title: An olfactory reference syndrome successfully treated by aripiprazole augmentation of antidepressant therapy.
abstract: OBJECTIVE
  To describe a case of a 65-year-old woman with persistent olfactory hallucination and delusional self-reference, successfully treated by aripiprazole augmentation of antidepressant therapy.
  
  
  BACKGROUND
  Olfactory reference syndrome is a nosologic entity, which has been assimilated to various Diagnostic and Statistical Manual of Mental Disorder-IV-text revision codified diseases and several pharmacologic treatments have been proposed without a constant clinical response.
  
  
  METHODS
  Psychiatric, neurologic, neuropsychologic, imaging, and electroencephalogram data are reported.
  
  
  RESULTS
  The patient showed a significant improvement with aripiprazole.
  
  
  CONCLUSIONS
  We propose a pathophysiologic model of olfactory reference syndrome to explain the good response of our patient to aripiprazole. We hypothesize a disruption in the top-down regulation of the orbitofrontal cortex on the primary olfactory cortex and the olfactory bulb at the basis of the illness. Aripiprazole acting as a partial agonist of dopamine D2 receptors in the olfactory bulb compensates for the lack of modulation in this site, restoring the correct processing of olfactory information.
authors.affiliation: Department of Psychiatry, University of Milan Medical School and San Paolo Hospital, Italy. rickymuffy@supereva.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Muffatti
authors.forename: Silvio
authors.initials: S
authors.lastname: Scarone
authors.forename: Orsola
authors.initials: O
authors.lastname: Gambini
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D003702:Delusions / Q000188:drug therapy / Q000523:psychology; D004569:Electroencephalography; D005260:Female; D006212:Hallucinations / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D009830:Olfactory Bulb / Q000473:pathology; D010879:Piperazines / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D015363:Quinolones / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use; D012903:Smell / Q000502:physiology*
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole; D020280:Sertraline