Case Study of Monosymptomatic Delusion of Unpleasant Body Odor with Structural Frontal Abnormality

Abstract

We report a 63-year-old man with a monosymptomatic delusion of unpleasant body odor contracted at the age of 61 years, who believed that his body reeked of some type of paint. He had symmetrical atrophy in the bilateral frontal lobes of unknown etiology on MRI. Further, quantitative rCBF measurement with SPECT brain scan using ^99mTc-HMPAO showed relative hypoperfusion localized in the bilateral frontal lobes. EEG, neurological and neuropsychological tests were all normal, including the WAIS-R and Wechsler Memory Scale tests. However, he showed poor results on the Wisconsin Card Sorting test, presumably on account of frontal dysfunction, attaining only two categories with frequent perseverative errors. Although it is undetermined whether the illness in this case can be classified as organic delusional syndrome or paranoid disorder according to DSM-III-R criteria, these results imply that delusions are associated with frontal lobe abnormality.

Neuropsychological Research in Delusional Disorder: A Comprehensive Review

“…They found that these patients showed deficits in cognitive flexibility and associative learning as measured by this test. These results suggest an executive functioning deficit, replicating the previously reported data of Jibiki et al [173], which showed a relationship between low scores on the WCST and frontal cognitive impairments in a single patient with monosymptomatic delusions. Fujii et al [172] concluded that erotomania might be associated with deficits in cognitive flexibility and associative learning mediated by frontal-subcortical systems.…”

Structural and Functional Neuroimaging Findings in Delusional Disorder: Diagnostic and Therapeutic Implications

“…Six studies were excluded because they reported findings in organic DD patients [10][11][12][16][17][18]. Further, five studies were excluded due to the following reasons: (1) no diagnostic criteria (DSM-III-R, DSM-IV) for DD were specified [8,14,15,19,20], and (2) no neuroimaging findings were reported [20].…”

“…Ten journal articles fulfilled our inclusion criteria. Studies that were not included and the reasons for exclusion are as follows: (1) five studies reported diagnostic criteria for organic DD [11,12,[16][17][18], (2) one article was based on a review [21], and (3) four studies failed to report DSM-III-R or DSM-IV diagnostic criteria [8,19,22,23].…”

Case study: The man who called himself ?hockey stick': a case report including misidentification delusions

“…From these reports, Benson and Stuss postulated that damage to the frontal lobe could be responsible for delusions. Jibiki et al [9] reported of an organic delusional disorder with associated MRI scan findings of bilateral frontal lobe damage and included a SPECT scan to quantify the decreased cerebral blood flow to the damaged region. In fact, right hemispheric damage, especially frontal, is a recurring theme amongst those cases that have a unilateral identifiable [7].…”