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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 30  |  Issue : 4  |  Page : 421-422

Oral cenesthopathy – the psychological malady: Report of two cases


Department of Oral Medicine and Radiology, College of Dental Sciences and Research Centre, Ahmedabad, Gujarat, India

Date of Submission22-Sep-2018
Date of Acceptance26-Sep-2018
Date of Web Publication17-Jan-2019

Correspondence Address:
Dr. Bharvi A Shukla
Block E-1/6, “Vikramnagar”, ISRO Colony, Behind Iskon Temple, Ambli-Bopal Road, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_113_18

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   Abstract 


Cenesthopathy is characterized by bizarre or strange sensations at various parts of body, and it is common to occur at the oral area (oral cenesthopathy). In such cases, the patients seek dentists for medical care, but will mostly fail to find any causes of the disease. The nosography of oral cenesthopathy has been discussed in some case reports and reviews but is overlooked in mainstream medicine. Thus the aim of this article is to focus review on the various aspects of oral cenesthopathy with report of two cases.

Keywords: Abnormal bodily sensation, amitriptyline, oral cenesthopathy, oral dysesthesia rating scale


How to cite this article:
Ruparelia PB, Shukla BA. Oral cenesthopathy – the psychological malady: Report of two cases. J Indian Acad Oral Med Radiol 2018;30:421-2

How to cite this URL:
Ruparelia PB, Shukla BA. Oral cenesthopathy – the psychological malady: Report of two cases. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2019 Jun 26];30:421-2. Available from: http://www.jiaomr.in/text.asp?2018/30/4/421/250240




   Introduction Top


Background

“Cenesthopathy” was introduced by Dupré and Camus in 1907 to describe pathologic bodily sensations as phenomenology in mental illness.[1] It is the complaint of abnormal bodily sensation where no underlying organic cause can be identified.[2] The oral cavity is one of the frequent sites of cenesthopathy, thus the term “oral cenesthopathy.”[3] Patients have firm conviction that their annoying symptoms have a somatic base, so they often visit dental clinics, without consulting a psychiatrist, seeking invasive treatment, and repeatedly try unnecessary procedures. This may sometimes create a dilemma between the dentists and patients.[3],[4] Thus in such cases, proper identification and management by the dentist plays a very crucial role.

Terminologies and Categorization

Oral cenesthopathy is also known as oral dysesthesia, oral parasitosis, or oral somatic delusion and it represents medically unexplained oral symptoms/syndromes.[2],[5]

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), oral cenesthopathy is classified as a “delusional disorder, somatic type (DDST)” whereas in the ICD-10 Classification of Mental and Behavioral Disorders, it is categorized as a “persistent delusional disorder” or “other schizophrenia.”[3]


   Case Reports Top


Case 1

A 23-year-old male came with the chief complaint of some pebble-like substance coming out from his inner cheek region from right side since 4 months. There was no relevant medical or family history. However, on further questioning he said that he was suffering from financial crises as he lost his job 6 months back. On intraoral examination there was no abnormality detected. Also salivary gland function was reported normal. The Hospital Anxiety and Depression (HAD) scale was used to measure the level of anxiety and depression in which mild depression was noted. On evaluation with the Oral Dysesthesia Rating Scale (Oral DRS),[6] the Symptom Severity Scale (SSS) score was 2 and the Functional Impairment Scale (FIS) score was 1. Considering the above symptoms the patient was diagnosed as having oral cenesthopathy. Psychological counseling was done and amitriptyline 10 mg per day at bed time was prescribed. Patient responded well and after 1 week the symptoms were totally resolved.

Case 2

A 55-year-old male came with the chief complaint of sensitivity in all his teeth since 3 months. There was no relevant medical or family history. On intraoral examination, patient was completely edentulous and was wearing his maxillary and mandibular dentures since 3 years. HAD scale was used to measure the level of anxiety and depression in which moderate depression was noted. On evaluation with the Oral DRS, SSS score was 7 and FIS score was 1. Considering the above features, as it was a post-extraction case we kept phantom tooth pain as differential diagnosis but as the complaint was of sensitivity and not pain in all teeth of his complete denture which was absent in case if patient does not wear denture, a very strange or bizarre sensation; a diagnosis of oral cenesthopathy was given. Psychological counseling was done and amitriptyline 10 mg per day at bed time was prescribed. After 2 weeks of follow up, the symptoms were reduced and after 1 month they were totally resolved.

Moreover, both the patients were further advised to follow paramedical lifestyle-related corrective measures like yoga and meditation.


   Discussion Top


Cenesthopathy is important to address because patient complains of unusual sensations without any somatic base. According to Hozaki (1960) and Yoshimatsu (1966) the age distribution in oral cenesthopathy is bimodal, 20's to 30's and 50's.[3] This is in favor of our patients which comes under this age group. However, Umezaki et al. (2017) reported two cases of oral cenesthopathy in older age group (70's).[2] Moreover according to Takahashi et al. (2013) oral cenesthopathy was predominant in elderly female patients and that non-oral cenesthopathy was predominant in younger male patients.[1] Also Umezaki et al. (2017) reported two cases of oral cenesthopathy in female patients.[2] However, in our case both patients were male complaining about oral cenesthopathy.

Cenesthopathic symptoms in general can occur in all parts of the body, such as the head, abdomen, chest, or limbs; moreover in particular a high percentage of patients complain of abnormal sensations in the mouth.[7]

The oral complains are common in the buccal mucosa and related to teeth as found in present cases while it is comparatively less related to gingiva.[2],[3],[8] Also Umezaki et al. (2017) reported cases of oral cenesthopathy at palate and related to teeth respectively.[2]

According to classification of cenesthopathy given by Hozaki (1960) in both the present cases the cenesthopathy is of secondary type which is due to depression. However, Umezaki et al. (2017) reported the cases with no psychiatric disorders.[2] Moreover according to classification given by Yoshimatsu (1966) both the cases belongs to third group as they are experiencing bizarre sensations.[3]

Investigations like single-photon emission computed tomography (SPECT) showed asymmetrical regional cerebral blood flow (rCBF) pattern (right > left) in a broad area of the brain, including the frontal and temporal lobes of patients with oral cenesthopathy.[3]

Treatment of oral cenesthopathy includes antidepressants like amitriptyline, milnacipran, paroxetine, and mianserin. Also antipsychotics like haloperidol, pimozide, tiapride, sulpiride, risperidone, perospirone, and aripiprazole and drugs like lithium carbonate and donepezil have been reported to be beneficial. Moreover non-pharmacological modalities like electroconvulsive therapy (ECT) and psychotherapy are also suggested.[2],[3] In present cases, both the subjects responded well to amitriptyline.


   Conclusion Top


Oral cenesthopathy is a strange oral sensation without corresponding abnormal findings. Moreover we found a marked improvement of oral cenesthopathy with amitriptyline. Also because the patients with oral cenesthopathy generally do not seek psychiatric consultation on their own and rely on dental examination, the psychological assessment and dental examination together are very important.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Takahashi T, Fuke T, Washizuka S, Hanihara T, Amano N. A review of recent case reports of cenesthopathy in Japan. Psychogeriatrics2013;13:196-8.  Back to cited text no. 1
    
2.
Umezaki Y, Uezato A, Toriihara A, Nishikawa T, Akira Toyofuku A. Two cases of oral somatic delusions ameliorated with brain perfusion asymmetry: A case report. Clin Neuropharm 2017;40:97-9.  Back to cited text no. 2
    
3.
Umezaki Y, Miura A, Watanabe M, Takenoshita M, Uezato A, Toriihara A, et al. Oral cenesthopathy. Biopsychosoc Med 2016;10:20.  Back to cited text no. 3
    
4.
Umezaki Y, Katagiri A, Watanabe M, Takenoshita M, Sakuma T, Sako E, et al. Brain perfusion asymmetry in patients with oral somatic delusions. Eur Arch Psychiatry Clin Neurosci 2013;263:315-23.  Back to cited text no. 4
    
5.
Toyofuku A. Psychosomatic problems in dentistry. Bio Psycho Social Med 2016;10:14.  Back to cited text no. 5
    
6.
Uezato A, Toyofuku A, Umezaki Y, Watanabe M, Toriihara A, Tomita M, et al. Oral dysesthesia rating scale: A tool for assessing psychosomatic symptoms in oral regions. BMC Psychiatry 2014;14:1696.  Back to cited text no. 6
    
7.
Honma F, Kimura M, Endo S, Ohtsu M, Okada T, Satoh T. Oral cenesthopathy examined by Rorschach test. Psychiatry Clin Neurosci 2006;60:154-9.  Back to cited text no. 7
    
8.
Watanabe M, Umezaki Y, Miura A, Shinohara Y, Yoshikawa T, Sakuma T, et al. Comparison of cerebral blood flow in oral somatic delusion in patients with and without a history of depression: A comparative case series. BMC Psychiatry 2015;15:42.  Back to cited text no. 8
    




 

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