“Adolescent paranoia” includes phobias of emitting foul odor from one's own body, fear of eye-to-eye confrontation and dysmorphophobia.
A 21-year old man visited the department of dentistry of our hospital complaining of foul breath, whose concern about his odor was delusional. He also exhibited “egorrhea” symptoms, such as fear of eye-to-eye confrontation and monologue, and was diagnosed as having adolescent paranoia by a psychiatrist. The patient had started avoiding people, shut himself away in his room and talked to himself from the age of 15 or 16, after initially becoming concerned about his pimples. He also became concerned about foul breath and having suspicious eyes from the age of 17, felt that others were avoiding him, and became self-recriminatory. He later presumed that his thoughts were being expressed by his mouth contrary to his will.
The self-rating questionnaire for assessing the severity of phobia of emitting foul breath received a high score of 36 out of 40. The questionnaire indicated the delusion of having halitosis, delusion of reference and poor social adaptability. He was, accordingly, diagnosed as suffering from Group III (severe) type of phobia of emitting foul breath. On the day of his first visit, he was also examined by a psychiatrist, and diagnosed as having adolescent paranoia and administered 1 mg of risperidone.
This patient's symptoms suggested the possibility of schizophrenia. Thus it was preferable to pay attention to other symptoms of schizophrenia and the patient was therefore observed carefully.
Dentists are likely to receive outpatients of this type who require immediate referral to psychiatrists. The case of this patient demonstrates the importance of an accurate differential diagnosis regarding complaints of emitting foul breath.
