Relevant Patient Odors for Mental Status Examinations

Pleasant odors, such as perfume, soap, or laundered clothing may indicate that the patient has some social interaction and possesses the ability and motivation for self-care.

Poor hygiene, anaerobic infections, and halitosis are factors in malodor and may contribute to social isolation.

Smoking and/or drug use may compromise not only the patients' health but also their sense of smell.

Former smokers should be educated that they are at risk for relapse if they live with smokers.

Detecting inhalants (chemical odor on breath or clothes) or alcohol may reveal the underlying substance use disorder and prompt a referral for treatment.

If patients report an inability to smell, an underlying sinonasal or neurodegenerative disease may be present.

Patients reporting anxiety, depression, or social isolation due to unpleasant body odor (where no odor is present) may be experiencing olfactory reference syndrome.

Treatment with SSRIs, atypical antipsychotics, and/or cognitive behavior therapy can be beneficial.

Additional Reading
Effect of network social capital on the chances of smoking relapse: a two-year follow-up study of urban-dwelling adults.
Adolescent inhalant use prevention, assessment, and treatment: A literature synthesis.
Sniffing out olfactory reference syndrome.
Anosmia-A Clinical Review.

1. Samala RV, Davis MP. Comprehensive wound malodor management: Win the RACE. Cleve Clin J Med. 2015;82(8):535-543. 
2. Bicak DA. A Current Approach to Halitosis and Oral Malodor- A Mini Review. Open Dent J. 2018;12:322-330. 
3. McNeely E, Mordukhovich I, Staffa S, Tideman S, Coull B. Legacy health effects among never smokers exposed to occupational secondhand smoke. PLoS One. 2019 Apr 18;14(4):e0215445. doi: 10.1371/journal.pone.0215445. eCollection 2019.

Dr Scarff is a psychiatrist in the Behavioral Health Service Line, Kenner Army Health Clinic, Fort Lee, VA.