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Akira Toriihara - One of the best experts on this subject based on the ideXlab platform.
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Two Cases of Oral Somatic Delusions Ameliorated With Brain Perfusion Asymmetry: A Case Report
Clinical Neuropharmacology, 2017Co-Authors: Yojiro Umezaki, Akihito Uezato, Akira Toriihara, Toru Nishikawa, Akira ToyofukuAbstract:Oral cenesthopathy is the complaint of abnormal oral sensation where no underlying organic cause can be identified. It is also called oral dysesthesia or oral Somatic Delusion and classified as Delusional disorder, Somatic type. The patients with oral cenesthopathy show right > left asymmetric regional cerebral blood flow (rCBF) in the broad brain region. However, the studies scrutinizing the rCBF change before and after the successful treatment are still a few so far. We present 2 cases of oral cenesthopathy, who responded well to aripiprazole. The asymmetric rCBF patterns were attenuated after successful treatment in both cases. We found a marked improvement of oral cenesthopathy with aripiprazole. It is suggested that right > left rCBF asymmetry in the frontal and temporal lobes and thalamus, and the dopaminergic and serotonergic dysfunctions are involved in the pathology of oral cenesthopathy.
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Comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression: a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:Background A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group). Methods Participants were 27 patients of a psychoSomatic dentistry clinic, all diagnosed with OSD. They were categorized into either the non-depression group (17 patients) or the depression group (10 patients) on the basis of assessments by their personal medical providers. CBF was examined using single-photon emission computed tomography. Results There was no difference in clinical presentation between the two groups. A significant right dominant asymmetry in the temporal and posterior cerebral regions was observed in both groups. In the central region, a right dominance was seen in the non-depression group, while a left dominance was seen in the depression group. Moreover, the mean regional CBF values for patients in the depression group were significantly lower in several regions (including bilateral callosomarginal, precentral, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, and hippocampus; and right central and cerebellum) than for patients in the non-depression group. Conclusion These results suggest that the temporal and posterior cerebral regions are involved in in the pathophysiology of OSD, regardless of depression history, and that widespread CBF reduction is a characteristic of remitted depression.
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comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group).
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Brain perfusion asymmetry in patients with oral Somatic Delusions
European Archives of Psychiatry and Clinical Neuroscience, 2013Co-Authors: Yojiro Umezaki, Akihito Uezato, Akira Toriihara, Motoko Watanabe, Tomomi Sakuma, Ayano Katagiri, Miho Takenoshita, Emi Sako, Yusuke Sato, Hitoshi ShibuyaAbstract:Oral cenesthopathy is a Somatic Delusion or hallucination involving the oral area and is categorized as a Delusional disorder, Somatic type. The pathophysiology of this intractable condition remains obscure. In this study, we clarified the pathophysiology of oral cenesthopathy by evaluating regional brain perfusion. We performed single photon emission computed tomography (SPECT) using ^99mTc-ethylcysteinate dimer in 16 subjects (cenesthopathy:control = 8:8). The SPECT images were visually assessed qualitatively, and quantitative analyses were also performed using a three-dimensional stereotactic region-of-interest template. The visual assessment revealed a right > left perfusion asymmetry in broad areas of the brain among the patients. The quantitative analysis confirmed that the regional cerebral blood flow values on the right side were significantly larger than those on the left side for most areas of the brain in the patients. A comparison of the R/(R + L) ratios in both groups confirmed the significant brain perfusion asymmetry between the two sides in the callosomarginal, precentral, and temporal regions in the patients. Qualitative evaluation of the SPECT images revealed right > left brain perfusion asymmetry in broad regions of the brain. Moreover, the quantitative analyses confirmed the perfusion asymmetry between the two sides in the frontal and temporal areas. Those may provide the key for elucidation of the pathophysiology of oral cenesthopathy.
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improvement of asymmetrical temporal blood flow in refractory oral Somatic Delusion after successful electroconvulsive therapy
Journal of Ect, 2012Co-Authors: Akihito Uezato, Naoki Yamamoto, Akeo Kurumaji, Akira Toriihara, Yojiro Umezaki, Akira Toyofuku, Toru NishikawaAbstract:AbstractOral cenesthopathy is a Somatic Delusion in the oral area and categorized as Delusional disorder, Somatic type. Patients experience unusual and annoying sensations in the mouth such as pulling on the teeth, moving teeth, overly secreting mucus, tingling and pain, and so on, without a Somatic
Yojiro Umezaki - One of the best experts on this subject based on the ideXlab platform.
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Two Cases of Oral Somatic Delusions Ameliorated With Brain Perfusion Asymmetry: A Case Report
Clinical Neuropharmacology, 2017Co-Authors: Yojiro Umezaki, Akihito Uezato, Akira Toriihara, Toru Nishikawa, Akira ToyofukuAbstract:Oral cenesthopathy is the complaint of abnormal oral sensation where no underlying organic cause can be identified. It is also called oral dysesthesia or oral Somatic Delusion and classified as Delusional disorder, Somatic type. The patients with oral cenesthopathy show right > left asymmetric regional cerebral blood flow (rCBF) in the broad brain region. However, the studies scrutinizing the rCBF change before and after the successful treatment are still a few so far. We present 2 cases of oral cenesthopathy, who responded well to aripiprazole. The asymmetric rCBF patterns were attenuated after successful treatment in both cases. We found a marked improvement of oral cenesthopathy with aripiprazole. It is suggested that right > left rCBF asymmetry in the frontal and temporal lobes and thalamus, and the dopaminergic and serotonergic dysfunctions are involved in the pathology of oral cenesthopathy.
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Comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression: a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:Background A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group). Methods Participants were 27 patients of a psychoSomatic dentistry clinic, all diagnosed with OSD. They were categorized into either the non-depression group (17 patients) or the depression group (10 patients) on the basis of assessments by their personal medical providers. CBF was examined using single-photon emission computed tomography. Results There was no difference in clinical presentation between the two groups. A significant right dominant asymmetry in the temporal and posterior cerebral regions was observed in both groups. In the central region, a right dominance was seen in the non-depression group, while a left dominance was seen in the depression group. Moreover, the mean regional CBF values for patients in the depression group were significantly lower in several regions (including bilateral callosomarginal, precentral, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, and hippocampus; and right central and cerebellum) than for patients in the non-depression group. Conclusion These results suggest that the temporal and posterior cerebral regions are involved in in the pathophysiology of OSD, regardless of depression history, and that widespread CBF reduction is a characteristic of remitted depression.
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comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group).
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Brain perfusion asymmetry in patients with oral Somatic Delusions
European Archives of Psychiatry and Clinical Neuroscience, 2013Co-Authors: Yojiro Umezaki, Akihito Uezato, Akira Toriihara, Motoko Watanabe, Tomomi Sakuma, Ayano Katagiri, Miho Takenoshita, Emi Sako, Yusuke Sato, Hitoshi ShibuyaAbstract:Oral cenesthopathy is a Somatic Delusion or hallucination involving the oral area and is categorized as a Delusional disorder, Somatic type. The pathophysiology of this intractable condition remains obscure. In this study, we clarified the pathophysiology of oral cenesthopathy by evaluating regional brain perfusion. We performed single photon emission computed tomography (SPECT) using ^99mTc-ethylcysteinate dimer in 16 subjects (cenesthopathy:control = 8:8). The SPECT images were visually assessed qualitatively, and quantitative analyses were also performed using a three-dimensional stereotactic region-of-interest template. The visual assessment revealed a right > left perfusion asymmetry in broad areas of the brain among the patients. The quantitative analysis confirmed that the regional cerebral blood flow values on the right side were significantly larger than those on the left side for most areas of the brain in the patients. A comparison of the R/(R + L) ratios in both groups confirmed the significant brain perfusion asymmetry between the two sides in the callosomarginal, precentral, and temporal regions in the patients. Qualitative evaluation of the SPECT images revealed right > left brain perfusion asymmetry in broad regions of the brain. Moreover, the quantitative analyses confirmed the perfusion asymmetry between the two sides in the frontal and temporal areas. Those may provide the key for elucidation of the pathophysiology of oral cenesthopathy.
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improvement of asymmetrical temporal blood flow in refractory oral Somatic Delusion after successful electroconvulsive therapy
Journal of Ect, 2012Co-Authors: Akihito Uezato, Naoki Yamamoto, Akeo Kurumaji, Akira Toriihara, Yojiro Umezaki, Akira Toyofuku, Toru NishikawaAbstract:AbstractOral cenesthopathy is a Somatic Delusion in the oral area and categorized as Delusional disorder, Somatic type. Patients experience unusual and annoying sensations in the mouth such as pulling on the teeth, moving teeth, overly secreting mucus, tingling and pain, and so on, without a Somatic
Motoko Watanabe - One of the best experts on this subject based on the ideXlab platform.
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comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group).
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Comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression: a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:Background A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group). Methods Participants were 27 patients of a psychoSomatic dentistry clinic, all diagnosed with OSD. They were categorized into either the non-depression group (17 patients) or the depression group (10 patients) on the basis of assessments by their personal medical providers. CBF was examined using single-photon emission computed tomography. Results There was no difference in clinical presentation between the two groups. A significant right dominant asymmetry in the temporal and posterior cerebral regions was observed in both groups. In the central region, a right dominance was seen in the non-depression group, while a left dominance was seen in the depression group. Moreover, the mean regional CBF values for patients in the depression group were significantly lower in several regions (including bilateral callosomarginal, precentral, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, and hippocampus; and right central and cerebellum) than for patients in the non-depression group. Conclusion These results suggest that the temporal and posterior cerebral regions are involved in in the pathophysiology of OSD, regardless of depression history, and that widespread CBF reduction is a characteristic of remitted depression.
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Brain perfusion asymmetry in patients with oral Somatic Delusions
European Archives of Psychiatry and Clinical Neuroscience, 2013Co-Authors: Yojiro Umezaki, Akihito Uezato, Akira Toriihara, Motoko Watanabe, Tomomi Sakuma, Ayano Katagiri, Miho Takenoshita, Emi Sako, Yusuke Sato, Hitoshi ShibuyaAbstract:Oral cenesthopathy is a Somatic Delusion or hallucination involving the oral area and is categorized as a Delusional disorder, Somatic type. The pathophysiology of this intractable condition remains obscure. In this study, we clarified the pathophysiology of oral cenesthopathy by evaluating regional brain perfusion. We performed single photon emission computed tomography (SPECT) using ^99mTc-ethylcysteinate dimer in 16 subjects (cenesthopathy:control = 8:8). The SPECT images were visually assessed qualitatively, and quantitative analyses were also performed using a three-dimensional stereotactic region-of-interest template. The visual assessment revealed a right > left perfusion asymmetry in broad areas of the brain among the patients. The quantitative analysis confirmed that the regional cerebral blood flow values on the right side were significantly larger than those on the left side for most areas of the brain in the patients. A comparison of the R/(R + L) ratios in both groups confirmed the significant brain perfusion asymmetry between the two sides in the callosomarginal, precentral, and temporal regions in the patients. Qualitative evaluation of the SPECT images revealed right > left brain perfusion asymmetry in broad regions of the brain. Moreover, the quantitative analyses confirmed the perfusion asymmetry between the two sides in the frontal and temporal areas. Those may provide the key for elucidation of the pathophysiology of oral cenesthopathy.
Tomomi Sakuma - One of the best experts on this subject based on the ideXlab platform.
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comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group).
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Comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression: a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:Background A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group). Methods Participants were 27 patients of a psychoSomatic dentistry clinic, all diagnosed with OSD. They were categorized into either the non-depression group (17 patients) or the depression group (10 patients) on the basis of assessments by their personal medical providers. CBF was examined using single-photon emission computed tomography. Results There was no difference in clinical presentation between the two groups. A significant right dominant asymmetry in the temporal and posterior cerebral regions was observed in both groups. In the central region, a right dominance was seen in the non-depression group, while a left dominance was seen in the depression group. Moreover, the mean regional CBF values for patients in the depression group were significantly lower in several regions (including bilateral callosomarginal, precentral, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, and hippocampus; and right central and cerebellum) than for patients in the non-depression group. Conclusion These results suggest that the temporal and posterior cerebral regions are involved in in the pathophysiology of OSD, regardless of depression history, and that widespread CBF reduction is a characteristic of remitted depression.
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Brain perfusion asymmetry in patients with oral Somatic Delusions
European Archives of Psychiatry and Clinical Neuroscience, 2013Co-Authors: Yojiro Umezaki, Akihito Uezato, Akira Toriihara, Motoko Watanabe, Tomomi Sakuma, Ayano Katagiri, Miho Takenoshita, Emi Sako, Yusuke Sato, Hitoshi ShibuyaAbstract:Oral cenesthopathy is a Somatic Delusion or hallucination involving the oral area and is categorized as a Delusional disorder, Somatic type. The pathophysiology of this intractable condition remains obscure. In this study, we clarified the pathophysiology of oral cenesthopathy by evaluating regional brain perfusion. We performed single photon emission computed tomography (SPECT) using ^99mTc-ethylcysteinate dimer in 16 subjects (cenesthopathy:control = 8:8). The SPECT images were visually assessed qualitatively, and quantitative analyses were also performed using a three-dimensional stereotactic region-of-interest template. The visual assessment revealed a right > left perfusion asymmetry in broad areas of the brain among the patients. The quantitative analysis confirmed that the regional cerebral blood flow values on the right side were significantly larger than those on the left side for most areas of the brain in the patients. A comparison of the R/(R + L) ratios in both groups confirmed the significant brain perfusion asymmetry between the two sides in the callosomarginal, precentral, and temporal regions in the patients. Qualitative evaluation of the SPECT images revealed right > left brain perfusion asymmetry in broad regions of the brain. Moreover, the quantitative analyses confirmed the perfusion asymmetry between the two sides in the frontal and temporal areas. Those may provide the key for elucidation of the pathophysiology of oral cenesthopathy.
Ayano Katagiri - One of the best experts on this subject based on the ideXlab platform.
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comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group).
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Comparison of cerebral blood flow in oral Somatic Delusion in patients with and without a history of depression: a comparative case series
BMC Psychiatry, 2015Co-Authors: Motoko Watanabe, Yojiro Umezaki, Anna Miura, Yukiko Shinohara, Tatsuya Yoshikawa, Tomomi Sakuma, Chisa Shitano, Ayano Katagiri, Miho Takenoshita, Akira ToriiharaAbstract:Background A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral Somatic Delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group). Methods Participants were 27 patients of a psychoSomatic dentistry clinic, all diagnosed with OSD. They were categorized into either the non-depression group (17 patients) or the depression group (10 patients) on the basis of assessments by their personal medical providers. CBF was examined using single-photon emission computed tomography. Results There was no difference in clinical presentation between the two groups. A significant right dominant asymmetry in the temporal and posterior cerebral regions was observed in both groups. In the central region, a right dominance was seen in the non-depression group, while a left dominance was seen in the depression group. Moreover, the mean regional CBF values for patients in the depression group were significantly lower in several regions (including bilateral callosomarginal, precentral, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, and hippocampus; and right central and cerebellum) than for patients in the non-depression group. Conclusion These results suggest that the temporal and posterior cerebral regions are involved in in the pathophysiology of OSD, regardless of depression history, and that widespread CBF reduction is a characteristic of remitted depression.
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Brain perfusion asymmetry in patients with oral Somatic Delusions
European Archives of Psychiatry and Clinical Neuroscience, 2013Co-Authors: Yojiro Umezaki, Akihito Uezato, Akira Toriihara, Motoko Watanabe, Tomomi Sakuma, Ayano Katagiri, Miho Takenoshita, Emi Sako, Yusuke Sato, Hitoshi ShibuyaAbstract:Oral cenesthopathy is a Somatic Delusion or hallucination involving the oral area and is categorized as a Delusional disorder, Somatic type. The pathophysiology of this intractable condition remains obscure. In this study, we clarified the pathophysiology of oral cenesthopathy by evaluating regional brain perfusion. We performed single photon emission computed tomography (SPECT) using ^99mTc-ethylcysteinate dimer in 16 subjects (cenesthopathy:control = 8:8). The SPECT images were visually assessed qualitatively, and quantitative analyses were also performed using a three-dimensional stereotactic region-of-interest template. The visual assessment revealed a right > left perfusion asymmetry in broad areas of the brain among the patients. The quantitative analysis confirmed that the regional cerebral blood flow values on the right side were significantly larger than those on the left side for most areas of the brain in the patients. A comparison of the R/(R + L) ratios in both groups confirmed the significant brain perfusion asymmetry between the two sides in the callosomarginal, precentral, and temporal regions in the patients. Qualitative evaluation of the SPECT images revealed right > left brain perfusion asymmetry in broad regions of the brain. Moreover, the quantitative analyses confirmed the perfusion asymmetry between the two sides in the frontal and temporal areas. Those may provide the key for elucidation of the pathophysiology of oral cenesthopathy.