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.
Method: 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.