DELUSIONAL HALITOSIS IN A NIGERIAN PATIENT WITH DEPRESSIVE NEUROSIS AND A REVIEW OF THE LITERATURE

Delusional halitosis in a Nigerian patient with depressive neurosis

Abstract

BACKGROUND: Delusional halitosis is a psychiatric disorder 
characterized by persistent beliefs about malodour from the mouth. 
It is often associated with avoidance, humiliation, embarrassment 
and significant psychological distress.  
OBJECTIVE: This report aimed at highlighting the relationship 
between delusional halitosis and psychopathology as well as 
reporting on the current collaborative management approach of such 
conditions. 
CASE REPORT: A 40-year-old single, male patient presented with 
persistent bad breath of six months duration. He claimed that he 
brushed his teeth more than ten times daily and rinsed his mouth with 
various types of mouthwashes without any improvement. No bad 
breath was perceived using the organoleptic measurement and a 
diagnosis of delusional halitosis was made. He was referred to 
Consultant Psychiatrist who made a diagnosis of moderate 
depressive episode with psychotic features using a self-rating 
depression scale. The patient was treated with 25mg amitriptyline 
daily for 4weeks, then increased gradually to 75mg over 3months 
and weekly cognitive behavioural therapy for 12 weeks. There was 
remission after 3months and patient was placed on maintenance doze 
of 25mg amitriptyline daily for 12 months. 

CONCLUSION: This report demonstrates that delusional halitosis 
can be associated with patients suffering from depression with 
psychotic features, which should be referred to the mental health 
expert for psychiatric or psychological interventions. Also, it 
supports collaboration between the dental practitioners and mental 
health experts in institutions where both departments exist.