absurdity, even if the distance of
time between the two events, about two years, is surely too farther. If
"she has recovered the sequence of preparing and cooking the meat sauce.
Her speaking is less difficult, even if not always she finds at once the right
word", that wants to say that the cranial trauma had left negative
neuropsychological outcomes, which can be considered signals of an increased
weakness. On it, the loss of the sense of smell and of the taste, could have
added as further effects, whatever a distance habitually considered without any
relationship.
Both women showed cacosmia at the first
consultation. Of fact, here it cannot be thought as an autonomous symptom
(Cocchi, 2005b), but a sign of gravity. The answer of White in both cases to
the Test "Which is the opposite of the colour Red?" is a typical
answer from trouble of the half-brain dominance, as the opposite of the colour
Black (Cocchi, 2005a ). In the second case, the correction with Black of the
first answer, confirms the neuropsychological relationship between the two
colours, but even the possible masked depression. Then it blew up, during the
therapy, in spite of the assumption of the antidepressant.
Another point to underline is that the therapy
on sense of smell and taste, in the post-traumatic patient, initially did get a
good answer, then followed a complete regression due to a
psychological-relational stress.
It remains however the fact that each case
is a particular case, and it results difficult, at least for now, to try to
delineate some guidelines, which could ease a less individual approach.
References.
Cocchi R. An anosmia-hyperosmia case with
hypogeusia, from probable stress, Improved following an antistress<span
style="mso-spacerun: yes"> </span>drug therapy 2002
<www.stress-cocchi.net/Other1.htm>.
Cocchi R. A second case with
hyperosmia-anosmia with ageusia (a taste trouble), improved following an
antistress drug therapy. 2003c <www.stress-cocchi.net/Other8.htm>.
Cocchi R. A third case of anosmia-hyperosmia
with ageusia, following stress and possible viral infection, improved with an
antistress drug therapy. 2004a <www.stress-cocchi.net/Other7.htm>.
Cocchi R. A fourth case of anosmia, with
cacosmia and ageusia, treated with antistress and antidepressant drug therapy.
2004b <www.stress-cocchi.net/Other10.htm>.
Cocchi R. Hyperosmia in a woman with
atypical depression. His disappearance with the improvement of the depression.
2004c <www.stress-cocchi.net/Other13.htm>.
Cocchi R. Hyperosmia, and headache's fits
from heavy, olfactory stimuli in a 35-years-old man of 35 years. An approach
with antiepilectic and antistress drugs 2004d
<www.stress-cocchi.net/Other14.htm>.
Cocchi R. A case of melancholic depression
with hyposmia, ageusia, cacosmia and tinnitus. Its evolution with antistress
and antidepressant drug therapy. 2004e
<www.stress-cocchi.net/Depression5.htm>.
Cocchi R. Anosmia, cacosmia and dysgeusia,
with preceding benign positional paroxysmal vertigo, in a woman treated with
antidepressant and antistress drug therapy. July 2005b
<www.stress-cocchi.net/Other20.htm>.
Cocchi R. The answer "White" to
the test "Which is the contrary of the Red colour" and previous
behaviour of "The Contrary Mary." an investigation on clinical
reports of the years 2003-2004. Marzo 2005a
<www.reversebrain.net/Domin16.htm>
Cocchi R. A case of intermittent
cacosmia-phantosmia, without any anosmia, hyperosmia or ageusia, lasting 14
years, in a man of 40 years. July 2005b
<www.stress-cocchi.net/Other21.htm>.
Cocchi R. Another case of anosmia,
hyperosmia, cacosmia, ageusia and dysgeusia in a 41-years old woman at the
first consultation, and treated by antidepressant and antistress drugs. March
2006 <www.stress-cocchi.net/Other23.htm>.
Posted on internet on 4 August 2006. Copyright by Renato Cocchi, 2006.
Author's address: dr Renato COCCHI, via Mercalli 10
42100 Reggio Emilia
renatococchi@libero.it
Drug modulation of stress answers.
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