Transdiagnostic Approach to Olfactory Reference Syndrome: Neurobiological Considerations

Current Understanding of the Neurobiology of Agitation

Introduction

Managing agitation in the clinical setting is a challenge that many practitioners face regularly. Our evolving understanding of the etiological factors involved in aggressive acts has better informed our interventions through pharmacologic and behavioral strategies. This paper reviews the literature on the neurobiological underpinnings of aggressive behaviors, linking psychopathology with proposed mechanisms of action of psychiatric medications shown to be effective in mitigating agitation.

Methods

We performed a review of the extant literature using PubMed as a primary database. Investigation focused on neurobiology of agitation and its relation to the current evidence base for particular interventions.

Results

There are well-established pathways that can lead to increased autonomic response and the potential for violence. Psychopathology and substance-induced perceptual distortions may lead to magnification and overestimation of environmental threat, heightening the potential for aggression. Additional challenges have arisen with the advent of several novel drugs of abuse, many of which lead to atypical clinical presentations and which can elude standard drug screens. Our interventions still lean on the evidence base found in Project BETA (Best Practices in Evaluation and Treatment of Agitation). Although not a new drug and not included in the Project BETA guidelines, ketamine and its use are also discussed, given its unique pharmacology and potential benefits when other protocoled interventions have failed.

Conclusion

Aggression can occur due to manifold reasons in the clinical setting. Having an informed understanding of the possible determinants of agitation can help with more tailored responses to individual patients, limiting the unnecessary use of medications or of interventions that could be deemed forceful.

"Would you tell me If i smelled bad?," 14-year-old Dylan diagnosed with olfactory reference syndrome: A case report

TOPIC

Olfactory reference syndrome (ORS) is a psychiatric condition that is not known to many psychiatric providers and yet it is thought to be far more common than generally recognized. Symptoms of ORS are disruptive, debilitating, and can severely impair the daily functioning of patients dealing with it.

PURPOSE

This article provides an overview of ORS and explores how it can be mistaken for other diagnostic constellations. A case report that details the treatment of a 14-year-old male illustrates how a clinician employs a multimodal approach to address symptoms that overlap with other diagnoses to successfully treat a patient with ORS.

SOURCES

Existing literature on the treatment of ORS and obsessive-compulsive disorder in adults, adolescents, and children and the clinical experience of providing care to a 14-year-old patient in an outpatient setting.

CONCLUSIONS

Nurses and other healthcare providers should be made more aware of the symptoms, criteria, and diagnosis of ORS. Research needs to be increased to solidify ORS as a formal diagnosis and treatment recommendations are required to better treat this underserved population.