A SECOND CASE WITH
HYPEROSMIA-ANOSMIA WITH AGEUSIA
(A TASTE TROUBLE),
IMPROVED FOLLOWING AN ANTISTRESS
DRUG THERAPY. (Updated March 2004)
Renato COCCHI, a neurologist and a medical
psychologist.
(11 other articles on this topic)
Summary.
It is presenting the case report on a
49-years-old woman with hyperosmia-anosmia with partial ageusia, which appeared
about three years ago. She had treatment with a low dosing
antistress-antidepressant drug therapy, acting on GABA, serotonin, and
glutamate. The improvement of the taste and of the smell, already began after
month and half from the therapy starting, and progressed after more than five
months therapy
Key words: Anosmia, hyperosmia, dysosmia,
ageusia, stress, depression, GABA, glutamate, serotonin, pharmacotherapy.
Drug modulation of stress reactions
It came to my attention a female patient
with hyperosmia-anosmia with partial ageusia, who showed improvements following
an
antistress therapy. As a further case, a
little different from the first one (Cocchi, 2002), I wanted to give here the
initial report. I am postponing to the first case as for the recent literature
on this topic.
The case history.
Female, of 49 years at the first
examination, without particular specific precedents.
15 Oct. 2003: Since about three years she
observed an unpleasant smell referable to the air coming out from the pipe
unions of the car air conditioner. Sometimes she smells the same, when she is
going to car driving, even without the conditioner in operation. Moreover, she
bears badly the female perfumes, the odour of the peeled tomatoes in a can, of
skin transpiration, the odour of the coloured persons. The same happens for the
odour of the Iranians (persons working with her husband), of the Marsille soap
and of the cheap bars of soap. The odour of the exchanges of air in her working
office is similarly unpleasant. She doesn't feel absolutely the odour of the
Bostik (TM) glue.
She has even taste troubles concerning the
seasoned salad, the cooked vegetables, the fish. It rests to her a persistence
of olfactory and taste unpleasantness that it may last till 24 hours. If she
slept, this unpleasantness reduced.
She had job and health problems. She had
thyroid surgery for which she does do a substituting therapy with 50mg of
sodium levotiroxine. Even she had a uterine fibroma, with uterectomy, without
any ovariectomy. She stopped menses and now she is in the menopause with
substituting hormonal therapy
From one year she is losing her hair. She
suffers from frontal and of vertex headaches after the lunch. She thinks that
her troubles are seasonal, in prevalence in springtime and in autumn. She has
an easiness to the respiratory infectious illnesses, mainly the cold Some days
she is pale with eye sockets.
From one year she is losing her hair. She
suffers from frontal and from vertex headaches after the lunch. She thinks that
her troubles are seasonal, in prevalence in springtime and in autumn. She has
an easiness to respiratory infectious illnesses, mainly the cold. Some days she
is pale with eye sockets.
She does not stand the cold, does breakfast
gladly, with increased sweet things consumption, mainly chocolate. Normal taste
for the meat or cube broth.
She needs time to fall asleep, slobbers when
sleeping, does not have bad dreams, not nighttime cramps. Her sleep is in
motion, and in the mornings stretches. She doesn't ever speak during the sleep
and has some nighttime bruxism, but often "dental shut" by day. She
has intrusive thoughts, even when she is sleeping. Now, she is unable to
control her thoughts.
The dyslaly does not appear. She bears badly
light, noise and people confusion. Often she cries because very emotional
sensitive. When depressed, she may prefer to stay home, or ask to go out and to
pay visits to other persons. She does need to count objects without reason.
At the test "Say me the opposite of the
Red" she answered Black like depressed people do. No disbandment feelings
reported, but fainting feelings. She suffers from colic ache, with diarrhea,
but this does not happen frequently. She has sudden fatigue, for no reason. She
was a child that with poor peers relationships. When she was a student, she did
better mathematics.
Therapy (daily doses, by the oral via):
glutamine 125mg; pyridoxine 75mg; carbamazepine 100mg; amitriptyline 10mg;
bromazepam 0.6mg.
03 Dec. 2003: The first checkup. She says
that is going better. The unpleasant smells persist lesser, about 3-4 hours
instead of the previous long lasting till even 24 hours. As first, the sleep
improves the situation.
Positive results: For what concerns the
troubled smell, she answers that the unpleasant smell referable to the air
coming out from the pipe unions of the car air conditioner, reduced 85%.
The tolerance towards the female perfumes
increased 60%. For the perception of the odour of the Iranian people there is
80% diminution. She says that in her office arrived an Italian colleague that
smells bad: perhaps are the drugs he assumes. This man smokes, but the smoke
not gives her bother. She is still anosmic for the Bostik (TM).
Even the taste (?) improved, with less thick
saliva, less nausea.
For tastes, of the stew dried cod has felt
well carrots and parsley.
Not verified or negative results: By herself
she did not drive without the conditioner, for which she doesn't know if she
did no feel the same odour without the air conditioner in operation. She
doesn't know how to reply about canned tomatoes, for the other people's
transpiration, for the odour of the coloured persons. She doesn't know how to
reply about the changes of the air in office. For the tastes, she doesn't say
anything on the vegetable because she avoided eating them.
Less intrusive thought. Now she bears better
the noise and the people confusion. Perhaps she has less facility to weep.
Positive results on other symptoms: The
after lunch headache attenuated. Hair loss diminished. Now she is well off even
in the afternoon. No drooling when sleeping, but she has less motion during it,
as her husband reported. Not more feelings of fainting occurred and less colic
ache. Not more sudden fatigue. She has more relaxed face with more beautiful
skin, and fewer eye sockets. The falling asleep improved as the whole sleeping
time. Her hair is less fat. She did not suffer from the cold.
Results not verified or negative on other
symptoms: She doesn't know if she suffers less the cool, because the weather
has been mild. She eats sweet things in the same amount. The dental shut did
not have attention. She is strained and scary as first.
Therapeutic variation (daily doses, by the
oral via ): Glutamine 250mg; biotin 2.5mg; amitriptiline 14 mg.
22 March 2004, the second checkup. The
patient says that she noted some improvement.
Sense of smell: The persistent unpleasant
smells disappear just she distracted, while till the first checkup they lasted 2-3
hours. The odour of the car air conditioner disappeared, while the odour of
gases from the exhaust-pipe of her car persists unpleasant. Now, she doesn't
feel more a particular odour that initially she attributed to all persons. The
tolerance of the female perfumes currently is up to 75-80%, as rated by the
patient.
She doesn't smell more the odour of the air
conditioner in her office. Now, she bears well the odour of the Bostik (TM),
also that much unpleasant of the stain remover for her husband's shirt collars.
On the other hand, she bears always badly the odour of the Marseilles soap.
Sense of taste: She feels now all the
tastes, and she thinks she recovered entirely the sense of the taste, with less
thick saliva. The nausea is nearly missing and, when present, it not has any
link with foods. She could eat some salad and cooked vegetable, which first she
did not tolerate.
Positive results on other symptoms: At night
she sleeps well and is less turning during the sleep. She does not feel
fatigue, and her headaches after lunch occur primarily on Sundays. The loss of
the hair went down. Now she feels less intrusive thought and improved
concentration. Now she bears well noise and confusion.
Her face is more beautiful and more serene,
a fact confirmed even from a female colleague. She is less pale, with fewer
days with eye sockets. She doesn't cry anymore. Her easiness to the cold
improved, which now the cold rarely appears and it lasts a few. She eats fewer
sweet things, and feels less her abdomen blown up.
Unchanged symptoms: Recently she suffered
from stress by working circumstances. If she alarms, she has at once some
headache. Dental shut by day still occurs. She bears always badly tension and
fears. Sometimes she has some stomachache.
Therapeutic variation (daily dosing, by the
oral via): Carbamazepine 200; Alpha-tocopherol 50mg.
Discussion.
This time too it is not so easy to classify
the anosmia type here described, according to the criteria of Gil-Carcedo,
Gil-Carcedo, Vallejo and Ortega, 1999. If we remember its debut, the lack of a
defined peripheral cause and the good result obtained following an antistress
drug therapy, it seems that it fits better the reference frame of the
sensorineural anosmia, central variety, idiopathic type.
Even by the fact that it has answered to an
antistress drug therapy does doubt of the causal specification of idiopathic.
Even for this case, as for the preceding
case, it is not into the range of the reversible anosmias following a specific
causal therapy (Reiss and Reiss, 2000). Nevertheless there is an initial
recovery of the sense of smell, in a rather short time.
Even here there was not any
psychotherapeutic support, in spite of that as an essential element of the
therapeutic regimen (Koch-Gromus, and Schmeling-Kludas, 2000).
I return to say that as for that I believe
the psychotherapeutic support as useless, but in this patient it had no room.
Unlike the preceding patient, this was the
first episode. Till now I cannot define the olfactory trouble as mainly a
hyperosmic or a parosmic one, even if some anosmia appeared, as for example for
the Bostik (TM).
As for the hyperosmia presence, a
quantitative anomaly of the sense of smell, there were even some discussions if
exists such a phenomenon. It seems more probable that it exists, as it happens
for sounds, and lights. In migraine fits it has been found an abnormal
sensitivity to these three senses (Adams and Victor, 1989).
The parosmia in premenstrual syndrome is a
known symptom.
Another element of interest is the implication
of the sense of the taste. This fact is not a novelty. The association with the
hyposmia forms an idiomatic syndrome described by Henkin et al., 1971, or a
side result of flu (Henkin et al., 1975).
However we cannot say that the subjective
feeling corresponds to a true partial loss of the taste. That sense depends, to
a large extent, from foods and drinks deriving volatile particles that reach
the olfactory receptors through the rhino-pharyngeal pathway. The perception of
the taste comes from the combination of the senses of smell and of taste (Adams
and Victor, 1989). In our patient the reduced taste surely finds its cause in
the anosmia or in the parosmia. Anyway, we do not know if it is an exhaustive
one, not having the patient performed specific tests for the sense of the
taste.
Feelings of hypersensitivity of the taste
for the bitter or for the acid, had reports in some patients with cancer (Adams
and Victor, 1989 ).
I considered symptoms of stress.
- the hairs losing;
- headaches after the lunch;
- an easiness to respiratory infectious
illnesses;
- days of pallor with the eye sockets
- the reduced threshold for light, noise and
people confusion;
- the increased sweet things intake;
- the drooling during the sleep, the
nighttime bruxism and the daily dental shut;
- the intrusive thinking;
- the fainting feelings;
- the colic troubles with diarrhea;
- the sudden fatigues.
Surely the patient suffered even from
depression, with a depressive answer (Black ) to the test: Say me the opposite of
the colour Red. She was even with easy weeping, emotional hypersensitivity and
difficulty in falling asleep.
The low dose antistress and antidepressant
drug therapy prescribed as a trial, acting on both A and B GABA receptors, on
the serotonin and on the glutamate, had already shown its effectiveness in one
month and half. From the beginning it was integrated with the pyridoxine by
aiming to act even on the glutamic acid decarboxylase (GAD), with the glutamine
for the glutamic acid and then of GABA neoproduction. In the first patient, a
sure link between troubles of the sense of smell and stress came out from the
hyperosmic troubles increasing in the premenstrual phase. The symptoms of that
syndrome are not specific, and I stated them as stress symptoms (Cocchi, 1998).
Besides that, it has to annotate that the prevailing condition hyperosmia, in
this patient, leads to think to an intermediary situation.
It is a great deal probable that this
sensory chain - normality -> hyperfunction -> hypofunction/loss and
possible vice versa -is not an individual feature. Moreover, it is not specific
of the sense of smell. Drugs can even influence it, as it happened here too.
This last however is a speculative consideration, which needs many other
confirmations.
Conclusions.
An anosmia-hyperosmia case with partial loss
of the taste in a patient of 49 years, lasting three years, had treatment by
antistress-antidepressant low dose drug therapy, acting on the GABA, on the
serotonin and on the glutamic acid. The partial restoration of the taste and of
the smell was reported just after one month and half, and progressed after more
than five-months drug therapy.
(Four other articles on this topic)
References.
Adams RG, Victor M. Principles of Neurology.
McGraw-Hill, New York, 1989.
Cocchi R. Pre-menstrual syndrome as the
paradigm of an internal biochemical stress. Melbourne, 1998. In internet, on
www.stress-cocchi.net/speculation3.htm
Cocchi R. An anosmia-hyperosmia case with
hypogeusia, from probable stress, improved following an antistress drug
therapy. Giugno 2002. On internet, on www.stress-cocchi.net/Other1.htm
Cocchi R. Pre-menstrual syndrome as the
paradigm of an internal biochemical stress. Melbourne, 1998. On internet, on
www.stress-cocchi.net/speculation3.htm
Gil-Carcedo LM; Gil-Carcedo E; Vallejo LA;
Ortega P. Proposed classification scheme for quantitative olfactory function
alterations. Otolaryngol Head Neck Surg 1999, 121: 820-825.
Henkin RI, Schechter PJ, Hoye R, Mattern
CFT. Idiopathic hypogeusia, with dysgeusia, hyposmia and dysosmia. A new
syndrome. JAMA 1971, 217: 434.
Henkin RI, Larson AL, Powell RD. Hypogeusia,
dysgeusia, hyposmia, and dysosmia following influenza-like infection. Ann Otol
Rhinol Laringol (USA)1975, 84: 672-682
Koch-Gromus U; Schmeling-Kludas C.
Psychoosmologie an der Jahrtausendwende: Von der "nasalen
Reflexneurose" zur modernen Psychosomatik des "Riechsturzes".
Zum 60. Geburtstag von Herrn Prof. Dr. Michael v. Rad. Psychother Psychosom Med
Psychol 2000, 50: 259-270.
Reiss M; Reiss G. Zur Problematik von
Riechstorungen. Z Arztl Fortbild Qualitatssich 2000, 94: 149-153.
Posted on Internet on December 2003. Copyright by Renato Cocchi, 2003.
Author's address: Dr.
Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
Drug modulation of stress reactions